Case Study of Narcissistic Personality Disorder: A Psychodynamic Approach
I. Presenting Complaint & History
A 34-year-old man named Alex came in for therapy after going through a personal and
professional crisis. He said that his presenting complaint was, "I just feel like everyone is against
me, and I can't seem to hold on to a relationship or a job for more than a couple of years."
Despite what he described as a very successful life, he felt "empty" and misunderstood. A
sudden public demotion at his prominent finance company and the breakup of a long-term
relationship caused his most recent crisis. He characterized his former boss as "incompetent"
and "jealous" of his talent, and his now-ex-girlfriend as "unsupportive" and "unappreciative" of
his accomplishments. Alex had neither a formal psychiatric diagnosis nor a history of substance
abuse. He did, however, acknowledge a history of interpersonal conflict, a pervasive sense of
entitlement, and a deep-seated fear of failing and being embarrassed in front of others.
II. Clinical History and Psychosocial Context
A recurring theme in Alex's developmental history is emotional neglect and conditional love. His
parents were extremely successful, ambitious, and emotionally aloof, and he was the only child.
Attention and affection were not given freely; rather, they had to be earned via achievements.
His sense of value became inseparable from outside approval, particularly for his superiority in
sports and academics. He was taught early on that his performance determined his worth. He
remembers how his father, who was a fiercely competitive person, would often make subtle
negative comments about other people in order to boost his own ego. This practice normalized
the practice of devaluing other people in order to boost one's own self-esteem. Alex's character
was shaped in large part by this early exposure to a parent's use of archaic defense strategies
like splitting and devaluation. He adopted a worldview in which people are seen as extensions
of his own ego rather than as unique beings with intrinsic value, either to be devalued as
dangers to his brittle sense of self or to be idealized as reflections of his conceit. Alex learned
from this setting that success on the outside was the only thing that counted and that showing
emotional weakness was a sign of weakness.
This formative experience is reflected in his relational patterns. He maintains relationships in his
social life that support his brittle sense of self. He quickly discards those who disagree with him
and builds a small circle of "admirers" who support his conceited self. His inability to share
emotional space, compromise, or accept his partners as unique, independent people with their
own needs and feelings has caused several of his romantic relationships to end abruptly.
I. Presenting Complaint & History
A 34-year-old man named Alex came in for therapy after going through a personal and
professional crisis. He said that his presenting complaint was, "I just feel like everyone is against
me, and I can't seem to hold on to a relationship or a job for more than a couple of years."
Despite what he described as a very successful life, he felt "empty" and misunderstood. A
sudden public demotion at his prominent finance company and the breakup of a long-term
relationship caused his most recent crisis. He characterized his former boss as "incompetent"
and "jealous" of his talent, and his now-ex-girlfriend as "unsupportive" and "unappreciative" of
his accomplishments. Alex had neither a formal psychiatric diagnosis nor a history of substance
abuse. He did, however, acknowledge a history of interpersonal conflict, a pervasive sense of
entitlement, and a deep-seated fear of failing and being embarrassed in front of others.
II. Clinical History and Psychosocial Context
A recurring theme in Alex's developmental history is emotional neglect and conditional love. His
parents were extremely successful, ambitious, and emotionally aloof, and he was the only child.
Attention and affection were not given freely; rather, they had to be earned via achievements.
His sense of value became inseparable from outside approval, particularly for his superiority in
sports and academics. He was taught early on that his performance determined his worth. He
remembers how his father, who was a fiercely competitive person, would often make subtle
negative comments about other people in order to boost his own ego. This practice normalized
the practice of devaluing other people in order to boost one's own self-esteem. Alex's character
was shaped in large part by this early exposure to a parent's use of archaic defense strategies
like splitting and devaluation. He adopted a worldview in which people are seen as extensions
of his own ego rather than as unique beings with intrinsic value, either to be devalued as
dangers to his brittle sense of self or to be idealized as reflections of his conceit. Alex learned
from this setting that success on the outside was the only thing that counted and that showing
emotional weakness was a sign of weakness.
This formative experience is reflected in his relational patterns. He maintains relationships in his
social life that support his brittle sense of self. He quickly discards those who disagree with him
and builds a small circle of "admirers" who support his conceited self. His inability to share
emotional space, compromise, or accept his partners as unique, independent people with their
own needs and feelings has caused several of his romantic relationships to end abruptly.
