- Some hypochondriacs are not looking for a cure for their ailment but rather a witness to their suffering.
- Often narcissistic personalities are vulnerable to hypochondria because they transform their psychological frailty into physical fragility.
- Narcissistic personalities may fear falling apart physically because they sometimes know that their sense of self can be abruptly shattered.
Narcissistic personalities are particularly vulnerable to hypochondria and morbid fears of death.
In an earlier blog, I wrote about one narcissistic dynamic present in some hypochondriacs – the search for an ideal mother who is concerned for the child’s symptoms and expresses empathy for their pain. These hypochondriacs are not looking for a cure for their ailment but rather a witness to their suffering. They go from doctor to doctor, desperately seeking an omnipotent professional able to sort out all the disappointments of earlier doctors. But the inevitable disappointment of the idealized doctor results in criticizing their incompetence, making the doctor less sympathetic to their pain. Often the patient’s perpetual dissatisfaction alienates spouses, friends, and relatives, creating a self-fulfilling prophecy.
Other narcissistic personalities are vulnerable to hypochondria because they are in touch with their fragile self. They transform their psychological frailty into physical fragility. These narcissistic personalities fear falling apart physically because they know that their sense of self can be abruptly shattered. A real or perceived criticism can turn their feeling of self-righteous superiority into feeling like a nobody.
My patient, Barry, often feels that he will have a stroke; he feels that his body is falling apart and is frequently sure he is dying. Early in our work together, Barry insisted that his problems were physical rather than psychological. If I did not concur that his body was falling apart, he would go into a rage and threaten to end treatment. He wanted affirmation that his pain and suffering were real. I had to find a way to communicate that I believed him and understood his pain, but the cause was not organic.
At first, I agreed with him that he might have a physical problem and that he should go to a doctor to find out rather than perseverating about it. It took him two years before he made an appointment with a doctor. The doctor reassured him that he was healthy, but he was worried about having a stroke again in a few days. After repeating this dynamic multiple times, Barry was able to see that fear of having a stroke was a displacement of anxiety about something that worried him, and ruminating about dying was anxiety about his tenuous sense of self falling apart.
It took years of work together for Barry and me to develop a process by which we backtracked from the stroke or the conviction he was dying until we found the trigger that had destabilized him. Usually, the trigger was something he judged to be a transgression of his values (e.g., he lied to someone or omitted the truth). Remorse threatened his sense of self because he was unable to tolerate his imperfection. He experienced a stroke instead of bearing the pain of having done something hurtful to someone.
In the session with me, when we backtracked to the trigger of his “stroke,” he felt guilty, projected his judgment onto me, and then felt shame and rage because I could see his imperfection. But by the end of the session, he felt relieved and calm.
In conclusion, we can see that Barry's fear of self-fragmentation was displaced onto his body. Each time we worked through what had triggered his “stroke” or feeling that he was dying, his sense of self strengthened. He learned that he was able to tolerate his transgressions and started forgiving himself. The more he was able to forgive himself, the less he needed to displace his guilt into physical symptoms.
Nancy McWilliams, (1994). Psychoanalytic Diagnosis: Understanding Personality Structure in the Clinical Process, New York: The Guilford Press.
Dolores Albarracin, (2015). "Narcissism and Object Relations in Hypochondria", Psychoanalytic Review, Volume 102, No. 4, August.