Transitory or Pseudo-Organicity and Borderline Personality in a 7-Year-Old Child

Abstract

In some children, signs suggestive of organicity consistent with the minimal brain dysfunction syndrome may mask a borderline condition. If the treatment in these cases is based solely on the so-called “organicity,” which the child may or may not have, the child is in danger of acquiring, so to speak, an added iatrogenic vulnerability. By virtue of the label Minimal Brain Dysfunction, and the treatment that ensues, significant personality difficulties may be either missed or inadequately treated. Minimal brain dysfunction is defined here operationally in terms of a cluster of deviant behavior items (Eisenberg, 1957; Pincus and Glaser, 1966; Wender, 1972). These may include short attention span, distractibility, hyperkinesis, impulsiveness, labile emotions, poor motor coordination, deficits in the perception of space, form, movement and time, disordered or delayed language or symbol development, diminished ability to experience pleasure, and a diminished responsiveness to both positive and negative reinforcement. A particular behavior item may be present in varying degree at any given time and place, and is in no way pathognomonic. Multiple, heterogenous etiological factors, including biogenetic, congenital, traumatic, infective, and psychosocial elements, may underlie each item. Such children often appear to be stimulus-hungry and have strong object-seeking tendencies. Unfortunately, they are also often misunderstood, and are rejected by their parents, their peers, and their teachers, which reinforces their already low self-esteem. The natural history of the syndrome, not surprisingly, is as varied as its forms; some have a good prognosis, while others develop