Examine individual changes

'{{short description|Abuse by a narcissist, particularly emotional abuse in parent-child and adult-to-adult relationships}} '''Narcissistic abuse''' is a hypernym for the psychological, financial, sexual, and physical abuse of others by someone with [[Narcissism|narcissistic]] traits or suffering from [[Narcissistic Personality Disorder|narcissistic personality disorder (NPD)]]{{Citation needed|date=September 2020}}. Narcissistic Personality Disorder has been referred to as a mental health condition by several medical research and journal organisations, such as, for example, the [[United States National Library of Medicine]], [[Mayo Clinic]], and [[Cochrane (organisation)|Cochrane]] medical journals.<ref>{{Cite journal|title=Narcissistic Personality Disorder in Clinical Health Psychology Practice: Case Studies of Comorbid Psychological Distress and Life-Limiting Illness|year=2017|publisher=United States National Library of Medicine|pmc=5819598|first1=E. L.|last2=Ennis|first2=N.|last3=Pereira|first3=D. B.|journal=Behavioral Medicine (Washington, D.c.)|volume=43|issue=3|pages=156–164|doi=10.1080/08964289.2017.1301875|pmid=28767013}}</ref> <ref>{{Cite web|last=|first=|date=|title=Narcissistic Personality Disorder|url=https://www.mayoclinic.org/diseases-conditions/narcissistic-personality-disorder/symptoms-causes/syc-20366662|url-status=live|access-date=1 September 2020|website=|publisher=Mayo Clinic}}</ref> <ref>{{Cite web|last=|first=|date=|title=Condition - Narcissistic Personality Disorder|url=https://data.cochrane.org/concepts/r4hp3qkyhfbk|url-status=live|access-date=1 September 2020|website=|publisher=Cochrane}}</ref>{{Relevance inline|date=September 2020}} == Types of abuse == The concept of narcissistic abuse, based on [[Alice Miller (psychologist)|Alice Miller]]’s observations in ''The Drama of the Gifted Child'' based on a mother-son relationship, has grown to be used in reference to all kinds of relationships. There is little evidence to show psychological, financial, sexual or physical abuse manifests itself differently or more often in people with narcissistic traits or narcissistic personality disorder.<ref>{{cite book |last1=McMurran |first1=Mary |last2=Howard |first2=Richard |title=Personality, personality disorder and violence: An evidence based approach |date=2009}}</ref> === Psychological abuse === {{main|Psychological abuse}} === Financial abuse === {{main|Economic abuse}} === Sexual abuse === {{main|Sexual abuse}} === Physical abuse === {{main|Physical abuse}} Narcissists do not avoid treatment because of stigma but rather because they cannot accept the notion that anyone can help them more than they can help themselves. === Social stigma === [[Social stigma]] is the disapproval of, or discrimination against, a person based on perceivable social characteristics that serve to distinguish them from other members of society. Despite efforts to combat the [[Mentalism|stigma against mental illness]], analysis indicates that attitudes towards mental illness have not improved, recent research highlighting the continued prejudice and discrimination experienced by those with mental illness.<ref>{{cite journal |last1=Schomerus |first1=G |title=Evolution of public attitudes about mental illness: A systematic review and meta-analysis |journal=Acta Psychiatrica Scandinavica |date=2012 |volume=125 |issue=6 |pages=440–52 |doi=10.1111/j.1600-0447.2012.01826.x |pmid=22242976 |s2cid=24546527 }}</ref> Evidence suggests that personality disorders are more stigmatized than other psychiatric diagnoses<ref>{{cite journal |last1=Catthoor |first1=K |title=Adolescents with personality disorders suffer from severe psychiatric stigma: Evidence from a sample of 131 patients |journal=Adolesc Health Med Ther |date=2015|volume=6 |pages=81–89 |doi=10.2147/AHMT.S76916 |pmid=25999774 |pmc=4427063 }}</ref>, with negative reactions being the common public reaction to personality disorders<ref>{{cite journal |last1=Adebowale |first1=LV |title=Personality disorder: Taking a person-centered approach |date=2010}}</ref>. There is little research done in regards to the stigma of narcissistic personality disorder, with most research in regards to personality disorders and stigma being focused on borderline personality disorder.