Bargains, treaties, and delusions.

Using a case example, I have explored a particular type of difficult patient. This individual has typically suffered poor attachment with his maternal object and through projective identification has developed highly conflicted object ties within the ego. These relations produce cycles of intense persecutory and depressive anxieties, forcing the subject to rely on excessive splitting and other primitive defenses. As part of these protective maneuvers, the ego begins to build internal bargains and treaties with the adversarial objects. These repetitious intrapsychic negotiations lead to delusional thought systems that bring on the very anxiety the ego tried to avoid, creating vicious feedback loops with more severe delusional systems and more rigid bargains to strike. For the price of survival, and the maintenance of an intact object, the ego builds and maintains certain relational configurations. These are attempted solutions for fantasies about destructive forces threatening the ego or the object. Self and object protection are the goals. If these intrapsychic bargains break down, fantasies about self and object destruction, loss, or annihilation enter the forefront. Infusing the concept of compromise formation with the ideas of object relations theory allows a better understanding of this highly defended anxiety state.