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I recently (re)discovered two interesting passages in Freud's (1914) paper on narcissism, in which he speculates about a possible parallel between the development of neurotic anxiety in the transference neuroses and the occurrence of hypochondriacal anxiety in the narcissistic neuroses:
I will merely mention that from this point of view we may suspect that the relation of hypochondria to paraphrenia is similar to that of the other 'actual' neuroses to hysteria and obsessional neurosis: we may suspect, that is, that it is dependent on ego-libido just as the others are on object-libido, and that hypochondriacal anxiety is the counterpart, as coming from ego-libido, to neurotic anxiety. Further, since we are already familiar with the idea that the mechanism of falling ill and of the formation of symptoms in the transference neuroses—the path from introversion to regression—is to be linked to a damming-up of object-libido, we may come to closer quarters with the idea of a damming-up of ego-libido as well and may bring this idea into relation with the phenomena of hypochondria and paraphrenia (pp. 84–85).
The difference between paraphrenic affections and the transference neuroses appears to me to lie in the circumstance that, in the former, the libido that is liberated by frustration does not remain attached to objects in phantasy, but withdraws on to the ego. Megalomania would accordingly correspond to the psychical mastering of this latter amount of libido, and would thus be the counterpart of the introversion on to phantasies that is found in the transference neuroses; a failure of this psychical function gives rise to the hypochondria of paraphrenia and this is homologous to the anxiety of the transference neuroses (p. 86).
Essentially, Freud argues here that hypochondriacal anxiety results from the damming-up of narcissistic libido, just as neurotic anxiety derives from the damming-up of object libido. His argument rests on his early economic concept of anxiety as