Liz C., 62, who spoke on the condition that her last name be withheld for safety concerns, was unfamiliar with the expression. As she scoured the internet, her reading on narcissism led her to works by clinical psychologist Ramani Durvasula and clinical psychotherapist Les Carter. Through them she discovered a phenomenon known as “narcissistic abuse.”
Narcissistic abuse, she learned from her research, consists of psychological, emotional, financial or sexual manipulation inflicted by a narcissist, sometimes with coercive control — a pattern of behavior used to dominate and control a partner — or physical violence.
The relationship usually begins gloriously, with grand gestures and “love bombing” — barraging someone with lavish gifts, affection or attention. But experts say it can quickly turn from romantic and flattering to critical and invalidating, or remain in a pernicious purgatory. Those on the receiving end can experience fear, confusion, anxiety, gaslighting, blame-shifting and manipulation.
The idea resonated deeply with her.
“It was like the door had been thrown open and I could see clearly,” she said. “I began to have an answer for why we were where we were.”
Reframing a bad relationship
“Narcissist” is a label that has gained traction over the past decade or so, one that has been liberally applied to everyone from the humblebragger in your book group to former president Donald Trump.
Narcissists, we are told, lack empathy. They lie. They crave attention. They think they’re above the law, and they need constant external validation. “It’s the triple E: exploitation, entitlement and empathy impairment,” said clinical psychologist Craig Malkin, author of “Rethinking Narcissism: The Secret to Recognizing and Coping with Narcissists.” “That’s the core of pathological narcissism.”
Along with the term’s increased visibility came an interest in the type of damage narcissists can inflict on those around them. Millions of people have characterized themselves as having been victimized by a narcissist, not only by their romantic partners, but family members, friends, bosses or colleagues. #Narsissisticabuse has more than 1.4 million posts on Instagram; the phenomenon has become so widely recognized it even has its own day, June 1, World Narcissistic Abuse Awareness Day.
Many of the 1.7 million followers of Durvasula’s YouTube channel believe they have experienced it. Same for the more than 6.2 million downloads of her podcast, “Navigating Narcissism.”
Clearly, many people are treated poorly in relationships. But when the abusive party is a narcissist, the argument goes, the mistreatment is taken to the next level.
While a toxic relationship may be frustrating or hurtful, “it doesn’t leave you confused or feeling as though you’re losing your reality,” said Durvasula, the author of “It’s Not You: Identifying and Healing from Narcissistic People,” a New York Times bestseller. A relationship with a narcissist can yield “hypervigilance, rumination, confusion, self-blame and self-doubt.”
Like so many things, narcissism exists on a spectrum. On one end is mild narcissism, which includes self-centeredness, emotional immaturity and hypersensitivity. While these folks can be challenging to deal with, it’s the malignant narcissists at the spectrum’s other end who are the most deleterious. Many of them, Durvasula said, are likely to meet the criteria for narcissistic personality disorder, or NPD. That’s a clinical diagnosis listed in the Diagnostic and Statistical Manual of Mental Disorders, or DSM, the guide to officially recognized mental disorders.
Experts aren’t sure how common NPD is. The disorder is underdiagnosed, partly because symptoms can be confused with other personality disorders and partly because most narcissists aren’t rushing into therapy.
“Prevalence studies sometimes rely on ‘self-reporting’ by the patient/subject — who are likely to minimize self-pathology,” Ronald W. Pies, a professor emeritus of psychiatry at SUNY Upstate Medical University in Syracuse, said in an email.
There are some estimates. According to a 2022 report in Focus: The Journal of Lifelong Learning in Psychiatry, 1 to 2 percent of the general population in the United States may have NPD. Recent unpublished data collected by Durvasula and statistician Heather Harris found that 10 percent of the population have enough narcissistic traits to affect their relationships.
A 2023 study in the Journal of Personality and Social Psychology of more than 270,000 participants also found that men scored higher for narcissistic traits than women.
But there is little about narcissistic abuse in academic literature, and skeptics argue that the term is nothing more than a popular hashtag — the explanation du jour for bad behavior.
“I think it spiraled into a trend because survivors so desperately need answers,” said Bea Coté, director of Impact+ Abuse Prevention Services, which provides domestic violence intervention programs in the Charlotte area. “This is an answer that they can buy into as to why this man that they loved, who appeared to love them, later abused them.”
Skeptics also question whether adding a speculative diagnosis of the perpetrator adds value when discussing emotional abuse.
“One of the questions is whether the consequences of these relationships are unique or are these people simply suffering from a bad relationship,” said Paul S. Appelbaum, past chair of the DSM-5 steering committee for the American Psychiatric Association and a professor of psychiatry at Columbia University. “That’s not to say they might not need professional assistance in extricating themselves from the relationship — the two aren’t necessarily independent.”
Lisa Aronson Fontes, author of “Invisible Chains: Overcoming Coercive Control in Your Intimate Relationship,” calls the term “hollow pop psychology.”
“Certainly, some people act more abusively than others, and those people may have narcissistic traits,” she said. “But it makes no sense whatsoever to call interpersonal abuse ‘narcissistic abuse.’ Why not just call it abuse? Or coercive control? Or workplace sexual harassment?”
What’s more, she added, labeling something as a disorder implies a mental illness that can’t be controlled. Abusers can control their behavior.
