Review Finds Fragile Evidence That Pathological Narcissism Impairs Intimacy

A narrative review published in Borderline Personality Disorder and Emotion Dysregulation examines how pathological narcissism relates to intimacy, and its central conclusion is deliberately cautious. According to the review, empirical studies provide some evidence supporting intimacy impairment in pathological narcissism, but that conclusion is undercut by the indirectness of the intimacy measures used so far. In other words, the field has accumulated suggestive findings rather than definitive ones, and the tools used to detect intimacy problems may themselves be part of the problem.

To organize what is known, the review grouped putative mechanisms of intimacy impairment into three broad areas. The first is interpersonal functioning, covering interpersonal patterns, interpersonal regulatory processes, attachment styles, rejection sensitivity, and romantic patterns. The second is self-functioning, which includes self-regulatory interpersonal processes, entitlement, and perfectionism. The third area concerns motivational factors. By mapping candidate mechanisms across these domains, the review offers a structured picture of how narcissistic traits might, in theory, interfere with close relationships.

That picture comes with substantial caveats. The author discusses the putative mechanisms in light of methodological limitations, including a paucity of studies that used observational and performance measures, limitations of relying on self-report measures of pathological narcissism, a general scarcity of studies, and indirect measures of intimacy. Because most evidence depends on how people describe themselves and their relationships, the review argues that the field cannot yet be confident that the reported intimacy deficits reflect observable relational behavior rather than reporting patterns.

One of the more substantive contributions is an attempt to explain inconsistencies across studies. The review highlights paradoxical findings and proposes an explanatory hypothesis to account for why different studies reach different conclusions. It also reports that studies suggest distinct, yet partially overlapping, mechanisms associated with intimacy impairment in grandiose versus vulnerable narcissism, implying that the two presentations of pathological narcissism may disrupt closeness through partly separate routes.

Looking forward, the review sets a clear agenda. Future studies should use clinical samples, longitudinal and experimental designs, and observation, interview, and experimental measures of intimacy and its underlying mechanisms. The author also notes explicitly that more studies are warranted to test the conclusions of the review itself. Until such work accumulates, the evidence linking pathological narcissism to impaired intimacy should be read as preliminary: plausible, mechanistically rich, and methodologically unproven.

Subject of Research: The relationship between pathological narcissism and intimacy, and the mechanisms proposed to explain intimacy impairment

Article Title: Intimacy in pathological narcissism: a narrative review

Article References: Weinberg, I. (2026). Intimacy in pathological narcissism: a narrative review. Borderline Personality Disorder and Emotion Dysregulation. https://doi.org/10.1186/s40479-026-00380-0

Image Credits: AI Generated

DOI: 10.1186/s40479-026-00380-0

Keywords: pathological narcissism, intimacy, narrative review, attachment styles, rejection sensitivity, entitlement, perfectionism, grandiose narcissism, vulnerable narcissism, interpersonal functioning, methodological limitations, pathological