The most prominent problem of narcissistic personality disorder is the incapacity to love. Kernberg makes this argument in his 2018 book Treatment of Severe Personality Disorders: Resolution of Aggression and Recovery of Eroticism. He writes: 

This deficit of love is regulated by means of promiscuous sexual conquests, characterized by a never-ending cycle of transitory infatuations followed by rapid disappointments and devaluation. For example, within days or weeks, a person may become convinced that they have finally found the "ideal" partner. This intense idealization may then be followed just as rapidly by disappointment and devaluation, as the person loses interest, sees only the partner's shortcomings, and begins searching for a new relationship. 

According to Otto Kernberg, this pattern of behavior has traditionally been observed more frequently in men with narcissistic pathology. Dr. Kernberg argues that one important reason for this is the cultural double standard characteristic of patriarchal societies, which encourages sexual freedom in men while imposing ideals of chastity and traditional domestic roles on women. 

Historically, women’s narcissistic pathology has been expressed much more in other areas of family life. However, with the development of the women’s rights movement, and the gradual equalization of social functions, sexual freedom, and workforce participation, this sexual pattern has become more frequent in women.

Over the past several decades, however, we have witnessed a marked increase in the prevalence of this same pattern among women. 

Similar cultural influences affect other personality disorders as well, and the dominant cultural conventionalisms influence character formation and pathological personality traits. 

Thus, for example, while masochistic love relations are more frequent in women than in men, masochistic sexual perversion (paraphilia) is more frequent in men, and characterologically, men’s submitting themselves to chronically frustrating and suffering situations in the context of work and profession is more frequent than parallel masochistic tendencies in women.

Frequently, the severity of the narcissistic patient’s incapacity for stable object relations leads to casual sexual encounters and sexual excitement and gratification as his or her only open channel to involvement with others. 

There are narcissistic patients with stable couple relations, from a conventional viewpoint, sometimes in a joint interest with a narcissistic partner who is comfortable with this arrangement but without real emotional involvement and generally with little sexual involvement as well.

It may also be added that individuals with the vulnerable subtype of narcissistic personality disorder may avoid intimate relationships altogether. On the one hand, they are deeply ashamed of themselves and their bodies; on the other, they believe that only a perfectly ideal partner would be worthy of entering into a relationship with them. 

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(c) Yuliia Holopiorova,

Ukrainian Association of Transference-Focused Psychotherapy