Ronningstam - Identifying and Understanding the Narcissistic Personality

Early Psychiatric and Psychoanalytic Development

Ellis (1898) introduced the phenomenon of narcissism to psychiatry in his psychological study of autoeroticism, in which he described the Narcissus-like tendency to absorb sexual feelings into self-admiration (p. 280). The following year, Paul Ncke (1899) was first to use the term narcissism in a study of sexual perversions. Freud first mentioned narcissism in a footnote added in 1910 to Three Essays on the Theory of Sexuality ( Freud, 1905/1957 ), as a phase in the development of male homosexuality. In 1911 ( Freud, 1911/1957 ) he referred to narcissism as the choice of self as a libidinal object, a normal stage of autoerotism in the early libidinal development. The concept was by then acknowledged among psychoanalysts, and in subsequent accounts narcissism was considered both a part of normal development and human functioning and a type of deviation or perversion.

In the first psychoanalytic paper on narcissism, Rank (1911) discussed the development of self-love, specifically expressed through a woman's dreams and her experience of being unable to love a man unless she first knows that he loves her. Freud, in his main paper on the subject, On Narcissism (1914/1957) , and in his later comments ( 1915/1957 , 1917/1957 ), outlined definitions of primary and secondary narcissism, identified narcissistic object choice, and connected narcissism to the development of the ego-ideal and to self-preservation and self-regard as the libidinal complement of egoism. Another important observation of much relevance for the contemporary discussion of narcissism concerned the relationship between narcissism and inferiority. Freud suggested that the impoverishment of the ego due to the withdrawal of libidinal cathexis (investment of sexual drive energy) contributed to feelings of inferiority. In addition, he identified the role of narcissism in sleep and dreams and in the process of falling in love. Sadger (1910) , another European psychoanalyst, viewed narcissism as a normal phenomenon, an overvaluation of oneself seen in children and in a certain degree of self-love among adults, but its fixations and extreme manifestations, such as the overvaluation [Page 6] of one's own body, he considered to be pathological. He differentiated between normal egoism and narcissism, and suggested that friendship is an extended form of narcissism. The first American discussion on narcissism took place in 1915 in New York, at the sixth annual meeting of the American Psychopathological Association (1915) . The program included a paper by J. S. Van Teslaar titled Narcissism.

The connection between narcissism and self-esteem regulation, first alluded to by Freud in his discussion of self-regard and the development of the ego-ideal ( 1914/1957 ), was further developed by Horney (1939) , who differentiated healthy self-esteem from pathological unrealistic self-inflation, a substitute for an undermined self-esteem. Anne Reich (1960) added considerably to the understanding of pathological self-esteem regulation, which, in her opinion, serves to maintain grandiosity and undo feelings of inadequacy and insufficiency. She described the strategy of compensatory narcissistic self-inflation, which fails and results in hypochondriac anxiety and depression. Excessive inner aggression and inordinate self-consciousness leading to dependency on outside approval contribute to these regulation failures. Kohut (1971) identified defects in self-esteem regulation as one of the core disturbances in narcissistic personality disorder (NPD), and Goldberg (1973) proposed a separate diagnostic category of acute narcissistic injury to one's self-esteem that may manifest itself as depression but should be differentiated and treated differently from general depressive reactions or disorder.