Otto Kernberg’s description of the pathological narcissistic individual centers around a set of paradoxes: self-inflation existing alongside a limitless need for praise, a charming and engaging surface covering a ruthless interior, and a persona of self-sufficiency defending against underlying feelings of intense envy .

For Kernberg, the diagnosis of the narcissistic character also depends on the quality of the person’s object relations and the pattern of his or her intrapsychic defenses. Narcissistic individuals experience their relationships with others as exploitative and parasitic. They divide the world between those who contain something that they can extract and those who do not. They distinguish between extraordinary people on the one hand - in association with whom narcissistic individuals experience a sense of greatness themselves - and mediocre or worthless people on the other. Narcissistic individuals idealize the former and are contemptuous of the latter. Yet those they idealize they also fear, as they project onto them their own exploitative wishes and experience them as potentially attacking and coercive. They thus are unable to rely on any object and fear dependence on another person, rendering all their object relations empty and dissatisfying.

Like the borderline character, Kernberg’s narcissistic individual uses primitive defenses of devaluation, projective identification, omnipotence, and primitive idealization in his or her efforts to preserve self-esteem and self-coherence and to combat the intense feelings of envy and rage that threaten to undermine them. The narcissistic individual is distinguished from the borderline individual by his or her sense of object constancy, better impulse control, and better social and professional functioning, although these too may be fragile and hollow beneath a surface of apparent solidity. Although splitting as a defense is found in narcissistic pathology, its use is less prominent than in borderline pathology.

The grandiose self further differentiates the pathological narcissist from the borderline personality. In Kernberg’s theory, the grandiose self represents a pathological fusion of the ideal self, the ideal object, and the real self. It is a defensive structure designed to maintain self-admiration and avoid dependence on any real object by effectively eliminating a need for it from intrapsychic life. Although often toxic in its effects on interpersonal relationships, the grandiose self serves to maintain the narcissist’s otherwise tenuously coherent sense of self.