A 35-year-old executive with grandiosity and a need for admiration is passed over for promotion. He becomes enraged, disparages the committee as incompetent, and privately experiences intense humiliation and emptiness for days. This pattern of reaction to perceived failure is best explained as:

• A Projection of unconscious guilt
• B Narcissistic injury with rage masking fragile self-esteem ✓
• C Reaction formation against dependency needs
• D A brief psychotic episode triggered by stress

Explanation

Patients with narcissistic personality disorder harbour a vulnerable, fragile self-esteem beneath grandiosity. Criticism or failure produces narcissistic injury, met with narcissistic rage, contempt, or devaluation of the criticising source, while inwardly they feel humiliated and empty. There is no loss of reality testing to suggest psychosis, and projection or reaction formation do not capture the characteristic wound-and-rage sequence.

Reference: Kaplan and Sadock's Synopsis of Psychiatry, 12th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.