DIFFERENTIAL ASPECTS OF NARCISSISTIC DISTURBANCES OF NEUROTICS, BORDERLINE PERSONALITIES, DEPRESSIVES AND SCHIZOPHRENICS

Stressing the conception of self-psychology developed by Kohut and Kernberg, the author discusses four different kinds of psychiatic disorders in which a disturbance of narcissism plays an important role. After describing the self-pathology of narcissistic personality disorders, or >>narcissistic neuroses<< in Battegay's conception, as well as that of major depression, the author characterizes the borderline personality disorders and schizophrenia as a severe ego-pathology. This means that patients suffering from >>narcissistic neuroses<< have a solid ego-core, but developed a typical >>narcissistic hole<<, as described by Ammon. In major depression, the narcissistic emptiness leads to a tendency to compensate this deficiency by a strong fusion with the objects. Battegay underlines the fact that borderline personalities show a fragmentation tendency combined with a severe narcissistic deficit. In schizophrenics, this fragmentation leads to the feeling that parts of the ego and the body no longer belong to the individual. The author emphasizes that these different kinds of narcissistic disturbances need different treatments. While narcissistic neurotics can be treated by modified classical analysis with a more empathetic approach, the fragmentation-prone ego in borderline personalities and the fragmented ego in schizophrenics demand a very intensive reality-oriented treatment. Major depressive patients necessitate a more active approach. An optimal therapeutic setting for all narcissistic disorders includes the method of group psychotherapy combined with individual psychotherapy, cognitive training and, as far as necessary, pharmacotherapy.