How to spot narcissistic abuse: 6 signs and where to seek treatment

• Narcissistic abuse happens when someone with narcissistic personality disorder manipulates you.
• An abuser with NPD may try to control you by isolating you from friends and family.

Narcissistic abuse is often emotional or verbal, though isn't always obvious when you have a narcissistic abuser in your midst. Here are some of the more subtle signs that you're being abused by a narcissist.

NPD meaning

Narcissistic abuse is a form of emotional or psychological abuse perpetuated by someone who has narcissistic personality disorder (NPD).

NPD is estimated to affect up to 5% of the US population and is characterized by:

• An overinflated sense of self-importance
• Need for excessive admiration
• A sense of entitlement
• A lack of empathy and consideration for other people's feelings and needs

There are many reasons why a person might develop NPD: reserach suggests there is a genetic component, while negative childhood experiences, including rejection and excessive praise, are also thought to play a part.

Abusers with NPD may try to manipulate and control the people around them, says Jeff Temple, PhD, director of the Center for Violence Prevention at the University of Texas Medical Branch (UTMB). This can be especially difficult if someone with NPD is a roommate, significant other, parent, or coworker.

Important: While someone with NPD may abuse the people around them, not all people with NPD are abusers. Abuse can also occur regardless of the presence of a personality disorder. Narcissistic abuse is a particular type of emotional or psychological abuse someone with NPD may perpetuate, but it doesn't mean abuse and NPD go hand-in-hand.

Signs and symptoms of narcissistic abuse

Narcissistic abuse isn't always obvious and can be difficult to identify, especially since narcissists often come across at first as charming, kind, and supportive, says Paul Poulakos, DO, a board-certified psychiatrist with a private practice. But there are signs that indicate you may be experiencing narcissistic abuse and ways to get help.

Here are six signs of narcissistic abuse and the lasting effects this kind of emotional and psychological manipulation can have.

1. You feel worthless or useless

Abusers with NPD may try to damage the self-esteem of their romantic partners or other loved ones in an attempt to make those people rely solely on them for any notion of self-worth and validation, Temple says.

One way an abuser with NPD may try to break down your self-esteem is by constantly comparing you to others and how you don't measure up.

"This will often lead a victim to have low self-esteem in multiple areas of their life, like their job, parenting, or other relationships," Temple says.

2. You no longer recognize yourself

"After a period of time of being subjected to narcissistic manipulation, the victim finds themselves altering their identity to fit the wants of their partner whom they so badly wish to stay with," Poulakos says.

This constant accommodation to someone else's wants can make it difficult for the victim to recognize themselves and they may no longer feel like themselves.

Some signs of this are:

• You change yourself to fit the ideal that you think the abuser wants
• You stop doing things you like because you don't want the abuser to get mad
• You have trouble identifying your values, wants, and needs separate from your abuser

3. You question your reality

Gaslighting often goes hand-in-hand with narcissistic abuse, Temple says. Gaslighting is a form of emotional abuse that can cause you to question your own feelings and experiences and make you doubt that you are in an abusive relationship.

For example, if you try to bring up behaviors that you don't like, an abuser with NPD may try to gaslight you by making statements like "it is all in your head" or "you are way too sensitive," Poulakos says.

"The purpose is to make you feel irrational and thus easier to control," Temple says.

4. You are isolated from friends and family

A psychologically abusive partner or friend may try to prevent you from accessing your normal support groups, Temple says.

This is another tactic that can make someone more reliant on their abuser. Eventually, someone experiencing narcissistic abuse may stop reaching out to their friends and family out of fear of retaliation from their abuser.

5. Other people are brought into the abuse

In an attempt to maintain their image, an abuser with NPD may try to spread hurtful rumors or negative comments about you to others, Poulaoks says.

They may also try to pull other people into conflicts between the two of you in an effort to get someone else "on their side" and reinforce their position.

6. You experience physical changes in your body

The anxiety and stress from narcissistic abuse can cause many reactions in your body, Poulakos says, including:

• Changes in appetite
• Nausea
• Difficulty sleeping
• Fatigue
• Muscle aches and pains
• Headaches

Those who have experienced narcissistic abuse may also develop symptoms of post traumatic stress disorder (PTSD), like extreme irritability and feeling constantly on guard.

Long-term effects of narcissistic abuse

Forms of emotional and psychological abuse, like what you may experience with a narcissistic partner, friend, or parent, can be just as damaging as physical violence, Temple says.

Long-term effects of emotional and psychological abuse can include:

• Depression
• Anxiety
• Chronic pain
• Feelings of powerlessness
• Feelings of shame and guilt

Additionally, if you have experienced narcissistic abuse in the past, you may carry feelings of inadequacy, unworthiness, and mistrust into new relationships, Poulakos says.

"Many victims spend years believing they are worthless, or like they were walking on eggshells. Getting beyond this takes rebuilding and challenging those negative learned thoughts," Temple says. "Trauma-informed cognitive behavioral therapy can help a victim move beyond these negative thoughts and feelings."

How do victims of narcissists behave?

Every survivor's experience looks different. However, victims of narcissists exhibit common behaviors such as:

• People pleasing or "walking on eggshells"
• Self-isolation
• Irritability
• Freezing up
• Substance use
• Trouble sleeping
• Disordered eating

What does narcissistic abuse feel like?

No survivor's experience is less valid than another: there are countless emotions someone might feel when experiencing narcissistic abuse. These emotions could include:

• Low self worth
• Heightened stress levels
• Depression
• Anxiety
• Fear
• Disorientation
• Anger
• Loneliness

Treatments for narcissistic abuse

Narcissistic abuse can have debilitating and lasting effects on your mental and physical health, but there are ways to find support and heal.

Here are some ways to take care of yourself after experiencing this kind of abuse:

Exit the relationship

Let trusted friends or family know your intentions to break away from your abuser. Develop a plan that includes a safe place to stay if you need it and stop all contact with the abuser with NPD.

Find support groups

It may help to connect with others who have also experienced narcissistic abuse and know what you are going through.

You can utilize online support groups or reach out to the Support for People Affected by Narcissistic Abuse in Toxic Relationships (SPAN) network at narcissisticabuserecovery.online.

Explore therapy

Talking about your experience with a trusted mental health professional can help you rebuild your self-esteem, develop tools for coping with stress, and find yourself again.

Trauma-informed cognitive behavioral therapy with a licensed counselor can help you examine and reshape negative thought patterns you may have developed as a result of narcissistic abuse, Temple says.

Best online therapy providers

Teletherapy is a flexible way to access the help of licensed mental health professionals. Our guides recommend the best online therapy providers and free online therapy resources.

• Best for full access to a self-selected therapist: BetterHelp
• Best for limited access to an assigned therapist, covered by insurance: TalkSpace
• Best for cheap online therapy and self-guided work: Online-Therapy.com
• Best for free emotional support and trained listeners: 7Cups

Insider's takeaway

Narcissistic abuse is a form of emotional or psychological abuse perpetuated by someone with narcissistic personality disorder (NPD).

Those who have experienced narcissistic abuse may have low self-esteem, have trouble recognizing themselves, question their realities, and experience physical responses to stress, like difficulty sleeping, headaches, and fatigue.

If you are experiencing emotional or psychological abuse from an intimate partner, Temple suggests developing a safety plan that includes identifying safe friends, family, and places to go should the abuse escalate.

You can also contact the National Domestic Violence Hotline at 1-800-799-SAFE (7233) or the National Dating Abuse Helpline at 866-331-9474.

And if you believe a loved one is in an abusive relationship, you can support them by letting them know you are there for them when they are ready to exit the relationship, Temple says.