ABSTRACT
This chapter discusses a constellation of catastrophic anxieties concerning bodily integrity and psychic survival, as they featured in the intensive psychoanalytic psychotherapy of a 9-year-old boy whom the clinician calls him "Karim". It describes the nature of these primitive anxieties and discusses their possible contribution to some of Karim's personality features and behavioural difficulties. Karim's clinical presentation in the course of long-term psychotherapy suggests a more complex underlying picture than is indicated by a diagnosis of Asperger's syndrome. During the assessment, the clinician’s initial experience of being with Karim was of someone emotionally and mentally impervious. He seemed not to relate to the clinician as a person in an ordinary way and remained absorbed in merely doing things. His thoughts and behaviour appeared obscure, disjointed, and unpredictable, though not meaningless. Karim's growing awareness of his experiences of bodily terror, vulnerability, and helplessness led to the escalation of impulsive or violent behaviour.
