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Since Freud's work, "On Narcissism" (1914) many analytic papers have been devoted to the study of narcissistic disorders. Few, however, have dealt specifically with narcissistic disturbances observable in one category of patients in whom such manifestations are encountered with a certain regularity and often, in fact, are found to be the predominant features of their psychopathology. This is all the more surprising in view of Freud's statement that prominently lists among the means of approach "by which we may obtain a better knowledge of narcissism … the study of organic disease" (p. 82).
From the group of patients loosely described as "narcissists," that is, individuals in whose pathology narcissistic phenomena play a major role, I have selected a special category for discussion, namely, patients in whom a particular type of body defect—irrespective of the clinical diagnosis and classification—can be recognized as a nodal psychological factor in their ego development as well as a pathogenic element in the formation and maintenance of narcissistic disturbances. In view of the prevalence of compensatory narcissistic self-inflation, fantasies of grandeur, etc., among such persons, their analytic study can be expected to yield information about the role such defects play in the genesis and perseverance of certain narcissistic disturbances.
In focusing attention on such cases, I took as my point of departure Freud's papers "On Narcissism" (1914) and "Some Character-Types Met with in Psycho-Analytic Work" (1916), Jacobson's (1959) elaboration of the latter, A Reich's (1960) contributions to the understanding of the regulatory processes involved in the maintenance of self-esteem, related studies by Bychowski (1943), Greenacre (1952), (1958), Murphy (1958), (1959), and others. I also wish to draw attention