Clinical Approach to the Grandiose Self

As a result of pioneering work by many authors (e.g., Horney, 1950; Nemiah, 1961; Rosenfeld, 1964; Kohut, 1971; Kernberg, 1975; Masterson, 1981), the structural-dynamic characteristics of the narcissistic personality disorder are well defined and widely accepted. From the clinical standpoint, however, some of these structural concepts are not clearly specified but have remained rather theoretical and, to a certain extent, impractical.

This is particularly true of the concept of the grandiose self (a specific, dominant, and unique intrapsychic structure of narcissistic personalities), which primarily has metapsychological connotation and contains no clinical (or diagnostic) specifications. In that respect, one can only guess that descriptions like “grandiosity and extreme self-involvement” (Masterson, 1981) or “the grandiose sense of self-importance and uniqueness” (DSM-III; APA, 1980) refer to the role of the grandiose self in the creation of the overall clinical picture of narcissistic personality disorders.

The primary aim of this article is to systematize the existing data and to present some new findings regarding those clinical features of narcissistic disorder which are generically connected with the grandiose self. I emphasize here, and this is the central idea of this article, that systematized knowledge of the clinical expression of the grandiose self enables one to separate typically narcissistic elements within the clinical picture of the narcissistic disorder, thus bringing more selectivity into the clinical (and diagnostic) approach to “narcissistic” personalities.

According to current understanding, the grandiose self is a typical and uniquely narcissistic intrapsychic structure. As a defense against early frustration, the grandiose self is formed by condensation of all “good” mental structures present in the inner world in early childhood (Kernberg, 1975).