A Brief History of Narcissistic Personality Disorder

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Given the amount of current interest in the concepts of narcissism and narcissistic personality disorder (NPD), I think many people would find a brief history of this diagnosis useful. One of the difficulties that people encounter when they first start reading about narcissism is that different theorists use the terms narcissism and narcissistic personality disorder in varying ways. Some of this confusion is because the concept of narcissism has evolved over time.

I will be giving a very brief overview of what I consider to be highlights in the history of the diagnosis and treatment of what are commonly termed narcissistic personality disorders. This overview is meant as an orientation to the evolution of the concept and is in no way definitive or exhaustive. I have focused on the theorists and ideas that I find particularly interesting. In addition to my own background on this topic, I relied heavily on three scholarly overviews by Pulver, Cooper, and Morrison that I found in an extremely helpful book, Essential Papers on Narcissism (1986).

Origins of the term Narcissism

The word “narcissism” is derived from a Greek myth about a beautiful young man named Narcissus who spurned the love of the nymph Echo and many others, both male and female. A goddess punishes Narcissus by causing him to fall madly in love with the unobtainable: his own reflection in a mountain pool. In this myth, we see the origin of two themes that will continue into modern discussions of narcissism: inordinate self-love coupled with disdain and callousness toward others.

First Modern Uses of the Term Narcissism

1889: Paul Nacke (1851-1913) First to Use the Term Narcissism

Paul Nacke, a German psychiatrist, was credited by Sigmund Freud as the first person to use the term narcissism (In German, narzissmus) to describe a sexual perversion in which individuals took their own body as a sexual object.

1898: Havelock Ellis (1859-1939) Excessive Masturbation and Narcissism

Havelock Ellis, an English physician and psychologist who wrote extensively about sexual topics, used the term “narcissus-like” in a paper to describe excessive masturbation, whereby the person becomes his or her own sex object.

Note: In the late 19th century and into the early 20th century, the word “perversion” was used to describe the domination of adult sexual life by an aspect of infant sexuality. This usage is no longer common. In Western society, there has been a gradual shift toward viewing masturbation as a normal form of sexual expression.

Part of the reason that homosexuality was considered a perversion was Freud’s belief that male homosexuals were sexually attracted to other men because of the similarity to themselves. Thus, it could be viewed as another form of taking the self as a sex object.

Early Papers on Narcissism

1911: Otto Rank (1884-1939) Links Narcissism to Vanity and Self-Admiration

Otto Rank, an Austrian psychoanalyst who was a close colleague of Freud, published the first psychoanalytic paper, “A Contribution to Narcissism,” specifically concerned with narcissism, linking it for the first time with characteristics that are not overtly sexual: vanity and self-admiration.

1914: Sigmund Freud (1856-1939) Normal vs. Defensive Narcissism

Sigmund Freud, the father of psychoanalysis, wrote the only paper of his that would deal exclusively with the issue of narcissism: “On Narcissism: An Introduction.”

Freud makes a number of important points in this paper:

1. Narcissism can be normal: Love of oneself plays a role in normal human development and is not necessarily associated with sexual perversions.
2. Some narcissism is necessary for survival: A certain amount of narcissism in the form of self-love (libidinal investment of the self) is normal and necessary because it enables people to nurture, protect, and defend themselves.
3. There is a limited amount of love/sex/pleasure energy (libido) available: This love of self can be directed towards another person, but this diminishes one’s own supply, leaving one less able to nurture and protect oneself unless one is receiving love and affection in return.

Primary vs. Secondary Narcissism: Primary narcissism is libidinal investment in the pre-differentiated ego and it occurs before others are loved. Secondary narcissism involves a withdrawal of this love towards other people, redirecting it back to the self.

Freud’s psychoanalytic methods did not work with his narcissistic patients. As a result, interest in treating pathological narcissism temporarily reached a dead end.

Narcissism Essential Reads

16 Signs the Narcissist Is Going on the Attack

Does Narcissism Fade With Age?

1921: Karl Abraham (1877-1925) Narcissism and the Anal Character

Karl Abraham was a German psychoanalyst and psychiatrist who closely collaborated with Freud. He was particularly interested in how infant sexuality and childhood traumas relate to character development and later mental illness.

In his 1921 article “Contributions to the Theory of the Anal Character,” Abraham vividly describes the young child’s sense of omnipotent pleasure in the producing and withholding of feces and how this can lead to the toilet being seen in later life as a kind of throne.

