Kohut and Wolf (1978) argue that early deficits in mirroring, idealizing, and twinship lead to disorders of the self. For instance, failure to have one’s selfobject needs met adequately may activate either hunger or avoidance of those needs in adulthood. A child with absent, neglectful, or inconsistent caregivers who do not adequately mirror the child may foster the development of an adult who is mirror hungry and seeks out others to facilitate a feeling of being special.

Selfobject deficits have been linked to a wide range of psychological problems,
including pathological narcissism, difficulty regulating emotions, and deficits in interpersonal functioning. The degree and type of the resulting psychopathology, however, depends on the developmental stage in which these primary needs were arrested. At the extreme, the arrest occurs very early and precedes the awareness of selfobjects. At the opposite extreme, neurotic organizations involve individuals struggling to live up to their ideals. Moderate deficits lead to a failure to internalize realistic ambition or mature ego ideals, leading to fears of fragmentation and heightened vulnerability to criticism, failure, negative emotions, pessimistic thoughts, and loneliness.

Compare introjective pathology as described by Sidney Blatt:

Individuals with a self-critical personality style may be more vulnerable to depressive states in response to disruptions in self-definition and personal achievement. These individuals may experience “introjective” depressive states around feelings of failure and guilt centered on self-worth. In “Levels of Object Representation in Anaclitic and Introjective Depression,” Sidney Blatt reviews Fenichel and Bibring’s theories of development and extrapolates that introjective depression is considered more developmentally advanced than anaclitic depression. This conclusion is supported by both Bibring and Fenichel’s discussions that one source of depression (anaclitic) is primarily oral in nature, originating from unmet needs from an omnipotent caretaker; while another source is related to the (more developmentally advanced) formation of the superego and involves the more developmentally advanced phenomena of guilt and loss of self-esteem during the oedipal stage.

Patients with introjective disorders are plagued by feelings of guilt, self-criticism, inferiority, and worthlessness. They tend to be more perfectionistic, duty-bound, and competitive individuals, who often feel like they have to compensate for failing to live up to the perceived expectations of others. Within the introjective configuration, neurotic-level pathology ranges from paranoia, at the more primitive end of this spectrum, to obsessive compulsive disorders in the middle of the spectrum, to phallic narcissism and guilt-laden depression (i.e., introjective depression) at the higher end. Borderlinelevel pathology is of an introjective, or over-ideational type. Psychotic-level pathology includes paranoid schizophrenia, characterized by more rigid and fragmented-functioning compared with their more amorphous anaclitic counterparts (Ibid). If we are mapping introjective personality pathology onto DSM-III-R nosology, we find the Paranoid, Schizoid, Schizotypic, Antisocial, Narcissistic, Avoidant, Obsessive-Compulsive, and Self-Defeating personality disorders.

What is common among introjective pathologies is the preoccupation with more aggressive themes (as opposed to libidinal) of identity, self-definition, self-worth, and self-control. In the pathologically-introjective, development of satisfying interpersonal relationships is neglected as these individuals are inordinately preoccupied with establishing an acceptable identity (Ibid). As the authors note well, “The focus . . . is not on sharing affection—of loving and being loved—but rather on defining the self as an entity separate from and different than another, with a sense of autonomy and control of one’s mind and body, and with feelings of self-worth and integrity . . . The basic wish is to be acknowledged, respected, and admired.” It is suggested this preoccupation stems, in part, from a past in which important others have been controlling, overly-critical, punitive, judgmental, and intrusive—thus creating an environment in which independence and separation was made difficult.