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Narcissistic disorders in clinical practice.

Ronald Britton

    The Journal of Analytical Psychology
    |August 20, 2004
    PubMed
    Summary

    This paper reviews narcissism, defining clinical narcissism, innate tendencies, and narcissistic personality disorders. It explores subtypes and proposes developmental origins in early childhood containment failures.

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    Area of Science:

    • Psychoanalytic Psychology
    • Psychiatry

    Background:

    • Review of psychoanalytic literature on narcissism.
    • Definition of three distinct uses of the term: clinical narcissism, innate relational opposition, and narcissistic personality disorders (NPDs).

    Observation:

    • NPDs are further classified via transference/countertransference into borderline (thin-skinned), aloof (thick-skinned), and as-if (false-self) patterns.
    • Characteristics of each narcissistic disorder subtype are detailed.

    Findings:

    • Narcissistic disorders may stem from infantile containment failures, leading to a destructive super-ego and narcissistic organization.
    • Libidinal defensive organization results from parental containment failure; destructive organization from infant object-hostility.
    • Case studies illustrate destructive vs. libidinal narcissistic disorders, both linked to projective identification with an ego ideal to avoid a destructive parental super-ego.

    Implications:

    • Understanding the developmental origins of narcissistic disorders is crucial for psychoanalytic treatment.
    • Differentiating NPD subtypes informs therapeutic strategies and understanding of transference dynamics.
    • The concept of projective identification offers insight into the formation and maintenance of narcissistic pathology.

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