A preadolescent girl with the possibility of a genetic illness revealed many concerns that were similar to those of children with congenital defects. The girl's struggle with questions about her intactness, defectiveness, and badness were tied to her feminine identity and her genitals. Furthermore, the vagueness and uncertainty about her illness was instrumental in the development of a cognitive style that avoided facts and details in favor of a more global, impressionistic, and maladaptive viewpoint. Her self-hatred, the unacceptability of either gender for herself, and her inability to free herself from a regressed connection to her mother were all worked through and ameliorated in this sensitive analysis.