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The difference between passage à l’acte and acting out hinges on one specific issue: unlike the passage à l’acte, which refers to impulsive acts in daily life, acting out occurs within a transferential relation. Therefore, it is addressed to the therapist, who can interpret it as a significant aspect in the follow-up. Working from a case study, we attempt to illustrate how a passage à l’acte can become an instance of acting out. Flora is a young woman, aged 23, hospitalized in the drug addiction ward we work in. Since about the age of 14 she has been a runaway, drifting from place to place; she has suffered from anorexia, taking various drugs, attempting suicide, and self-harming. When she was hospitalized, Flora was prepared to accept and invest in regular follow-up sessions during which she had the opportunity to verbalize her entire story. However, as she went through the process of revealing things both to us and to herself and elaborating things in between our meetings, Flora started to self-harm again. At this stage in the transferential relation, the cutting was interpreted as being addressed to the clinician. These marks underpin certain representations and lead to the emergence of certain discourses.