Why Isn't Narcissistic Victim Syndrome a Real Diagnosis?

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With so much being written these days about narcissistic personality disorder (NPD) and narcissistic abuse, I have noticed a disturbing tendency for some uninformed people to label anyone who hurts them a "narcissist." The unfortunate corollary is that some people whose intimate partner has hurt them are now describing themselves as suffering from something that they are calling "narcissistic victim syndrome."

This term is catchy and is being liberally used in many internet posts as if it were an actual diagnosis, although there is no research or credible evidence to support its validity. Unfortunately, the repeated use of this term online is confusing to the general public, especially people trying to understand and recover from a disastrous relationship experience.

Before I go any further, I want to be absolutely clear: Narcissistic abuse is real. No one I know in the field of personality disorders doubts that people who meet the criteria for narcissistic personality disorder can be abusive to their partners. Anyone in a long-term intimate relationship with a narcissist is likely to experience some form of emotional abuse. Some will experience physical abuse as well. Many people married to narcissists develop stress-related ailments, both psychological and physical. The most common symptoms are some mixture of anxiety, depression, hyperarousal, insomnia, feelings of helplessness, and diminished self-esteem.

(Note: I will be using the terms NPD and narcissist as shorthand ways to describe someone who qualifies for a full diagnosis of narcissistic personality disorder.)

If narcissistic abuse is real, why shouldn't there be a diagnosis called narcissistic victim syndrome?

The main purpose of a mental health diagnosis is to help the clinician choose a useful course of treatment. Saying that someone suffers from narcissistic victim syndrome is not helpful because:

1. Not every abuser who is called a narcissist qualifies for the diagnosis.
2. Not every person who does qualify for a diagnosis of NPD is equally abusive.
3. Not everyone who is in an abusive relationship with a narcissist will experience the same type or degree of psychological damage.
4. The term "victim" implies that the partner was the helpless target of abuse and played no role in the relationship difficulties. This is not always true.
5. The depth of the injury is often related more to the victim's personality and childhood traumas than to the behavior of the narcissistic partner.

The term narcissistic victim syndrome does not in itself offer enough predictive value to be useful in formulating a treatment plan. Unless the abusive partner has been diagnosed with NPD, a therapist has no way of verifying that the symptoms the client is experiencing are due to being abused by a narcissist.

And while it would be helpful to learn as much as possible about the abusive partner's style to determine the appropriate treatment plan, each client will still need to be evaluated with regard to their specific symptoms.

These factors contribute to the most damage:

1. The person had an abusive childhood.
2. One or both of their parents were narcissists.
3. The person began the relationship with low self-esteem.
4. The person is submissive and has weak boundaries.
5. The person idealized the narcissistic partner.
6. The person suffers from severe abandonment issues that predate the relationship, which interfered with the person leaving when the abuse started.

Example: The Narcissistic Lawyer and His Women

I once had a strange situation that graphically demonstrated how differently two women could react to the same man with the exhibitionist form of narcissistic personality disorder. I was seeing two women in therapy who did not know each other. After a while, I realized they were both dating the same man. Neither woman knew about the other.

Interestingly, they had very different reactions to him. I have changed all names and details to protect their privacy.

Woman 1: Annie. My client Annie had just started dating Marc (the narcissist), and it was evident that she idealized him and desperately wanted to please him. One day, she came to therapy dressed very differently than usual. When I asked her about her new clothes, she said Marc wanted her to dress young and sexy. She also started taking baking classes because Marc wanted her to make him a cake.

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Annie turned herself inside out trying to please Marc and make herself into the type of woman she believed would be worthy of his love. But nothing she did was ever good enough for him. He always found something devaluing to say about Annie's efforts to please him.

Annie's sense that she was not good enough for Marc dated back to her early childhood. It had very little to do with Marc and everything to do with Annie's relationship with her mother. Annie's mother had been both clingy and devaluing. Her father had left when she was a toddler. It was just the two of them, and Annie became her mother's substitute for her absent mate.

As an adult, Annie could neither please her mother nor fully separate from her. She described herself as stuck. This is why Annie started therapy with me. Then Annie met Marc. She immediately switched her focus from her mother to Marc. Unfortunately, Marc's disapproval and his desire to make her over triggered Annie's old fears of inadequacy and made her cling to him even more.

Woman 2: Marcie. My new client, Marcie, was confident and self-sufficient. She dated Marc for a bit but was unimpressed by him. Unlike Annie, who worshipped him as a god to be pleased, Marcie thought he was pretentious and self-centered. Marc picked up on Marcie's confidence, and he tried to win her love. The fact that she was not very enthusiastic about dating him made him pursue her all the more.

So, how did this all turn out?

Annie lost what little self-esteem she had. She took everything Marc said as the absolute truth. The more Marc criticized her, the more hopeless, helpless, and depressed she became. As she said to me, "I feel like I will never find someone as great as Marc again. I am so depressed. I can’t eat or sleep. I think I am going crazy."

Meanwhile, Marcie decided to stop seeing Marc because she found him boring. She told me, "I see no reason to put up with his pretentious BS. The guy is an idiot. I know I can do better."

So, how would the concept of narcissistic victim syndrome help us understand Annie's and Marcie's reactions? In my opinion, it would not add any value. Annie's issues predated her relationship with Marc, and Marcie did not sustain any damage from the relationship.

Summary

The concept of narcissistic victim syndrome implies that there is a unique set of psychological problems that invariably develop as a result of being in an intimate relationship with a narcissist. It further assumes that there is some significant benefit to the client in being diagnosed as having narcissistic victim syndrome.

The reality is that clients are unique individuals with distinct histories, temperaments, strengths, and vulnerabilities. A treatment plan will depend on the client's symptoms and issues, not their partner's diagnosis.

To find a therapist, visit the Psychology Today Therapy Directory.

Adapted from a Quora post.