[Narcissistic personality disorder and factitious disorder on a borderline personality organization basis: a psychoanalytic psychotherapy process]

The aim of this presentation is to summarize the changes occurring during the psychoanalytic psychotherapy of a dystonic (due to anoxic injury), 25-years-old female patient both from the standpoint of diagnosis and dynamics as well as the changes occurring in the therapist. The patient was finally diagnosed as having narcissistic disorder with factitious traits on a borderline personality organization and was twice hospitalized for a wide variety of symptoms, such as suicidal attempts, auditory and visual hallucinations, animistic thoughts, obsessive compulsive symptoms, dissociative episodes, and fear of abandonment. Hospitalized treatment was started on a weekly basis. Avoidance of interpretation, acceptance of her fantasies, outbursts and hostile behaviour helped the patient to reveal herself as a helpless and lonesome person trying to get attention with pseudo-symptoms created throughout the therapy. The patient finally established a trusting relationship with the therapist. This, in turn helped the therapist to become more attuned to the patient's difficulties. It is obvious that establishing a positive working relationship is the basis of psychotherapy and that even on a once a week basis significant changes can occur in a patient's attitude towards his/her life and future. Another point emphasized in this paper is the importance of supervision, which helped the therapist to overcome prejudices and become more flexible.