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A review is given of recent literature on borderline states. The author discusses new aspects of an already published case of her own and adds notes on two further adolescent cases. In all these cases the disturbance of the ego is manifested in the pathological development of the object relationship with the mother. It consists in failure to develop that 'confidence' in forthcoming gratification considered to be the basis of permanent object formation—hence the pathological intolerance of these children to frustration by the mother.
As a result of this failure, anxiety states reflecting the helplessness of the ego in the face of id demands can be observed. The anxiety in these cases is not a signal of danger but is in the nature of traumatic anxiety in the face of relatively mild frustrations. The reactions of such patients to the outside world are based on the intrapsychic model of the ego's helplessness in dealing with instinctual demands. The prognosis in such cases will depend both on the nature of the early ego deficiency and on the pathogenic influences of the environment and accidental developmental factors. Children of this type lack the confidence of gratification by the mother when they enter the phase of first recognition of the mother, in which they still consider themselves part of her. They react to any frustration by the mother as if it were a total loss, a disaster. Consequently and subsequently the differentiation between the mother and the self does not take place, or if so, only incompletely. The pathological results will vary in intensity and extent in each case.