{Reference Type}: Case Reports {Title}: The fear of what goes up must come down: A case report of vulnerable narcissism. {Author}: Chong SC;Ang JK;Hashim H; {Journal}: Asian J Psychiatr {Volume}: 54 {Issue}: 0 {Year}: Dec 2020 {Factor}: 13.89 {DOI}: 10.1016/j.ajp.2020.102117 {Abstract}: Pathological narcissism or narcissistic personality disorder is commonly characterized by an exaggerated sense of self-importance, condescending attitude, need for excessive admiration, diminished empathy and exploitativeness. In contrast to these overt attributes, there is a different presentation of pathological narcissism which is underrecognized, as one's preoccupation with hypervigilant, self-effacement and proneness to shame in the context of covert grandiose fantasies. This report illustrates a patient who had this subtype of vulnerable narcissism, and how his defence had been activated to preserve own self agency during a session with the doctor by revealing his paraphilic fantasy.