Awareness of Narcissism Continues to Grow, but Treatment Remains Elusive

There has been a rise in awareness of narcissistic abuse in the past decade. Countless pop psychology videos can be found explaining the zero-sum game of the pathological narcissist, helping victims sort through the disorienting fallout of a psychologically abusive relationship.

Many professionals have attempted to discredit these influencers, calling it unwarranted panic.

The prevalence of those meeting diagnostic criteria for narcissistic personality disorder (NPD) is estimated to be up to 2% of the population or over 6.5 million people in the United States. Rates in clinical and outpatient therapy populations may be up to 20% (Weinberg & Ronningstam, 2022).

We know that narcissism is an inherently antagonistic personality type. Those meeting the diagnostic criteria for NPD are strategic and malicious in their efforts to maintain power and control over others. Insecurity, shame, emptiness, maliciousness, and chronic abusiveness define their worldview and actions.

Those who dismiss the prevalence of NPD perpetuate victim-blaming of anxious attachment and codependency traits to downplay narcissistic abuse. The difference is that those with attachment wounds can increase awareness and healing within healthy therapeutic and personal relationships. Childhood trauma may make people more susceptible to victimization, but it generally leads to an increased desire for mutuality rather than harm.

Perhaps the reluctance of experts to acknowledge the severity of the problem is due to the challenge of addressing it. People with narcissistic personality disorder are notoriously difficult to treat. Personality, of course, is not a mental illness. Narcissism is not a break from their baseline presentation. It is a way of being.

People with NPD (counter to common belief) often present in therapeutic settings with co-occurring or misdiagnosed conditions, complaining of relational difficulties. They resist vulnerability, self-reflection, and adaptation, using their other diagnoses to promote a grandiose vision of victimhood and an excuse for bad behavior.

Counselors universally understand that those with NPD are usually draining, treatment-resistant, and prone to creating conflict within the therapeutic relationship. They sabotage connection and problem-solving so much that therapy becomes futile.

Further, there are few validated interventions for these individuals, and most professionals lack the training or energy to provide them. Because of this, insurance providers will often not offer reimbursement for treating NPD.

Alarmingly, diagnostic criteria for NPD do not currently include angry outbursts, which research has proven is an intrinsic core feature of pathological narcissism (Green & Charles, 2019). This gap in diagnosis underscores the minimization of their condition and the danger they impose on their victims. Data shows that narcissistic rage episodes inevitably lead to physical violence (Green & Charles, 2019).

Why Not Focus on Victims Rather than the Abusers?

All interpersonal relationships have difficulties. However, narcissistic abuse often comes with uniquely perpetuating and escalating cycles of calculated cruelty, manipulation, and violation that create addictive neurological trauma bonds. Most victims see these as hurdles that can be overcome, not knowing the chaos is abnormal, intentional, and not likely to improve.

Abusive relationships are insidious because they also feel like loving relationships. They begin as caring and meaningful, slowly deteriorating over time after establishing a deep connection. Destructive and vengeful behaviors thus become normalized in relational dynamics. Identifying narcissistic abuse tactics (because they are so formulaic yet elusive) helps victims reorient and begin their healing journey.

Pop-psychologists are doing a vital service in reaching and empowering people. Targets of narcissistic abuse characteristically struggle with confusion, denial, anger, isolation, shame, and a loss of self. It is not difficult to see why machine-learning social media algorithms can identify the nature of the distress before the victims themselves can.

Psychology influencers are, after all, surprisingly accurate in their information, providing a helpful bridge to healing. Their viral online advice is often presented in a direct, clear, and specific nature that trauma victims can digest under duress, leading them to seek needed professional help. However, once they obtain assistance from a skilled professional, they continue to have a long road ahead of them.

Psychological abuse is at the core of complex post-traumatic stress disorder (C-PTSD). It is a mental health condition that involves debilitating stress from long-term trauma exposure. Domestic and childhood abuse survivors state that the damage they experience from C-PTSD is layered and isolating. It is the insidiousness of the ongoing relationship dynamics rather than instances of physical violence that are most destructive.

Due to the nature of C-PTSD, standard approaches for anxiety, depress i on, grief, or trauma are usually ineffective. Survivors require a systemic approach that addresses all layers of harm and promotes well-rounded post-traumatic growth. One-dimensional treatment models are unable to address all levels of wounding. The inadequacy of these approaches can perpetuate toxic shame (Walker, 2013).

Licensed therapists are often undereducated in identifying and treating victims of psychological interpersonal violence. They frequently use narrow approaches to address specific symptoms rather than a comprehensive intervention plan. Survivors then carry the additional burden of self-advocacy to obtain appropriate care.

Effective treatments focus on nervous system regulation, deprogramming, re-education, safety planning, cognitive restructuring, acceptance therapies, and griefwork. All aspects of treatment should be geared toward reshaping a survivor’s sense of self-trust, correcting their distorted worldview, and increasing overall protective factors.

The rising public focus on pathological narcissism is warranted. Some experts believe personality disorders have been exacerbated due to the complexity of navigating modern life (Lester, 2019). Further, advances in technology have made narcissistic abuse tactics more complex and destructive than ever.

Pop psychology influencers are using technology for good: reaching victims who might otherwise remain caught in the inherently abusive trap of a narcissistic partner. These survivors are increasing their understanding of their distress and can better advocate for their healing.

Licensed professionals need to stop dismissing YouTubers and improve their interventions. Trauma exposure, especially when untreated, is the number one predictor of future revictimization. Influencers can influence, but they cannot treat. That is for the therapists to figure out.

About the Author: Bethany Palmer, MSW, SWLC is a clinical social worker, therapist, and mom. She has worked with older adult populations and terminal patients in the fields of abuse intervention and hospice care for over 20 years.

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References

Green, A., & Charles, K. (2019). Voicing the Victims of Narcissistic Partners: A Qualitative Analysis of Responses to Narcissistic Injury and Self-Esteem Regulation. Sage Open, 9(2). https://journals.sagepub.com/doi/10.1177/2158244019846693
Lester, G. (2018). Personality disorders certification training: Advanced diagnosis, treatment & management [Video]. PESI. https://catalog.pesi.com/sales/bh_c_001287evg_advpersonalitydisorders_organic-89736
Walker, P. (2013). Complex PTSD: from surviving to thriving : a guide and map for recovering from childhood trauma. First Edition. Lafayette, CA, Azure Coyote.
Weinberg, I., & Ronningstam, E. (2022). Narcissistic personality disorder: Progress in understanding and treatment. Focus. (American Psychiatric Publishing), 20(4), 368–377 https://psychiatryonline.org/doi/10.1176/appi.focus.20220052

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