Abraham attributes characteristics to clients with anal characters that most of us today would describe as typically narcissistic: pretentiousness, arrogance, the tendency to underestimate others, an exaggerated belief in one’s own uniqueness, extreme sensitivity to external encroachments on one’s power of choice, and the demand that others be compliant. Everyone who personally knows a grandiose and devaluing exhibitionistic narcissist will find Abraham’s description of his client who says “Everything that is not me is dirt” very familiar.

1923: Martin Buber (1878-1965) Relating to Others as Objects or Equals

Martin Buber was a noted Austrian philosopher and scholar. In his famous essay Ich and Du, (I and Thou), Buber hypothesizes we either relate to others as equals (I-Thou) or as objects (I-It). In the I-Thou dialogue, we are placing ourselves fully in the relationship and making our authentic selves completely available to the other. In the I-It dialogue, we have an agenda and are keeping part of ourselves out of the relationship. We may be trying to hide our vulnerability, manipulate the other in order to get something that we want, or, more benignly, we may be trying to help the other person.

Buber’s relationship schema helps us understand something important about the narcissist’s way of relating. People with NPD primarily engage in I-It relationships because of their need to maintain a defensive, superior, grandiose image of the self.

1949: Wilhelm Reich (1897-1957) Character Armor, the Body, and Narcissism

Wilhelm Reich, an Austrian psychoanalyst, was a brilliant, innovative, and polarizing figure. He theorized that repression leads individuals to develop defensive muscular “body armor” that inhibits their full sexual expression, and that this can be observed in how they move. According to Reich, character is essentially a narcissistic protection mechanism.

1940s-1960s: Ego Psychology Renews Interest in Narcissism

Heinz Hartmann (1894-1970) Ego Psychology and Narcissism

Heinz Hartmann and other ego psychologists refocused psychoanalytic attention on the functions of the ego and stimulated a renewed interest in narcissism, especially such concepts as the ego ideal, self and object representations, the role of the object in self-esteem maintenance, and narcissistic entitlement.

1970s-1990s: The Modern Masters

Heinz Kohut (1913-1981) A New Approach to NPD

Heinz Kohut developed an entirely new approach to the treatment of NPD. He named and identified the three main narcissistic transferences: mirroring, idealizing, and twinship. Kohut’s work focuses on meeting the client’s need for empathy and normalizes the narcissist’s need for “self objects” to help maintain self-esteem and a cohesive sense of the self. His work gave rise to self psychology as a treatment for narcissistic personality disorder.

Otto Kernberg (1928-Present) Combines Freudian Theory With Object Relations

Otto Kernberg attempted to keep aspects of Freudian theory and was influenced by Melanie Klein’s object relations insights about the infant’s inability to integrate the good mother and the bad mother. Kernberg advocates confronting all narcissistic defenses as they appear in the therapy session and interpreting both the positive and negative aspects of the transference. One of the main goals of the therapy is to integrate the split of contradictory parts of the personality. Kernberg also developed a new intensive form of psychoanalytic psychotherapy known as transference-focused psychotherapy (TFP).

James F. Masterson (1926-2010) A Developmental, Self, & Object Relations Approach

James F. Masterson replaced the term personality disorder with disorders of the self and described his work as a developmental, self, and object relations approach. Masterson’s treatment for NPD combines empathy with interpretation. He created an extremely useful intervention called a “Mirroring Interpretation of Narcissistic Vulnerability” that helps narcissists understand that their over-the-top abusive responses are a defense against their underlying self-doubt and shame.

Masterson’s work could be described as holding the middle ground between Kohut’s empathic self psychology and Kernberg’s confrontive approach. Like Kohut, he takes an empathic stance, and his interpretations are always from the narcissistic patient’s point of view. However, like Kernberg, he believes that empathy alone is not enough to create meaningful change and that the acquisition of whole object relations is necessary for healthy and stable functioning. Both Kernberg and Masterson focus on the quality and content of the person’s internal self and object representations.

Summary

The modern concept of narcissism evolved from an early association with sexual perversions in the 1890s to something more recognizable as what we describe as narcissistic personality disorder today. Because Freud’s psychoanalytic methods did not work with his narcissistic patients, this diagnosis was pushed to the side until interest in it was revived by Heinz Hartman and the ego psychologists in the 1950s. However, there was still no accepted psychotherapeutic method for helping people recover from narcissistic personality disorder. That would have to wait until the 1970s and the advent of self psychology and object relations approaches to narcissistic personality disorder. These are still the primary treatment approaches to narcissistic personality disorder.

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