Narcissistic Disorder and ITS Treatment

BEFORE DISCUSSING the treatment of narcissistic disorder I shall outline my view of its nature, since I believe that this syndrome differs from other personality disorders. Some points will recur which I made in my previous papers on the subject (LEDERMANN 10, 11). Psychoanalysts and analytical psychologists are well-known to disagree, in some respects, about the nature of narcissistic disorder. Both consider it to be a disorder of the self, but they work with different concepts of the self. I see pathological narcissism as the opposite of what narcissism means in ordinary parlance. The Oxford English Dictionary defines narcissism as the ‘tendency to self-worship, absorption in one's own personal perfections’. That seems to me to describe the defence or facade in people who suffer from narcissistic disorders. The actual disorder is, in fact, the opposite of self-worship. It is the inability to love oneself and hence the inability to love another person. As I said in my previous papers, narcissistic patients suffer from severe defects in their object relations which make them appear self-absorbed. They are fixated on an early defence structure which springs into being in infancy—when, for whatever reasons, there is a catastrophically bad fit between the baby and the mother, frequently compounded by the lack of an adequate father and by other inimical experiences in childhood.

Babies, thus deprived, grow into persons who lack trust in other people. They replace mature dependence by spurious pseudo-independence and delusions of omnipotence. They experience their lives as futile and empty, and their feelings as being frozen or split off. In severe cases these patients feel themselves outside the human ken and suffer from a terror of non-existing. This terror and emptiness are frequently covered over by a superficially smooth social adaptation, sometimes by feelings of aloofness and superiority, at times even by grandiose ideas about themselves.

In my previous