<ref name=penney>{{cite journal |last1=Penney |first1=Eirika |last2=McGill |first2=Brittany |last3=Witham |first3=Chelsea |title=Therapist Stigma towards Narcissistic Personality Disorder: Lessons Learnt from Borderline Personality Disorder |journal=Australian Clinical Psychologist |date=2017 |volume=3 |issue=1 |page=63–67 |url=https://acp.scholasticahq.com/article/1745-opinion-piece-therapist-stigma-towards-narcissistic-personality-disorder-lessons-learnt-from-borderline-personality-disorder}}</ref> === Clinical stigma === Clinical or provider stigma is the disapproval of, or discrimination against a person based on perceivable patient characteristics that serve to distinguish them from other patients. In an opinion piece by psychologist Erika Penney, Brittany McGill and Chelsea Witham titled "Therapist Stigma towards Narcissistic Personality Disorder: Lessons Learnt from Borderline Personality Disorder", they propose the link to the stigma of BPD and NPD. Extensive research on the stigma against borderline personality disorder has been done but the same has not been done for narcissistic personality disorder.<ref name=penney /> This is significant given that clinical stigma impacts the treatment outcome of patients.<ref>{{cite journal |last1=Ferguson |first1=A |title=Borderline personality disorder and access to services: A crucial social justice issue |date=2016}}</ref> It is a common response for therapists to use [[countertransference]] such as retaliation or devaluation against common narcissistic symptoms and behaviours.<ref>{{cite journal |last1=Behery |first1=W |last2=Dieckmann |first2=E |title=Understanding and treating pathological narcissism |journal=Schema Therapy for Pathological Narcissism: The Art of Adaptive Re-parenting |date=2013 |page=285}}</ref> Such responses are likely to reenact familiar behavioural patterns and reinforce unhealthy coping mechanisms in patients. Common countertransference to narcissistic behaviour shown in table below. {| class="wikitable" |- ! Patient Experience !! Observable Behaviour !! Common Therapist Countertransference |- | Overcompensation to avoid a sense of vulnerability. || Idealisation of the self or expression of superiority. || Admiring, disengaged, bored, resentful,inadequate, or frustrated. |- | Avoidance of uncomfortable emotions. || Avoidance of emotions with self-stimulating or self-soothing activities (e.g., gambling, alcohol, risk-taking, grandiose fantasising, binge eating, or excessive dedication to work). || Anxious, critical, disengaged, frustrated, helpless, overwhelmed, or feeling stuck. |- | Activation of rage when vulnerability threatens to surface || Rage and uncontrolled aggression. || Anxious, afraid, overwhelmed, ‘walking on egg-shells,’ confused, mistreated, angry, resentful, urge to retaliate, or urge to withdraw. |} The de-stigmatization of mental health disorders is important discourse for clinical psychologists and the widespread use of highly stigmatizing language may promote avoidance of further research and discrimination against people with NPD.<ref name=penney /> === Self stigma === Self stigma is the process in which a person internalizes the stigma and stereotypes around them by applying them to the self<ref>{{cite book |last1=Bathje |first1=Geoff |title=Encyclopedia of Critical Psychology |chapter=Self-Stigmatization |year=2014 |pages=1713–1716 |doi=10.1007/978-1-4614-5583-7_395 |isbn=978-1-4614-5582-0 }}</ref>. This can lead to problems with self-esteem, depression and identity<ref>{{cite journal |last1=Sheehan |first1=Lindsay |last2=Nieweglowski |first2=Katherine |last3=Corrigan |first3=Patrick |title=The Stigma of Personality Disorders |journal=Current Psychiatry Reports |date=2016 |volume=18 |issue=1 |page=10|doi=10.1007/s11920-015-0654-1 |pmid=26780206 |s2cid=23014378 }}</ref>. Research has shown that the public is less likely to think individuals with personality disorders need professional help<ref>{{cite journal |last1=Furnham |first1=A |title=Mental health literacy and borderline personality disorder (BPD): What do the public "make" of those with BPD? |date=2015}}</ref> and instead hold the belief that those with personality disorders should be able to exhibit control over behaviours caused by said disorders<ref>{{cite journal |last1=Aviram |first1=RB |title=Borderline personality disorder, stigma and treatment implications. |journal=Harvard Review of Psychiatry |date=2006|volume=14 |issue=5 |pages=249–56 |doi=10.1080/10673220600975121 |pmid=16990170 |s2cid=23923078 }}</ref>, combined with the clinical belief that people with Narcissistic Personality Disorder are untreatable.