Erectile dysfunction and narcissism are two psychological ideas which, when you experience them, can consume many other aspects of your life. But, you might be surprised to learn that these phenomena, though on the surface seemingly totally separate, might actually be related. 

Interestingly, understanding this relationship can also be the key to treating both concerns with therapy, too. 

Clinical psychologist and author, Michael Kinsey, Ph.D., has noted a definitive link between the two in his patients. “In my clinical practice, I have often seen erectile dysfunction occur alongside hypermasculine displays of narcissism,” he confirms.

Although erectile dysfunction tends to be a problem experienced later in life, Dr. Kinsey explains that the seeds for it are planted in the environment men have grown up in. “The foundation for later problems, including getting and maintaining erections, can be built when men have been reared in a macho environment,” Dr. Kinsey says, “Some features of such an environment include where there has been punishment for signs of vulnerability (which is viewed as a weakness), where they have experienced ridicule for expressions of “feminine” virtues like warmth, empathy and emotional sensitivity, and where conflict resolution consists of competitive displays of dominance and/or violence.”

Put simply, erectile dysfunction can be an effect of the emotional disturbances associated with narcissism.

Mark Goldberg is a licensed clinical marriage and family therapist and a certified sex therapist, and has particular expertise in helping resolving issues of erectile dysfunction. He too has noticed a distinct link between narcissism and impotence.

“Narcissists tend to have a difficult time with criticism, real or perceived. Erectile dysfunction can be a way of avoiding potential criticism or simply not being the best lover that a partner has had. A narcissist is unlikely to say that he is concerned about what his partner thinks about him or his performance,” explains Goldberg, “Also, if erections are not working at all it becomes a lot easier to blame the partner, which is often a trait of narcissists as well.”

This narcissistic idea of blaming erectile dysfunction on a partner has also been noted by Caroline Madden, Ph.D.,  a licensed marriage and family therapist and the author of “Fool Me Once: Should I Take Back My Cheating Husband?” She recalls a particular case where a man refused to have sex with his partner but did have sex with prostitutes. “It’s about manipulation and control. It is another way for him to blame the woman.” 

Similarly, this could also be explained by the fact that narcissists can have trouble connecting emotionally, explains Indigo Stray Conger,  a certified sex therapist and writer for Choosing Therapy. 

“In terms of adult attachment styles, men with Narcissistic Personality Disorder (NPD) tend to be on the far end of the attachment spectrum, under Avoidant Attachment. Avoidant attachers have difficulty connecting emotionally during sex, often using masturbation in lieu of sex with partners and having less interest in sexual connection with partners as relationships become long term. Men with NPD, in addition to these factors, tend to use sex as a way to achieve self-esteem and emotional manipulation,” explains Conger.

“This cluster of issues around sexual connection lends itself to erectile dysfunction, particularly in longer relationships and as men age, as men with NPD have difficulty connecting emotionally and feeling embodied during sexual activity.” 

The link between narcissism and impotence is made even more understandable when we understand what exactly narcissism involves. 

Licensed professional counselor and psychotherapist Alena Scigliano specializes in Narcissistic Abuse. She provides therapy primarily to women who are searching for healing from relationships with pathologically narcissistic partners and parents.  

“The heart of pathological narcissism is a deep insecurity, and an extremely fragile sense of self.  The inherent nature of a pathological narcissist is to mask their insecurity, even from himself,” explains Scigliano, “It is quite possible that erectile dysfunction is a symptom of this need to mask, just as presenting a grandiose self-importance is, as a means to avoid discovering that one cannot perform well.” 

She adds that pathological narcissists rarely begin something that they can’t finish – and when applied to erectile dysfunction, that includes sex. “If they suspect that they won’t do well, they avoid doing it altogether. Since their fragile sense of self may include a fear of being judged for poor sexual performance, they may be subconsciously sabotaging the possibility of even beginning intercourse, simply for the sake of avoiding the risk of failure and therefore judgment.” 

Dr. Kinsey explains that we can look to gender stereotypes to explain the link, too. “Although this kind of gendered language has fallen out of fashion, we can understand human psychological wellbeing as having a balance of masculine and feminine traits.” 

