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The term “narcissistic injury” is often used casually or with disdain to describe over-sensitivity to hurt feelings. But the definition denotes a serious blow to one's self-worth. A narcissistic injury can sear straight into the flesh like a hot poker, boring a hole that goes down into the center, upsetting balance, esteem, regulation and thinking. If one can survive and grow from the experience, it can also bring about psychic reorganization and a regrouping of resources.

To begin with, not all injuries are narcissistic, and not all narcissistic injuries (from hereon referred to as “NI”s) are equal or the same. Some losses are painful but not injurious to self-esteem. To “qualify,” an NI must be a wounding of significant importance to its sufferer. What qualifies as an NI for one may not even make the radar screen for another. Not getting a return phone call or a compliment on a new outfit might be devastating for one, yet escape notice by another. One man or woman who loses a job might be crushed by the rejection and loss of power, while another might focus on the opportunity created by the opening. A woman whose husband looks at porn on the Internet might head for a divorce lawyer, while another might take it in stride. The awful feelings of helplessness, loss and shame associated with NIs have different sources for each of us, though some NIs are universal—like loss of status and loss of love, that bring a feeling of annihilation of self.

The use of the word “narcissistic” indicates a certain kind of injury, a blow to the organization of the self, leaving the ego momentarily collapsed. An NI is differentiated from other kinds of hurt, rejection, and loss in the way it impacts the individual. An identity central to self-image is suddenly in doubt or shattered, self-esteem plummets and one feels newly vulnerable and helpless, like a baby who cannot yet fend for itself.

recently suffered a narcissistic injury. An unexpected loss of recognition for a particular piece of work left me feeling angry, and ashamed. But there was also doubt: “Did my work suck? Was I not good enough?” These thoughts, of course, had crossed my mind at other times—when I was frustrated and felt I couldn’t reach a patient, when I made a misstep, or any of a dozen things that make the practice of psychotherapy and psychoanalysis “the impossible profession.” I was painfully flooded with memories of other losses that had reduced me to feeling inferior. As a child I remembered incidents where my mother had privileged my cousin over me. In college I made sorority—but not my first choice. Ouch. I had had my heart broken on occasion and was refused a job I’d wanted. In fact, I began not only to revisit the NIs I had received throughout my life—they came unbidden, a parade of ghosts marching through my mind, haunting me with accusations of the part I had played in provoking them. The resultant anxiety and guilt made me miserable.

As I began to think more about, and categorize, narcissistic injuries, I began to recognize that they are rooted in loss and engender shades of childhood helplessness and even infantile panic. One’s responses to an NI can inevitably be traced to developmental experiences. From age nine through adolescence, the CEO who lost his job had been “man of the house” in place of his absent father, giving him a false sense of manliness when he was still a child. Before this he had been a latchkey kid. As an adult he worked hard to be important and his success was the validation he needed to feel OK. The loss of his high power job came at the end of a long career as CEO and forced retirement wasn’t in his plans. Even though his contract was bought out, the termination infuriated and depressed him; it exposed him to an inner belief that he was not good enough, the reason he believed he was ousted. The NI overwhelmed his coping skills, which were not flexible enough to stave off depression or to enable him to move into another satisfying investment of his time and talent.

The woman whose husband dabbled in Internet porn came from a background rife with competition among siblings and feelings of being “invisible” in her family of origin from as early as she could remember. Now, her fragile psychic structure demanded that she be her husband’s “one and only,” and she interpreted his attention to porn as proof that she was nothing but an interchangeable object. Despite her husband’s attempts to set things right with verbal apologies and gifts, she became distant and embittered, punishing him with coldness and by withholding sex. She saw her husband’s transgression as giving her a position of “power” as the offended one—a defensive position from which she commanded control and felt comparatively safe from the risk of intimacy and further hurt. Acute anxiety and fear of annihilation of self had to be overcome in order to own her part in the situation.

The negative connotations of the word “narcissistic” overshadow the fact of healthy narcissism, referred to more commonly as self-esteem, self-confidence or positive self-regard. To sort out healthy narcissism from that which makes one prone to NI, one must be able to see the part one plays in the interaction that results in a NI—a sometime-dangerous undertaking. When narcissism is used to defend the nascent self it is extremely difficult to discern because the ego feels threatened and at risk—the whole house of cards (the “self”) could topple. The vulnerable self must be protected with the available defenses, and what prevails is a need to be right, good, and powerful. Being wrong is felt to be intolerable and is equated with badness and shame, all of which are then denied, projected and externalized. The other may be punished until “proper” apologies are offered and the injury is set right. Since the injury is almost never solely rooted in the present affront, an apology can almost never suffice to assuage an NI.

For myself, healing began when I told selected colleagues of my loss and the shame began to dissipate. I was surprised to learn how much company I had, in sympathy and in like experience. People came forward to say they had been rejected in some cases two and three times from positions for which they had applied or papers they had submitted. These were people I respected and admired, and I felt less alone in my experience. I began to analyze what had occurred and to think more clearly about the part I had played in the debacle. After the initial self-doubt, I struggled to reassess my strengths and weaknesses and considered how I might improve. I knew I had been honest and open about my shortcomings in the original situation, and that I would work with the new insights I had gained from the experience.

The affect of narcissistic rage is an attempt to restore narcissistic potency and defend against the helplessness and panic that accompanies feelings of loss of self. Allowing sadness and grief, owning one’s own realistic shortcomings, are each steps in working through narcissistic injuries. An NI pierces one’s defensive stance, a stance designed to protect the interior vulnerable self. It brings one into a new reality with an admittedly unwelcome thud. But like many undesired events, it may ultimately turn out to be the flax that can be spun into gold.

This article appeared in a column entitled "The Dynamic Psyche" in "The Therapist," a publication of the California Association of Marriage and Family Therapists.