Association between pathological narcissism and emotion regulation: The role of self-mentalizing
Open accessAbstract
Pathological narcissism (PN) is a common psychopathological issue leading to maladaptive strategies to cope with self-esteem threats, including self-enhancement and exploitation (grandiose strategies) or internalized shame, depression, and social withdrawal (vulnerable strategies). Mentalizing is a key process for regulating self and other representations and their associated emotions. Patients with PN further struggle with emotion dysregulation (ED), which during development is intertwined with the growing capacity to mentalize. We seek to contribute to emerging empirical data documenting the associations between PN and ED and between PN and mentalizing, and to provide information on the nature of their mutual relationships. In the present study, we assessed PN, ED, and three mentalizing dimensions (mentalizing self, other, and motivation to mentalize) in 183 patients consulting in our outpatient unit specialized in ED. We found that narcissistic vulnerability was negatively associated with self-mentalizing and positively associated with overall ED, both even after adjustment for borderline and attention deficit hyperactivity disorder (ADHD) symptoms. However, the association with ED was not maintained after further adjustment for self-mentalizing or overall-mentalizing, which suggests that mentalizing may play a mediating role in this relationship. On the other hand, narcissistic grandiosity was positively associated with other-mentalizing and ED and negatively associated with self-mentalizing in bivariate analyses, but these last two associations were not maintained after adjustment for comorbid borderline and/or ADHD symptomatology. This study provides new information on the link between PN and ED and on key mentalizing dimensions meaningfully relating to PN, notably through a potential role of self-mentalizing processes between PN and ED.
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Impaired self-mentalization drives emotion dysregulation in narcissistic individuals.
“Blay et al. (140) provide evidence that impaired self-mentalization drives emotion dysregulation in narcissistic individuals, making both key treatment targets.”
From Psychoanalytically informed MDMA-assisted therapy for pathological narcissism: a novel theoretical approach (2025) · cites this paper as [140]
The Discussion reports that self-mentalizing may mediate the association between narcissistic vulnerability and emotion dysregulation, and offers preliminary support for improving mentalizing as a treatment approach. It does not establish that impaired self-mentalizing drives dysregulation causally or that the finding applies to narcissistic individuals generally; the study examined a clinical sample of emotionally dysregulated patients. (LLM, conf=0.89)
Experimental — accuracy not yet measuredMDMA reduces brain's fear-avoidance response, enabling access and reprocessing of overwhelming emotions.
“It reduces the brain’s fear-avoidance response, enabling individuals to access and reprocess overwhelming emotions that might otherwise be too distressing for narcissistic patients to confront (140).”
From Psychoanalytically informed MDMA-assisted therapy for pathological narcissism: a novel theoretical approach (2025) · cites this paper as [140]
The Discussion (page unavailable) addresses narcissistic vulnerability, emotion dysregulation, and self-mentalizing, but not MDMA. Searches for MDMA, fear avoidance, and pharmacological treatment found no passage about reducing a brain fear response or enabling emotional reprocessing. (LLM, conf=0.76)
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“Alexithymia, or dif fi culty identifying, describing, and expressing one ’ s own emotions, is strongly associated with PN, where de fi cits in emotion identi fi cation and metacognition contribute to maladaptive coping and emotional dysregulation (74, 140, 148).”
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- Authors
- Blay, M., Bouteloup, M., Duarte, M., Hasler, R., Pham, E., Nicastro, R., Jan, M., Debbané, M., & Perroud, N.
- Affiliations
- Inserm (FR)
- University of Geneva (CH)
- University Hospital of Geneva (CH)
- Service of Psychiatric Specialties, Department of Psychiatry University Hospitals of Geneva Geneva Switzerland
- Centre Hospitalier de Versailles (FR)
- Corresponding author
- Blay, Martin
- ORCID
- Venue
- Personality and Mental Health
- Publisher
- Wiley
- Published
- 2024-05-06
- Volume
- 18
- Issue
- 3
- Pages
- 227-237
- ISSN
- 1932-8621 (ISSN-L)
- 1932-863X
- OpenAlex
- W4396701782
- Cited by
- 10
- References
- 56
- Citations by year
- 2026: 5 · 2025: 5
- FWCI
- 4.98
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Personality and Mental Health (publishedVersion)
- PubMed (publishedVersion)
- UCL Discovery (University College London) (submittedVersion)
- HAL (submittedVersion)
- Archive ouverte UNIGE (University of Geneva) (submittedVersion)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Personality Disorders and Psychopathology
- Social Sciences › Psychology › Clinical Psychology › Personality Traits and Psychology
- Social Sciences › Psychology › Clinical Psychology › Psychoanalysis and Psychopathology Research
- Keywords
- pathological narcissism, emotional dysregulation, mentalization, narcissistic grandiosity, narcissistic vulnerability, borderline symptoms, ADHD symptoms, mediation
- MeSH terms
- Mentalization, Emotional Regulation, Narcissistic Personality Disorder, Adolescent, Adult, Affective Symptoms, Attention Deficit Disorder with Hyperactivity, Female, Humans, Male, Middle Aged, Self Concept, Young Adult
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