Let us briefly study the pair of roles "sick-healthy" or "patient-doctor". The narcissist can assume either role in this pair.

If the narcissist is the "healthy" one, he attributes to his "sick" partner his own inability to form long-standing, emotion-infused couple relationships. This would be because she is "sick" (sexually hyperactive, "nymphomaniac", frigid, unable to commit, to be intimate, unjust, moody, or traumatised by events in her past).

The narcissist, on the other hand, judges himself to be homely and striving to establish a "healthy" couple. He interprets the behaviour of his partner to support this "theory". His partner displays emergent behaviours, which conform with her role. Sometimes, the narcissist invests less in such a relationship because he regards his mere existence - sane, strong, omnipotent, and omniscient - to be a sufficient investment (a gift, really), voiding the need to add "maintenance efforts" to it.

In the other, converse case, the narcissist labels many of his behaviour patterns as "sick". This usually coincides with latent or open hypochondriasis. The partner's health is idealised to form the background with which the narcissist's purported sickness is contrasted. This is a responsibility shifting mechanism. If the narcissist's pathology is deep seated and irreversible - then he cannot be held responsible for his actions, past and future.

This role playing is the narcissist's ways of coping with an insoluble dilemma.

The narcissist is mortally terrified of being abandoned by his partner. This fear drives him to minimise his interactions with his partner to avoid the inevitable pain of rejection. This, in turn, leads exactly to the feared abandonment. The narcissist knows that his behaviour instigates that which he is so afraid of.

In a way he is happy about it, because it gives him the illusion that he is in exclusive control of the relationship and of his own fate. His alleged "sickness" helps to explain his unusual conduct.

Ultimately, the narcissist loses his partners in all his relationships. He hates himself for it and is enraged. It is because of the life-threatening magnitude of these negative emotions that they are repressed. Every conceivable psychological defence mechanism is employed to sublimate, transform (through cognitive dissonance), dissociate or re-direct this self-mutilating wrath.

This constant inner turmoil generates unremitting fear manifested in the form of anxiety attacks, or an anxiety disorder. In the course of such life crises, the narcissist briefly believes that he is intrinsically deformed and defective and that he is irreparably dysfunctional when it comes to establishing and to maintaining relationships (which is true!).

The narcissist - especially during a life crisis - loses touch with reality. Defective reality tests and even psychotic micro-episodes are common. Narcissists interpret the (fairly common) mismatch between personalities that doomed the relationships in an apocalyptic manner. Dependence, a symbiotic interaction, raises doubts regarding the narcissist's very ability to form relationships.

But throughout all this, the narcissist needs a collaborative partner. He needs someone to serve as a sounding board, a mirror, and a victim. In other words, he needs a Polyandric woman.

The narcissist thinks of all women as either Monoandric or Polyandric.

The Monoandric woman is psychologically mature. She is usually older and sexually sated. She prefers intimacy and companionship to sexual satisfaction. She is in possession of a mental blueprint, which dictates her short-term goals. In her relationships, she emphasises compatibility and is predominantly verbal.

The narcissist reacts with fear and repulsion (mixed with rage and the wish to frustrate) to the Monoandric woman. Consciously, though, he realises that intimacy can be created only with this kind of woman.

The Polyandric woman is young (if not of age, then at heart). She is still sexually curious and varies her sexual partners. She is not adept at creating intimacy and emotional rapport. Because she is more interested in the accumulation of experiences - her life is not guided by a "master plan", or even by medium-term goals.

The narcissist is aware of the transience of his relationship with the Polyandric woman. So, he is attracted to her while being devoured by his fear of abandonment.

The narcissist, almost always, finds himself paired with Polyandric women. They pose no threat of getting emotionally close to him (of being intimate). The incompatibility between the narcissist and Polyandric women is so high and the probability of abandonment and rejection so great - that intimacy is all but excluded.

Moreover, this consuming fear of being left behind leads to a re-enactment of the primordial Oedipal Conflict and to a whole set of transference relations with the Polyandric woman. This inevitably results in the very abandonment the narcissist so dreads. Serious psychological crises follow such relationships (narcissistic trauma or injury).

The narcissist knows (or, if less self-aware, feels) all this. He is not as much attracted to the Polyandric woman as he is repelled by the Monoandric variety. Monoandric women threaten him with two things deemed by the narcissist to be even worse than abandonment: intimacy and a loss of uniqueness. Monoandric women are the venue through which the narcissist can communicate with his very threatening inner world. Last but not least, they want him to settle into a moulded non-unique way of life common to virtually all humanity: marriage, children, a career.

On the one hand, there is nothing like children to make the narcissist feel threatened. They are the embodiment of commonness, a reminder of his own, dark, childhood, and an infringement upon his privileges. They compete with him for scarce Narcissistic Supply.