Mental Health Care For Post-Traumatic Stress Disorder (PTSD) From Narcissistic Abuse

Narcissistic abuse can occur in various settings and may have a lasting impact on the mental well-being of survivors. Following this or any type of abuse, it’s common for people to experience challenges like anxiety, depression, post-traumatic stress disorder (PTSD), and other complications. Here, we’ll explore the signs of narcissistic abuse, specific mental health challenges often associated with narcissistic abuse (including PTSD), and how to seek support in healing from traumatic experiences. 

Process past trauma with a compassionate therapist

Match with a provider online

Understanding narcissistic abuse

Narcissistic abuse is a form of emotional and psychological abuse where the perpetrator actively manipulates, controls, and exploits those around them. This form of abuse takes place when the abuser has narcissistic traits and/or narcissistic personality disorder (NPD), a recognized mental health disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). According to the DSM-5, NPD is characterized by grandiose thought and behavior, attention-seeking, a lack of empathy, and more, though keep in mind that only a qualified healthcare professional can diagnose NPD. 

Key aspects of narcissistic abuse

Narcissistic abuse can take many different forms, but there are often some common threads. A 2020 qualitative study interviewed several hundred survivors of narcissistic abuse about their experiences, and some of the top themes noticed in the abuser were:

• A sense of arrogance and entitlement
• A lack of empathy
• Being hyper-critical of those around them
• Being exploitative and controlling, including financially
• A sense of grandiose self-importance
• Telling frequent lies
• Neglecting the needs of others
• Seeming unable to recognize or apologize for harm they’ve caused
• Being emotionally cold
• Showing rage and throwing tantrums
• Being vengeful and suspicious

Again, while not all of these traits may qualify as abuse on their own, it’s easy to see how they could potentially contribute to, exacerbate, or occur alongside abusive behaviors. Narcissistic abuse specifically could take the form of any of the following, and is usually also marked by controlling behaviors and social isolation:

• Psychological abuse, which uses manipulation to make a person doubt their reality, memories, or worth
• Emotional abuse, which uses threats, intimidation, criticism, insults, or other means to degrade a person’s self-esteem
• Physical abuse, such as hitting, choking, kicking, blocking exits, etc.
• Sexual abuse, such as forced sexual acts
• Financial abuse, such as controlling the target’s ability to make or use money

Narcissistic personality disorder in relationships

Due to their narcissistic traits—such as self-importance, a need for attention, and a lack of empathy—it can be challenging to date someone with untreated narcissistic personality disorder (NPD). Research suggests significantly higher levels of disharmony in relationships where one or more partners has pathological narcissism, even if abuse is not present.

Common experiences in a relationship with someone who has NPD

Navigating a relationship with a person who has NPD or narcissistic tendencies can be challenging. What often starts out as excessive charm and affection can, over time, potentially turn into manipulation, criticism, and control. Other common experiences include:

• Love bombing in the early stages of a relationship, followed by devaluation through criticism
• Gaslighting and blame-shifting
• Withholding emotional support and dismissing their partner’s emotional needs
• Isolating their partner from their loved ones
• Difficulty building genuine intimacy
• Grandiosity and a constant need for validation and admiration 

Keep in mind that these behaviors are most common in people with narcissistic traits that are unaddressed or NPD that is untreated. Treatment can sometimes help a person gain awareness of their tendencies or symptoms and gradually work toward addressing them. 

Potential mental health impacts of narcissistic abuse

Having been in an abusive relationship with someone who has narcissistic traits or NPD symptoms can affect a person's mental health and well-being in many different ways, in both the short and long-term. Narcissistic abuse has the potential to lead to various mental health conditions and trauma-related disorders in addition to often contributing to low self-esteem. It may also impact a person’s ability to trust others and form healthy relationships.  

Possible long-term mental health challenges: post-traumatic stress disorder and more

In addition to potentially developing anxiety, depression, or another diagnosable condition, a person could also experience long-term challenges like:

• Low self-esteem
• Trouble making their own decisions
• Feelings of helplessness
• Physical symptoms of stress, such as gastrointestinal issues or sleep problems

Finally, as with any experience of abuse, those who have experienced narcissistic abuse may also be at risk of developing post-traumatic stress disorder.

What is PTSD from narcissistic abuse?

