Intimacy in pathological narcissism: a narrative review

This narrative review examines the relationship between pathological narcissism and intimacy. Empirical studies provide some evidence supporting intimacy impairment in pathological narcissism, though this conclusion is undercut by the indirectness of the intimacy measures used thus far. In addition, this review focused on putative mechanisms of intimacy impairment based on studies in the following areas: interpersonal functioning (interpersonal patterns, interpersonal regulatory processes, attachment styles, rejection sensitivity, romantic patterns), self-functioning (self-regulatory interpersonal processes, entitlement, perfectionism), and motivational factors. The paper discusses putative mechanisms in light of methodological limitations, including paucity of studies that used observational and performance measures, limitations of reliance on self-report measures of pathological narcissism, a paucity of studies, and indirect measures of intimacy. The review also discusses paradoxical findings and proposes an explanatory hypothesis to account for inconsistencies among different studies. Studies suggest distinct, yet partially overlapping mechanisms associated with intimacy impairment in grandiose versus vulnerable narcissism. Future studies should utilize clinical samples, longitudinal and experimental designs, as well as observation, interview, and experimental measures of intimacy and its mechanisms. More studies are warranted to test conclusions from this review.