Two distinct forms of narcissistic personality disorder: Illustrations from Goethe's writings
Gina Moser-Golub (2000)
There is increasing evidence in the psychoanalytic literature for many subtypes of Narcissistic Personality Disorder (NPD). This theoretical dissertation describes two distinct forms of NPD, the thick- and the thin-skinned types. Both types share symptoms common to NPD: (1) a sense of grandiosity or entitlement and the need to feel "special," (2) labile self-esteem and a fragile sense of self and (3) the excessive need for gratification from external sources in the form of admiration by others or of merger with an idealized other. However, the internal experience (affective states) and the manifest behavior (defensive styles) of the two types differ markedly. The thick-skinned or more conventional type, described in the DSM-IV, is characterized by exaggerated grandiosity, extraversion, dominance and exploitation of others, intense envy, frequent bouts of rage, aggression, blaming others, and most importantly, the inability to consciously experience shame. In contrast, the thin-skinned narcissist exhibits a more covert symptomatology. These people usually direct their rage inwardly, resulting in dysphoria or depression, and they experience searing shame. Whereas the thick-skinned narcissist seeks to be admired, the thin-skinned type attempts to merge or fuse with an idealized other. The view that there are two distinct forms of narcissism may help to further explain some of the controversy between the theories of Otto Kernberg and Heinz Kohut. According to this conceptualization, Kernberg may have focused on the thick-skinned type and Kohut on the thin-skinned narcissist. The major differences between these two types of narcissism appear to he not only in the manifestations and management of affective states and defensive styles, but in (1) etiology, (2) tendencies toward fragmentation versus depletion, (3) sadism versus masochism, (4) the severity of pathology and (5) gender. Although the characteristics and behaviors of these different types overlap to some degree, usually only one of these self-states predominates at any given time. An example of the thick-skinned narcissist and the thin-skinned narcissist is illustrated from the works of Goethe's "Faust" and "The Sorrows of Young Werther", respectively. The implications of this exploration raise the question of whether the next DSM should acknowledge the thin-skinned narcissist if further studies support the existence of this distinct type for nosological, diagnostic and treatment purposes.