The Question of Narcissistic Personality Disorders: Self Pathology in Children

In this presentation, I would like to concentrate not so much on a specific narcissistic disorder as on the question of self pathology: the way we assess it initially at the diagnostic stage, how we perceive its manifestations in the clinical setting and, finally, how we handle it in the sessions.

I hope it will be borne in mind that I am highlighting only one group of atypical pathology and will focus on one aspect of the disturbance which is in the self, neglecting the discussion of conflictual and other aspects of the pathology. Equally, I will emphasise one ‘initiator’ of this disorder, and that is the environmental one. I do acknowledge, of course, that the manner in which a particular constitution reacts to a particular set of external circumstances is important. Nevertheless, in the two cases which I use to illustrate self pathology it is a hazardous task to evaluate the importance of the constitutional givens. Personally, I would question whether they had a significant impact. I would like to differentiate, also, between predominantly narcissistic and borderline pathology and, if possible, separate narcissistic disturbances from the imprecise diagnostic group labelled atypical.

Returning to the question of self pathology, I follow Hartmann (1964) in understanding narcissism as an emotionally significant investment of the self rather than the ego. The self is seen not as a mental structure in the sense that id, ego and superego are. In this context, the self refers to a specific group of human experiences, to the content of the mental apparatus. The self, in my usage, always refers to self experience and thus includes elements of experience of which we may be quite unconscious. The sum total of conscious and unconscious sensing of oneself is responsible for the quality of the sense of self. It is responsible for the cohesiveness of the self, for its continuity over time and for the way in which the essential sense of continuity and sameness in the midst of deve