Transcription
The narcissistic personality disorder is one of the severe personality disorders that presents borderline personality organization as a secondary defense against the fragmenting of one's self-concept and of one's concept of significant others.
And all this struggle between idealized and persecutory segments of experience, they have managed to construct what we call a pathological grandiose self that is constituted by a combination of ideal aspects of the self, ideal aspects of others that have been incorporated as if one possessed them, and ideal aspirations of the self as if one had achieved them.
While at the same time, one's need of others is denied, is devalued. Others are devalued. "We don't need them. We are fine. I'm just great by myself. I don't need anybody else." There is an ideal internal world of grandiosity and self-sufficiency, and the rest of the world is constituted by depreciated, worthless people. Those who are great, and one still has to admire in order to incorporate everything they have, and those who are potential enemies, one has to fight off.
That structure means that the person seems to be integrated in a way, is not divided, and becomes quite secure. They look much better than these other severe personality disorders. They show on the surface self-satisfaction, grandiosity, excessive concern with themselves, a tremendous need to be admired, but without any mutuality of the relationships. So there is an abnormal love of the self, incapacity to love others, an internal sense of grandiosity and emptiness at the same time.
In the treatment, their uh grandiosity becomes the dominant transference issue. They have to show their superiority to the therapist and keep themselves superior to the therapist because the only alternative is then, if they would need the therapist, it means that the therapist is superior to them, and they would feel immediately inferiorized, humiliated. So there is a long-term struggle: who is going to be superior, who is going to be inferior, without a capacity for real dependency that gradually has to be clarified and and resolved. And then the underlying problem of severe splits between idealized and persecutory relationships come to the fore. The underlying borderline structure against which the narcissistic structure was a defense.