<ref>{{cite journal |last1=Lewis |first1=B |last2=Appleby |first2=L |title=Personality disorder: The patients psychiatrists dislike |journal=The British Journal of Psychiatry : The Journal of Mental Science |date=1988 |volume=153 |pages=44–9 |doi=10.1192/bjp.153.1.44 |pmid=3224249 }}</ref> Low public mental health literacy has been linked to low treatment-seeking from those suffering from disorders the sufferers themselves stigmatize<ref>{{cite journal |last1=Corrigan |first1=PW |title=The impact of mental illness stigma on seeking and participating in mental health care |journal=Psychological Science in the Public Interest : A Journal of the American Psychological Society |date=2014 |volume=15 |issue=2 |pages=37–70 |doi=10.1177/1529100614531398 |pmid=26171956 |s2cid=2942361 }}</ref>. Narcissistic personality disorder has notably low treatment-seeking behaviour, most often seeking treatment for less stigmatized [[comorbid]] issues.<ref>{{cite journal |last1=Dhawan |first1=Nikhil |last2=Kunik |first2=Mark E |last3=Oldham |first3=John |last4=Coverdale |first4=John |title=Prevalence and Treatment of Narcissistic Personality Disorder in the Community: A Systematic Review" |journal=Comprehensive Psychiatry |date=2010 |volume=51 |issue=4 |pages=333–9 |doi=10.1016/j.comppsych.2009.09.003 |pmid=20579503 }}</ref> == Viewpoints == * 21st century [[transactional analysis]] has highlighted clients who suffered some narcissistic abuse as children (that is, an injury to their developing selves), examining for instance the boy in an all-female household who only survived by developing powerful [[emotional antennae]]{{Disambiguation needed|date=February 2020}} in order to respond to the emotional needs of his mother and sister.<ref>H. Hargaden/C. Sills, ''Transactional Analysis'' (2002) p. 131</ref> *[[Jung|Post-Jungians]] have explored the after-effects of an intense narcissistic wound resulting from an oppressively unempathetic parent.<ref>Andrew Samuels, ''Jung and the Post-Jungians'' (London 1986) p. 228</ref> In particular, [[Polly Young-Eisendrath]] emphasises how the narcissistic longings of parents to amass reflected glory through their children can bring disastrous results for parent and child if both lose their capacity for autonomous development.<ref>Polly Young-Eisendrath, ''Women and Desire'' (London 2000) p. 198</ref> *[[Object relations theory]] for its part stresses both that the most [[Psychological trauma|traumatizing]] experience of all is the absence of emotional giving from a parent, and that, in an intergenerational pattern, people who have been brought up by tyrannical authoritarian parents will often parent their children in the same way.<ref>Neville Symmington, ''Narcissism: A New Theory'' (London 1993) pp. 75, 79</ref> [[Adam Phillips (psychologist)|Adam Phillips]] adds that the parent who colonizes their child and stifles gestures of autonomy and difference breeds in them an often unconscious craving for the dead-end justice of revenge.<ref>Adam Phillips, ''On Flirtation'' (London 1994) p. 106</ref> * In another tradition, [[Julia Kristeva]] points out how a pairing of mothers and fathers, overprotective and uneasy, who have chosen the child as a narcissistic artificial limb and keep incorporating that child as a restoring element for the adult psyche intensifies the infant's tendency toward [[omnipotence]].<ref>Julia Kristeva, ''Black Sun'' (New York 1989) pp. 61–62</ref> *[[M. Scott Peck]] looked at milder but nonetheless destructive common forms of parental narcissism, as well as the depth of confusion produced by his mother's narcissism in a more serious instance.<ref>M. Scott Peck, ''The Road Less Travelled By'' (1990) pp. 175–77</ref> ==Theorists== ===Antecedents: Ferenczi=== {{Main|Sándor Ferenczi}} The roots of current concern with narcissistic abuse can be traced back{{How|date=February 2020}} to the later work of Sándor Ferenczi, which helped to shape modern psychoanalytic theories of "[[Schizoid personality disorder|schizoid]]," "[[Narcissistic personality disorder|narcissistic]]," and "[[Borderline personality disorder|borderline]]" [[personality disorders]].