This paper explores two clinical forms or aspects of narcissism and their psychopathological implications: thin-skinned, or vulnerable, narcissism (VN) and thick-skinned, or grandiose, narcissism (GN). The different names used and the characteristics with which they have been described are reviewed. Clinical vignettes are examined for both types of narcissism, emphasising their diagnostic characteristics and discussing their similarities and differences, in addition to the factors that may confer additional complexity to the clinical case. The importance of the experiences of shame and humiliation are emphasised. Based on these comparisons, the psychodynamic mechanisms at play are examined in both cases, especially their relation to the levels of mental functioning. The paper concludes that both VN and GN constitute failed ways to face the difficult dialectic articulation between self-affirmation and acknowledgement of the other.