[Narcissistic disorders in the light of modern psychoanalysis]

Whereas psychoanalysis in its beginnings was based preponderantly on drive-theory, later on attention was paid essentially on ego-psychology and in the last years on self-psychology. This development is seen in the context of developments in society, especially of the fact of an increasing outer direction of man in the modern world with the danger linked with it of loss of ego and of self. The designed development may be understood as a reactive one. After an overview on the different concepts of the self it is defined as the narcissism which gives to the instances ego, id and super-ego as well as to the body the feeling and the impression, to be an individual capable for feeling and cognitive processes, forming an entity which is experienced continuously and in its continuity. Two different narcissistic disturbances are described: Narcissistic neuroses (= narcissistic personality disorders in the sense of Kohut) with a consistent ego, but a lack in self-representation because of deficiency experiences in early childhood, Borderline-conditions with a severe ego-pathology and, as a consequence of it, rigid defense-mechanisms, extreme fusion tendencies and projective identification, splitting etc. The development of normal narcissism is discussed. At the end the slightly modified psychoanalytic technique in the treatment of patients with narcissistic neuroses and the analytically oriented expressive psychotherapy of borderline-patients which is directed on reality testing is described.