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Most of today's patients present with a mixture of features from different characterological styles. In spite of the prevalence of these mixed disorders, a search of the psychological literature revealed only three previously described combinations: paranoia and masochism (Nydes, 1963), narcissism and masochism (Cooper, 1988; Gear et al., 1981), and narcissism and sadism (Gear, Hill, and Liendo, 1981). The current authors have frequently observed a third mixed personality style that combines both narcissistic and obsessive-compulsive characteristics.
While differences between the narcissistic and obsessive-compulsive personalities have previously been discussed (Sorotzin, 1985; Trijsburg and Duivenvoorden, 1987), a clinical picture of individuals who manifest both obsessive-compulsive and narcissistic features has not yet been articulated. This article represents a preliminary attempt to delineate and discuss the unique features of a narcissistic character with obsessive-compulsive features including presentation in psychotherapy and salient treatment considerations.
Narcissistic characters with obsessive features often present with some typical characteristics related to an underlying narcissistic organization, obsessive-compulsive defenses, and the particular synthesis of both characterological features. These include: (1) extreme perfectionistic strivings; (2) intellectual grandiosity; (3) the need to be idiosyncratically special; (4) the proclivity to employ obsessive-compulsive mechanisms to defend against underlying narcissistic problems; (5) an impaired capacity to depend on others; (6) a strong capacity to narcissistically cathect their intellect and a