<ref>Janet Malcolm, ''Psychoanalysis: The Impossible Profession'' (London 1988) pp. 134–35</ref> In "Confusion of Tongues Between Adults and the Child", Ferenczi observed that patients often displayed "a striking, almost helpless compliance and willingness to accept my interpretations" even if he encouraged them not to agree with him.<ref name="confusion">{{cite journal |last1=Ferenczi |first1=Sándor |title=Confusion of the Tongues Between the Adults and the Child—(The Language of Tenderness and of Passion) |journal=The International Journal of Psychoanalysis |date=1949 |volume=30 |pages=225–230}}</ref> Ferenczi traced his patient's behavior to childhood trauma. He found that in cases of sexual abuse, children often misinterpreted the emotional responses of adults and responded to them by becoming passive toward the adult. The child developed an "anxiety-fear-ridden identification" with the adult, as well as "introjection of the guilt feelings of the adult": <blockquote>''"The same anxiety, however, if it reaches a certain maximum, compels them to subordinate themselves like automata to the will of the aggressor, to divine each one of his desires and to gratify these; completely oblivious of themselves they identify themselves with the aggressor."'' <ref name="confusion" /></blockquote> Ferenczi also argued that a child's tender love for a caretaker often involves a fantasy of "taking the role of mother to the adult". In what he identified as the "''terrorism of suffering''", the child has a "compulsion" to right the wrongs of the family by taking on responsibilities that are far beyond the child's maturity level. In this manner, "a mother complaining of her constant miseries can create a nurse for life out of her child, i.e. a real mother substitute, neglecting the true interests of the child." <ref name="confusion" /><ref>Ferenczi, "Confusion", in J. M. Masson, ''Freud: The Assault on Truth'' (London 1984) pp. 293–94</ref> Within such distorted patterns of parent/child interaction, 'Ferenczi believed the silence, lies, and hypocrisy of the caregivers were the most traumatic aspects of the abuse'—ultimately producing what he called '[[narcissistic mortification]]'.<ref>[[Martin S Bergmann|Martin S. Bergmann]], ''Understanding Dissidence and Controversy in the History of Psychoanalysis'' (2004) p. 162</ref> Ferenczi also looked at such distortions in the therapist/patient relationship, accusing himself of sadistic (and, implicitly, narcissistic) abuse of his patients.<ref>John E. Gedo, ''The Language of Psychoanalysis'' (1996) p. 97</ref> ===Kohut, Horney, and Miller=== A half-century later, in the wake of [[Heinz Kohut|Kohut]]'s innovative pronouncement that the age of "normal narcissism" and normal narcissistic [[entitlement]] had arrived<ref>James Grotstein, "Foreword", [[Neville Symington]], ''Narcissism: A New Theory'' (London 1993) p. xiii</ref> – the age, that is, of the normative parental provision of [[narcissistic supply]] – the concept of its inverse appeared: narcissistic abuse.{{Cn|date=February 2020}} According to Kohut, maternal misrecognition amounts to a failure to perform the narcissistic ''self object'' functions of [[Mirroring (psychology)|"mirroring"]], the cause of a narcissistic disturbance.<ref>Lior Barshack, ''Passions and Convictions in Matters Political'' (2000) p. 37</ref> Paternal misrecognition could produce the same result: Kohut explored for example a son's transference reproaches directed at the non mirroring father who was preoccupied with his own self-enhancement and thus refused to respond to his son's originality.<ref>Heinz Kohut, ''How Does Analysis Cure?'' (London 1984) p. 183</ref> [[Karen Horney]] had already independently highlighted the character disorder – particularly the compulsive striving for love and power – resulting from the childhood hurts bred of parental narcissism and abuse. She thus heralded today's work in this area by [[Alice Miller (psychologist)|Alice Miller]] and others.