“Most often, they strike out only at those who are closest to them, in private and in ways where they won’t be ‘caught’ by others,” she said.
Durvasula concedes that invalidating relationships have been around as long as people have coupled. But only recently has the discussion broadened in a meaningful way, she argues, because in the past we didn’t have the language to discuss nonphysical abuse.
“I have worked with clients who have been married 40 and 50 years,” she said. “They will acknowledge that the dynamics have been present ever since the beginning of their relationships. There was just no vocabulary for it, not even in the field of mental health.”
She insists that calling someone “narcissistic” isn’t an implication of a mental disorder, but merely a description of one’s personality. And no matter where a narcissist falls on the spectrum, “the common ingredients include variable empathy, entitlement, grandiosity, selfishness, the need for admiration and validation, fragile egos, and reactive anger at times of frustration, disappointment or criticism,” she said.
Daniel Shaw, author of “Traumatic Narcissism” and a psychotherapist in New York, cites four hallmarks of narcissistic abuse: seduction, intimidation, humiliation and belittling.
“Is the person always self-aggrandizing? Do they refuse to acknowledge any flaw in themselves? Are they contemptuous of others? If you try to tell them why you’re upset with them, do they deny that they did anything, or attack you by reversing who is victim and who is offender?
“A traumatizing narcissist is determined to find prey,” he continued. “They will find people they can control and exploit. They use everything they’ve got — charisma, charm, intelligence. They’re typically quite clever. They desperately need to be able to have people to control.” Controlling people reassures these individuals, who tend to be profoundly insecure, that they really are as powerful and superior as they want to believe, Shaw says.
Faith C. Echo experienced that kind of control. Unbeknownst to her, her former partner had placed video recorders all over their house and a GPS tracker on her car, and was reading her texts and emails. He’d hide her car keys; if she left her phone in one room and couldn’t find it, he’d tell her he hadn’t seen it.
“I’d search the whole house and my phone would be right next to him,” said Echo, 44, who writes and blogs about narcissistic abuse under a pen name because of safety concerns. “He’d be like, ‘You’re really losing it, you need psychological help.’”
She wasn’t allowed to have friends or spend time alone with their son. “I didn’t know who I was anymore. I no longer had an opinion,” said Echo, who self-published a book about her experience and is a licensed social worker. Even the smell of apple-scented candles would throw her into a panic; the couple often fought in a room in their home filled with the aroma.
She finally left in 2023, after 4½ years with him.
“It’s empowering and very validating to talk to people who’ve been through it,” she said. “Unless you’ve been through it you don’t understand the insanity.”
Why is it so hard to break free? “The narcissist can at the beginning of a relationship appear very caring, kind, thoughtful and committed,” said Vickie Howard, a lecturer and deputy program director in mental health and well-being in Hull, England, who has written about her own experience with narcissistic abuse. She compared it to leaving a destructive cult involving mind control mechanisms. Also, as with any kind of domestic abuse, financial, physical and psychological abuse often accompany narcissistic abuse. Or there are children involved, making it feel almost impossible to leave.
One of the challenges in getting treatment for narcissistic abuse is that many therapists lack training or experience recognizing people who’ve been in these types of unhealthy relationships. A 2019 study in the Journal of Counseling & Development analyzed a survey completed by 104 survivors of intimate partner abuse. About half of the respondents said that they felt counselors blamed them, telling them that they were “codependent” or had somehow chosen this sort of partner.
“When victims of intimate partner violence go into therapy, oftentimes their therapist might not be trained in how to work with trauma and doesn’t have an understanding of the system of psychological abuse and gaslighting that occurs,” said clinical psychologist Vaile Wright, senior director for health-care innovation at the American Psychological Association. (The term “gaslight,” which takes its name from the 1944 film of the same name, refers to psychological manipulation designed to make the victim doubt their own perceptions).
The last time Liz C. and her then-husband went to counseling together, she watched the therapist “fall under his spell,” she said.
“He was gaslighting, changing all the words. She just stated the same rhetoric, ‘You need communication, conflict resolution,’ all the typical marriage things that don’t apply to narcissists because they don’t play by the same rules.”
Durvasula has developed a training and certification program for clinicians who want to gain expertise working with patients in relationships with narcissistic people. So has Sandra L. Brown, founder of the Institute for Relational Harm Reduction and Public Pathology Education, which publishes Safe Relationships Magazine.
Caroline Strawson, a trauma-informed therapist and coach outside London with 42,000 women in her Facebook group, insists her clients have no contact with their narcissist, blocking them on social media and email. If children are involved, she advises clients to get another cellphone just for emergencies. “Otherwise, if you keep on communicating they will try to control you,” she said.
Durvasula, who also runs a recovery program, wants people to focus on themselves, rather than their abuser’s behavior.
“Healing means the radical acceptance of seeing it, recognizing the patterns as patterns, and understanding that it’s not going to change,” she said. “It also means ending the cycle of believing there is something you could do to make it better.”
In time, Liz C. realized her husband was never going to change. To have any chance of future happiness, she had to get out. Two years ago, she did.
“People underestimate the toll narcissistic abuse takes, and the damage it does,” she said. “Calling it abuse amps up the importance of it and I think that’s an accurate way to look at it.”
