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PULLING AT A LOOSE THREAD INADVERTENTLY may unravel an entire seam. In much the same way, focusing on the clinical symptom of entitlement initially seemed a modest enough enterprise. Gradually, however, it emerged as so prevalent and significant that, as one journal article has suggested, it, "may be a major factor in psychopathology." (Kreigman, 1983) Such a judgment seems excessive, at least if one goes by the meagre half dozen articles focused on this topic in the psychodynamic literature. Equally, it is excessive if one considers that entitlement is noted only once in DSM III (p. 317), and then merely as one of several traits which in combination constitute a single criterion among five pointing to a particular diagnosis, albeit a currently fashionable one, that is, Nacissistic Personality Disorder.
Perhaps concentration on any one symptom tempts the clinician to magnify its importance, given the nature of psychodynamic conceptualization in which everything connects with everything else, and not always very precisely. Thus entitlement is linked with self-image, idealization, grandiosity, need gratification and the reality principle, not to mention social role, exploitativeness and so forth. In fact, thinking about such ramifications makes it clear that, DSM III notwithstanding, attitudes about entitlement are relevant to more than narcissistic personality disorders. Karen Horney, for instance, introduces her discussion of what she calls "neurotic