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Narcissistic personality disorder in an identical twin.

An identical twin with a narcissistic personality disturbance was analyzed. Clinical and metapsychological issues were discussed. Phenomena of narcissistic pathology and twinship clarify one another. Persistence of the twin as a need-satisfying, mirroring, idealized object interferes with the maternal symbiosis, and the separation-individuation experience. If any object, be it twin, mother, nurse or sibling, retards individuation, there may be instability of the self-representation as well as faulty development of ego and superego structures. Confusing and primitive identifications, as occur in twinship, impair the more stabilizing identifications of the oedipal period, and promote narcissistic character malformation.