Narcissistic Abuse is an Abusive Phrase...for Us All.
Enough of "[stigmatized disorder] Abuse" tropes.
“Every time my Husband has one of his migraines, I never got to stop hearing about it. His migraine abuse has to stop. He turns off the lights. He demands all of the loud sound stops. He is a controlling nightmare, and I am done with his migraine abuse.”
—My Wife, Never.
It’s not often I get to lean into my “published academic on the treatment of narcissistic personality disorder” credentials, but today, I am…
I am both the absurdist journalist-doctor who writes a newsletter about health things and a frequent Neuromodulation research co-author. Still, Owen Muir, M.D. also happens to be an Anna Freud Centre Official Supervisor in Mentalization Based Treatment for Personality Disorders. I have a few “first author” papers to my name, but an academic work on how therapists think about working with NPD patients is one such work. Without further ado, here is an opinion piece.
Narcissistic abuse has had a day in the spotlight recently. People seem to love to level blame at those narcissists.
Few disorders are as misunderstood—and defined by others’ relationship to it —as Narcissistic Personality Disorder.
Nobody should be abused. Adding disorder modified to the term abuse provides no extra understanding. The term "bipolar abuse” would be considered an intolerable slur. Similarly, depressive abuse, diabetic abuse, migraine abuse, post-traumatic stress disorder abuse? Verboten!
As someone with bipolar disorder, I can tell you, from personal experience, I have sometimes been nasty to people in my life. I am not proud of this fact. Being abusive, shouting, yelling, being irritable, even insulting? These behaviors are deeply shameful in retrospect and sometimes even understandable in real-time.
We recognize abusive behavior is not acceptable. Nobody wants to have irritability directed at them. Similarly, no reasonable person wants to have their irritability lead to the abuse of others. Adding “disordered,” by definition, is stigmatizing for the disordered. It is crafted, linguistically, to create bias towards the person doing the abuse and the illness that it is alleged that they have— always by other people.
Individuals with narcissistic personality disorder suffer. Sometimes, other people suffer as a result of their impairments in meaningful connections. They can have difficulty caring enough about the thoughts and feelings of others. Usually, however, profoundly antisocial behavior— gross violations of the rights of others—actually fall under a different diagnostic rubric in the DSM: antisocial personality disorder.
It is a psychiatric diagnosis, and although it is routinely used to stigmatize the individuals assessed as such, it causes dysfunction and impairment for those individuals as well.
I believe these formulations are deeply misguided. It is not that narcissistically oriented individuals—especially those with NPD—cannot perpetrate abuse.
If we think narcissism is related to abuse, treating narcissism, and creating help that is understood as helpful to those suffering from NPD? It may lead to less abuse of others! Insults to potential abusers— adding a pejorative or even an accurate label—can't help.
For years, my wife,
and I ran a group, Therapy group that was originally conceptualized as a group that would allow for the ability to work successfully with individuals who self-identified as being misunderstood geniuses.The conceptual underpinning for this therapy was based on research and treatment models developed at the Anna Freud Center. They were working to allow for the treatment of antisocial personality disorder. We adapted this approach to individuals with difficulties that spanned multiple domains, but some met the criteria for NPD.
NPD is a common—estimates range above 1%. It is also highly Heritable, with 71% of the variance attributed to heredity.1
Individuals with NPD suffer. This is not unique to NPD. Partners, friends, family, and coworkers can also suffer in relationships with those who have a narcissistic personality disorder. This is also far from unique among close relationships of the troubled. Ask anybody struggling with a family member dealing with addiction, depression, bipolar disorder, or borderline personality disorder! Loved ones can also make you suffer. Tremendous distress, from any cause, can act in a way that is interpretable as abusive. And there is very real abuse done by all sorts of people.
As my lab’s research demonstrated, clinical attitudes toward NPD matter in determining what kind of work is likely to be done for those seeking help:
These results show that clinicians who view NPD as a diagnosis worth treating report more benefit from their care. These results also showed that participants who report formal didactic training in NPD have better results with their patients. The data also show that clinicians feel group therapy can be helpful in treating NPD, despite reporting that it is often not offered to NPD patients. This is an area that can direct future NPD research to develop a comprehensive approach to NPD management.
Nobody would stubbornly blame arthritis for the abuse those afflicted; inflexible hands meted out. We would want treatment to reduce the pain that leads to the problems. The same, perhaps, could be understood for inflexible minds.
That means it's genetically based. It's more genetically based than borderline personality disorder, which has a heritability of around 55%, and major depressive disorder, around 40%.
Thanks for this
Abuse is abuse, but new terms are sexy, sell books, and provide new opportunities for influencers and authors to specialize and become "experts."