NARCISSISTIC PERSONALITY DISORDER
The problem of understanding narcissism holds considerable interest, particularly in psychoanalysis, although increasingly so in the field of personality disorder theory and research. It is a condition that Sigmund Freud struggled with and rethought at several stages of his career (Baudry, 1983). Like other psychoanalytic explanations of personality disorders, a complete understanding of narcissistic personality disorder remains unsettled, despite Kohut's (1971, 1977) and Kernberg's (1975) systematic formulations of narcissism. It is also a condition plagued by imprecise terminology, perhaps more so than other personality disorders. I have reserved narcissistic personality disorder for a chapter by itself, not because it should be considered the paradigmatic or signature disorder of Kohut's self psychology, but rather because narcissistic personality disorder provides the clearest illustration of the fundamental premises of Kohut's ideas about the self. Consequently, this chapter serves both to introduce Kohut's concepts of the self and to apply these concepts to an understanding of narcissistic personality disorder. As I will do for each of the Axis II disorders in forthcoming chapters, I begin by examining the current status of this disorder with respect to its
diagnostic validity, clinical phenomenology, and relationships with other personality disorders. I summarize personality theory viewpoints about narcissism and then psychoanalytic perspectives emphasizing developmental and object relations views. Next, I present an overview of narcissistic personality disorder and the main tenets of Kohut's self psychology. I will emphasize in this context an important though sometimes overlooked point: Kohut's viewpoint began as an attempt to understand narcissistic personality disorder as an expansion of drive theory and psychoanalytic ego psychological premises. An idea introduced in chapter 1 bears repeating: As Kohut...