Pathological narcissism or narcissistic personality disorder is commonly characterized by an exaggerated sense of self-importance, condescending attitude, need for excessive admiration, diminished empathy and exploitativeness. In contrast to these overt attributes, there is a different presentation of pathological narcissism which is underrecognized, as one's preoccupation with hypervigilant, self-effacement and proneness to shame in the context of covert grandiose fantasies. This report illustrates a patient who had this subtype of vulnerable narcissism, and how his defence had been activated to preserve own self agency during a session with the doctor by revealing his paraphilic fantasy.
Keywords: Covert; Narcissistic personality; Paraphilia; Pathological narcissism; Vulnerable.
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