“Male gender expressions need to integrate a feminine side, also called the ‘anima,’ while healthy female gender expressions require that masculine traits (the “animus”) get assimilated into the personality,” expounds Dr Kinsey. 

Likewise, this plays into the gender stereotypes – and reactions against them – we have come to know. “The stereotype of women needing to become more comfortable with self-assertion, asking directly for what they want, and negotiating raises in the workplace is an example of working towards animus integration,” says Dr. Kinsey, “The stereotype of men needing to learn sensitivity, receptivity to emotional experiences, and expressing vulnerability is an example of anima integration.” 

This adds extra pressure on modern men, he adds: “In men, when the stress of maintaining a hypermasculine mask becomes too great, the body may alert him to the toxic imbalance through sexual dysfunction. It’s no accident that erectile dysfunction might be the only symptom sufficiently distressing to motivate him to seek help.” 

Understanding erectile dysfunction as a manifestation of narcissistic personality disorder goes hand in hand with understanding it as a somatic expression: a mind-body relationship. 

“It’s important for people to understand that “psychosomatic” does NOT mean ‘it’s all in your head,’” Dr. Kinsey is quick to point out, “People who experience erectile dysfunction or other psychosomatic phenomena are experiencing real things in their body.” 

“Psychosomatic expressions of emotions are a form of dissociation,” explains Dr. Kinsey, “a primitive defense mechanism that involves adopting a simplistic view of experience as being all good or all bad. This kind of defense is usually called ‘splitting.’ In the hypermasculine form of narcissism, experience is split into something like ‘strong’ and ‘weak.’” 

With these hypermasculine ideas in mind, Dr. Kinsey hypothesizes, “The more the mind insists on ‘strong,’ the body will express weak. Impotence is one way in which the body rejects the mind’s unreasonable demands.” 

Both erectile dysfunction, and narcissistic abuse can be incredibly emotional topics for people experiencing them. So, how do psychologists approach the issue clinically? 

“One of the main challenges clinically has already been overcome when the patient enters a psychotherapy office – that is getting him into therapy,” says Dr. Kinsey, “I suspect that many narcissistic men suffer unnecessarily from erectile dysfunction as they turn exclusively to MDs. A prescription to Viagra or Cialis may treat the symptom, but the underlying psychological cause could remain untreated.” 

Dr. Kinsey explains that in his experience, the biggest reason for impotence – and therefore in treating it –  can be psychological, rather than medical: “I have seen a number of men who have basically given up on ever having another erection since MDs were not able to address the impotence through medical intervention.”

Scigliano adds that narcissists actually rarely seek psychological help – so it’s understandable that they would be more likely to visit their primary care physician for erectile issues, rather than a therapist. “Even if the physician recommended therapy, the narcissist would probably just ignore the suggestion,” she adds, “But what does get them into counseling sometimes is a marital or partnership conflict.” 

This is a way for the narcissist to identify the unhealthy ways he expresses emotion, and learn healthier means of expression, says Scigliano. It’s also incredibly important to be aware of the partner of the narcissist, too, Scigliano says: “I would help the partner to understand how important it is to be non-judgmental during intimacy and encourage them to do their best to create an interpersonal dynamic of acceptance. Honestly though, this is an extremely simplistic explanation for something that would likely be much more complicated and nuanced.” 

“It’s also important it is to remain mindful of how vulnerable the partner of a narcissist is to psychological abuse, ensuring that I do not inadvertently create a worse situation for them. But overall, my hope would be that, as the patient begins to integrate healthier coping skills into his daily life, discussed in therapy, he will find that he experiences erectile dysfunction less and less.

Thankfully for many, therapy can be, and often is, the answer.

“If a man is in therapy, he has hope,” says Dr. Kinsey, “The main challenges at this point are: Convincing the patient that erectile dysfunction is a psychosomatic symptom, ensuring the cure is not more painful than the symptom, and offering the patient a model of more integrated masculinity that feels worthy of pursuit, or at the very least, tolerable.” 

“In psychotherapy, pain is the motivator for change. Building an accepting, honest, and emotionally-open relationship with the patient around this pain is the best way to address erectile dysfunction psychologically,” he adds. 

For more advice on therapy for relationships, and understanding psychological behaviors and their effects, head to Mindsplain now. 

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