The Borderline and Severely Neurotic Child

BLOS OPENED THE PANEL, RECALLING that childhood borderline states were first recognized in work with severely disturbed, nonpsychotic inpatients. These children had circumscribed ego malformations and disturbed object relations. Many had primary ego apparatus deficits. Successful analytic work with "better functioning" borderlines and severely neurotic children focused interest on the psychogenesis of borderline states. Yet the definition of the term "borderline" as applied to children remains unclear. Pine's description of the children's stable instability, predictable inappropriateness, and stable oddness is as close as we come to defining the disorder. This, and a forthcoming panel, will attempt to explore the meaning of borderline states in children, to characterize their self- and narcissistic pathology, difficulties with body image, gender identity, object relations, superego defects, defensive structure, and drive organization. Is there a subpopulation of borderline children for whom analysis is the treatment of choice? How are borderline states in children and adults related?

Paulina Kernberg described the psychiatric findings in borderline children. Borderline personality organization is associated with several childhood syndromes. Conduct disorders and attention deficit disorders with hyperactivity are common. Other presentations include separation anxiety; overanxious; schizoid; identity, eating, developmental, and language disorders; and elective mutism. Although checklists may be used to diagnose borderline personality disorder, Kernberg underlined three primary characteristics of the illness: (1) a disturbed sense of identity; (2) sudden shifts in level of functioning, and (3) relative inability to accept responsibility for one's actions. Disturbed identity sense is the most important. "Identity" does not have the same dimensions as in adults, but is applicable to children to indicate that they normally know what they can do, what they ar