Some Conceptual Problems Involved in the Consideration of Disorders of Narcissism*

In a number of different areas of work at the Hampstead Clinic research groups have been concerned with the progressive refinement of psychoanalytic concepts in their application to clinical material. In particular, the procedure of systematic indexing of psychoanalytic case material (Sandler, 1962) and the routine application of Anna Freud's Diagnostic Profile (Anna Freud, 1963), have thrown up problems relating to the conceptual tools at our disposal for the evaluation of what can, broadly speaking, be called “disorders of narcissism”.

An increasing amount of attention is being paid in psychoanalysis to the assessment and treatment of “disturbances of narcissism” in both children and adults. While originally the term “narcissistic disorder” was used by Freud (1923) to refer to the psychoses, the term has nowadays come to be used in connection with a much wider field of clinical disturbances, a field which encompasses a variety of conditions reflecting major disturbances in attitudes towards the self and in the regulation of well-being and self-esteem. These disturbances, which include depressive reactions in children as well as adults, show in their pathology not only conflict over drive discharge but also substantial intrasystcmic ego disturbance connected with the maintenance of self-object relationships and problems of self-regard and identity.

Thus while we may, for example, assess a child who has problems over exhibitionism from the point of view of neurotic conflict over the discharge of exhibitionistic drive impulses, we also include the consideration of the function of exhibitionism in connection with the maintenance by the child of a particular type of object-relationship, and its function as a possible technique for gaining admiration and praise in order to do away with underlying feelings of unworthiness, inadequacy or guilt. Thus, for example, it is well-known from psychoanalytic work with adults that actors may not only be