This article demonstrates the importance of a close monitoring of the emotion of shame in psychoanalysis. Shame is distinguished from guilt, and its special relationship to pathological narcissism is discussed. A typology of narcissistic pathology is also described, which is mediated by the extent to which grandiosity is consciously experienced by the patient. Specifically, where grandiosity is conscious and central, there is a distinct shame avoidance quality. Males tend to be overrepresented in this category. Where grandiosity is disavowed, although unconsciously present, there is a heightened sensitivity to shame. Women seem to cluster here. Case illustrations of each type are included, and theoretical approaches by Lewis, Kernberg, Kohut, and others are discussed.