ABSTRACT
Identifying NPD is dif®cult in initial sessions. Patients often only covertly communicate that they think they are exceptional and undervalued. They are unlikely to proclaim `I'm the king of the world'. They are more likely to complain, with a haughty and detached tone, of a vague dissatisfaction, anxiety or hypochondria (Kohut 1971), annoyingly chipping away at their lives. Their problems have an external cause: incompetent colleagues, indecisive partners or tiresome relatives. They keep a clinician away from their ivory tower and shut themselves up in their `cocoon' (Modell 1984).
