This chapter considers one of the fundamental aspects of the psychotic process: the transformation of identity that takes place during the course of the illness. Disturbances of personal identity differ in nature and gravity. In the psychotic state, the change of identity develops in parallel with perceptual distortions that alter the subject’s relationship with reality. The delusional transformation of identity occurs when the imagination invades psychic reality and confuses the patient. In Melanie Klein’s view, the areas of psychic death observed in serious pathologies result from processes of emptying out and loss due to the massive use of the mechanism of projective identification. The projective identification is made not with a real person, but with this omnipotent fantasy figure constructed through the alteration of perceptual reality. The loss of the delusional identity leaves behind an anxiety-ridden void; emergence from psychotic withdrawal to confront psychic reality is experienced as catastrophic.