Post-traumatic stress disorder (PTSD) is a mental illness that develops in some people as a reaction to a traumatic event or events. PTSD symptoms typically fall under a few key categories:

• Re-experiencing in the form of flashbacks or trauma nightmares
• Avoidance of people or situations that remind you of the abuse you experienced, or avoiding talking about what you experienced
• Hyperarousal, such as constantly feeling hypervigilant, alert, or on edge, being easily startled, or experiencing trauma irritability
• Negative emotions and thoughts, like believing the world is inherently dangerous and that you can't trust anyone

In cases of narcissistic abuse, PTSD can sometimes take the form of complex PTSD (c-PTSD), which tends to involve even more severe symptoms that result from ongoing, repeated trauma. In any case, PTSD is a diagnosable mental illness that is not your fault, and effective treatment for symptoms is available. 

Risk factors for developing post-traumatic stress disorder from abuse

Researchers have identified various factors that may make a person more or less likely to develop PTSD after experiencing trauma like abuse. For example, having strong social support and people you can share your experiences with and not be shamed may reduce the risk of developing PTSD after trauma. Conversely, having a history of trauma or other mental health conditions or a family history of PTSD may increase your risk.

Recovering from the trauma of abuse

Recovering from any form of traumatic experience—including narcissistic abuse—is a uniquely personal experience and can look different for each individual. That said, below are some strategies that may help in the healing and recovery process. It’s generally recommended that a person also reach out for professional support along the way, particularly if signs of PTSD are present. A mental illness like PTSD typically won’t go away and may worsen without professional treatment.

Steps to rebuild mental health after experiencing abuse

These techniques may be helpful in the ongoing process of healing from past abuse:

• Acknowledge that narcissistic abuse occurred and that it wasn’t your fault.
• Reconnect with friends and loved ones that you may have become isolated from.
• Prioritize interests and activities that bring you a sense of fun and fulfillment.
• Seek environments that feel safe, supporting, and nonjudgmental, such as in therapy and with supportive friends.
• Begin challenging harmful internalized messages planted by the narcissistic abuser, especially if they are impacting self-worth.
• Establish clear boundaries with individuals with narcissistic tendencies or NPD symptoms by limiting contact, or cutting off contact completely if needed.
• Practice self-compassion as you recover from what you’ve been through.
• Take steps to care for your physical health, which may promote emotional well-being and help you show yourself that you’re worthy of care. 

Post-traumatic growth after a traumatic experience

Abuse is a harmful experience that no one should have to go through. However, a helpful part of recovery can include looking out for signs of what’s known as “post-traumatic growth.” Research suggests that post-traumatic growth can lead to improvements in self-perception, interpersonal relationships, openness, self-awareness, and appreciation of life. 

While post-traumatic growth doesn’t negate the pain of a traumatic experience or make what one experienced okay, it does highlight the strength and resilience that people are capable of. It demonstrates how survivors can rebuild self-esteem, recover from mental health challenges, and reconnect to life and healthy relationships with a sense of purpose.

Online therapy to address the effects of narcissistic abuse

For people who have been the target of narcissistic abuse or other difficult or traumatic experiences, seeking therapy can be a crucial component of the recovery process. This can be especially true if an individual is experiencing signs of a mental illness like post-traumatic stress disorder. A trained therapist can offer a safe space where a person can process their experiences, cultivate healthy coping mechanisms, rebuild self-esteem, and find positive ways to move forward after abuse. According to the American Psychiatric Association, there are many approaches a therapist might use to treat PTSD or other trauma-related challenges, from cognitive behavioral therapy (CBT) to eye movement desensitization and reprocessing (EMDR).

While therapy can be a key component of healing and recovery, not everyone feels comfortable meeting with a therapist face to face. In such cases, online therapy may be a preferable alternative, since it allows individuals to work with a compassionate, licensed therapist from the comfort of home. With an online therapy platform like BetterHelp, you can get matched with a provider and then meet with them remotely, with the option to switch providers at any time for no additional cost until you find the right fit. 

Process past trauma with a compassionate therapist

Match with a provider online

The effectiveness of online therapy for treating PTSD from narcissistic abuse

In recent years, a wealth of research has emerged supporting the effectiveness of online therapy for addressing a variety of mental health challenges. For example, consider a 2023 study which indicates that internet-delivered cognitive behavioral therapy (iCBT) can often be equally effective for treating PTSD as in-person care.