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The escalation of self-destructive acting out in adolescence is viewed as a compulsive repetition of traumatic or repeated microtraumatic events. These traumatic events, which occurred during early childhood, are or were linked to the absence of the object and the subsequent sense of emptiness that was experienced. The different functions of compulsive repetition are then discussed in the context of identity search and borderline pathology during adolescence. Finally, the author discusses the mental work required of the therapist when working with adolescents presenting these types of issues, particularly when speech cannot be used for intersubjective communication.