<ref>Janet Sayers, ''Mothering Psychoanalysis'' (1991) p. 18</ref> Alice Miller lays special emphasis on the process of reproduction of narcissistic abuse, the idea that love relations and relations to children are [[Repetition compulsion|repetitions]]<ref>Barshack, p. 37</ref> of previous narcissistic distortions. Miller's early work in particular was very much in line with Kohut's tale of deficits in [[empathy]] and mirroring, with a stress on the way adults revisit and perpetuate the [[narcissistic wound]]s of their own early years<ref>Henry Sussman, ''Psyche and Text'' (1993) pp. 83–84</ref> in an intergenerational cycle of narcissistic abuse. In Miller's view, when abused for the sake of adults' needs, children could develop an amazing ability to perceive and respond intuitively, that is, unconsciously, to this need of the mother, or of both parents, for him to take on the role that had unconsciously been assigned to him.<ref>Alice Miller, ''The Drama of Being a Child'' (1995) pp. 9, 152</ref> === Modern theories === Current point of view of modern psychiatrists {{Where|date=February 2020}} believe that today's society is at fault for the increase in narcissistic abuse because society promotes competitiveness. Many features of narcissism are sources of success in the modern competitive society{{Citation needed|date=September 2020}}. The question is that to what extent the opportunistic abilities to bring out one's own proficiency and constantly strive for the better result in trample on other people and having an irresponsible and insensitive attitude to other people (see e.g. Lucher, Huston, Walker & Alex Houtson, 2011).{{Citation needed|date=September 2020}} In 2011 Maatta, Uusiautti & Matta published a study with an indication that modern society may shape the patterns of narcissistic abuse{{Cn|date=February 2020}}. The ideas of pleasing yourself first, taking care of yourself, climbing the ladder and general success in life are desired traits. And the explanation for the increase in narcissistic disorders may at least partly be found in the societal development as competitiveness, individualism, and opportunism are admired - those exact features that are often typical of narcissists.<ref>http://www.sakkyndig.com/psykologi/artvit/marju2012.pdf</ref>{{Relevance inline|date=September 2020}} ===Wider developments=== Miller's work, in its emphasis on the real-life interaction of parent and child, challenged the orthodox Freudian account of [[Oedipus|Oedipal]] fantasy, in a sustained indictment of the moral and pedagogical underpinnings of the therapy industry; and did so at a point when 'the keyword of the 1980s was invariably "abuse".<ref>Lisa Appignanesi & John Forrester, ''Freud's Women'' (2005) pp. 472–73</ref>{{Relevance inline|date=September 2020}} Thus in a "comprehensive dictionary of psychoanalysis" of 2009, the only appearance of the term is in connection with misuse of the couch for narcissistic gain: The fact that it is seen by some patients and therapists as a "[[status symbol]]" lends it to narcissistic abuse.<ref>[[Salman Akhtar]], ''Comprehensive Dictionary of Psychoanalysis'' (2009) p. 60</ref>{{Relevance inline|date=September 2020}} ==See also== {{Portal|Psychology}} {{Columns-list|colwidth=30em| * [[Abusive power and control]] * [[Atlas personality]] * [[Child abuse]] * [[Flying monkeys (psychology)]] * [[Healthy narcissism]] * [[Self psychology]] }} ==References== {{Reflist|2}} ==Further reading== * Angela Atkinson, Jillian Tindall, ''Navigating No-Contact with a Narcissist: A Recovery Roadmap for Survivors of Narcissistic Abuse'' (2017) * Patricia Evans, ''Controlling People: How to Recognize, Understand, and Deal with People Who Try to Control You'' (2003) * Alice Little, ''No Contact - The Final Boundary: Surviving Parental Narcissistic Abuse'' (2016) * Alice Miller, ''The Drama of the Gifted Child'' (1979) * Steven Stosny, ''Treating Attachment Abuse'' (1995) * Estela Welldon, ''Mother, Madonna, Whore: The Idealization and Denigration of Motherhood'' (1988) * Shahida Arabi ''POWER: Surviving and Thriving After Narcissistic Abuse: A Collection of Essays on Malignant Narcissism and Recovery from Emotional Abuse Paperback'' (2017) {{Narcissism}} {{Abuse}} {{DEFAULTSORT:Narcissistic Abuse}} [[Category:Narcissism]] [[Category:Abuse]] {{Domestic violence}}'