This paper describes a form of superego pathology which arises from very traumatic childhood experience. The youngster takes into him or herself the negative qualities of the cruel, neglectful, and unloving caretakers. This internal abuser becomes the conscience and gives rise to an inner image of the self as evil and meriting only punishment and reproof. This joins the ego ideal as one of the regulating elements in the superego. Milder cases result in a success neurosis; more severe pathology expresses itself as "a criminal from a sense of guilt." Such youngsters tend to find ways of blaming themselves for the misfortunes of their friends and kin, they find patterns of adaptation which allow for chronic self abasement, and they are very likely to drift into substance abuse. There are many varieties of this form of disturbance, but characteristically, in the face of therapeutic efforts, they respond with a negative therapeutic reaction. Some suggestions are offered for therapeutic approaches.