4. The Narcissistic Omnipotent Character Structure: A Case Of Chronic Hypochondriasis

I described in Chapter 1 how I came to identify a mode of relating which I called narcissistic omnipotent object relations. To try to make this concept more accessible I want to use this chapter to give a detailed report of a patient, Adam, whom I treated many years ago. His life history and personality structure were deeply influenced by narcissistic omnipotent object relations which apparently originated in earliest infancy in the feeding relationship to his mother. Adam could, therefore, be described as a patient with a narcissistic omnipotent character structure. The material from his analysis which I shall set out demonstrates the way narcissistic omnipotent object relations function in analysis, the influence of envy and defences against it, and its relationships to the formation of negative therapeutic reactions, hypochondriacal anxieties, and delusions about sexual identity, all of which were particularly pronounced with this patient.1

Before he began treatment with me, Adam had received many years of psychotherapeutic, mainly psychoanalytical, treatment with several analysts in his own country. He suffered particularly from hypochondriacal anxieties related to fears of cancer of the throat, stomach, rectum, penis, and heart. Two years before he started treatment with me he had an acute intestinal obstruction and was hospitalized for about a fortnight. He had psychotherapy at that