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A female teenager sits at home on the couch. Her mother is yelling at her, and she has PTSD from narcissistic abuse.

Wait, Can You Get PTSD From Narcissistic Abuse?

7 min.

In the aftermath of narcissistic abuse, survivors may find themselves grappling with negative mental health symptoms like nightmares and irritability. PTSD could be to blame.

By: Ashley Laderer

Clinically Reviewed By: Don Gasparini Ph.D., M.A., CASAC

October 18, 2023


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Table of Contents

A narcissist’s gaslighting, manipulation, belittling, and more can greatly impact a victim’s mental health, well-being, and quality of life. If you’re a survivor of narcissistic abuse, you might experience symptoms such as flashbacks, hypervigilance, irritability, and nightmares, even years later. You might even feel like you’re living in a constant state of anxiety or fear. These symptoms are related to a chronic mental health condition called post-traumatic stress disorder (PTSD). PTSD is sadly a common outcome of narcissistic abuse, affecting victims’ lives long after the abuse has ended.

Many people today use the word “narcissist” conversationally –– but it’s important to note that the term “narcissistic abuse” specifically refers to the tell-tale cycle of abuse inflicted by an individual with narcissistic personality disorder (NPD) –– or, if they aren’t diagnosed, someone who exhibits narcissistic traits. Here’s what you need to know about PTSD stemming from narcissistic abuse, symptoms of PTSD, treatment, and more.

PTSD from narcissistic abuse: What causes it? 

When most people think about PTSD, they likely think of PTSD due to acute trauma – trauma that occurs from a one-off traumatic event. Examples of this include sexual violence, witnessing mass violence, or surviving an accident or natural disaster. However, PTSD can also occur over time due to ongoing, repeated instances of trauma.

Narcissistic abuse is a type of emotional abuse –– and ongoing emotional abuse can absolutely cause PTSD. “A narcissist can only care about themselves, cannot imagine or care how they make you feel, and are willing to hurt others to get what they want,” says Monica Amorosi, a licensed psychotherapist and certified clinical trauma provider. This results in plenty of hurt to those who cross paths with a narcissist. 

Amorosi says there are three traits of narcissists that tend to lead to emotional abuse:

  1. High egocentrism: They are self-centered and cannot see things from other people’s perspectives. They view their own needs as the most important.
  2. Low empathy: They cannot imagine someone else’s emotions, they can’t feel someone else’s emotions, and they have little ability to actually care how another person feels. 
  3. Proclivity for harm: They tend to intentionally or unintentionally harm other people.

These narcissistic traits and tendencies cause repeated ongoing abuse and trauma for people in their lives, such as their children or their romantic partners. “A relationship with a narcissist can disrupt your worldview, diminish your self-esteem, expose you to repeated harm, neglect your needs, and place you in a state of terror or despair,” Amorosi says. “PTSD is very easily born out of experiences like this.”

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Symptoms of PTSD from narcissistic abuse 

PTSD stemming from narcissistic abuse can manifest in many ways. You might experience various emotional, cognitive, and physical symptoms. PTSD symptoms can vary depending on the individual, but some common signs of PTSD are:

  • Re-experiencing trauma through repeated upsetting memories
  • Feeling distressed (emotionally and/or physically) when you’re triggered by something that reminds you of your trauma
  • Flashbacks where you feel like you’re reliving the trauma
  • Nightmares 
  • Avoiding places, things, scenarios, thoughts, or memories that remind you of your trauma
  • Irritability and aggression
  • Being self-destructive or acting recklessly
  • Hypervigilance 
  • Heightened startle response 
  • Difficulty concentrating
  • Having trouble with sleep 
  • Struggling to remember parts of the traumatic incidents
  • Having drastic negative beliefs about yourself and/or others  
  • Blaming yourself or others for your trauma
  • Constantly feeling negative emotions and struggling to feel positive ones
  • Losing interest in activities you once enjoyed
  • Feeling like you can’t connect with others 
  • Depersonalization (feeling disconnected from your body) and/or derealization (feeling like things around you are not real)

Ongoing, repeated emotional abuse, such as the abuse that a narcissist inflicts, is often linked to complex trauma and complex post-traumatic stress disorder (C-PTSD), which is a specific type of PTSD. On top of the above PTSD symptoms, C-PTSD also involves:

  • Trouble with emotional regulation (such as anger, difficulty calming down, perpetual sadness, or feeling suicidal)
  • Difficulties with interpersonal relationships (such as isolating yourself, avoiding relationships, and distrusting others)  
  • Negative self-concept (such as feeling worthless, guilty, or like a failure) 

What is narcissistic abuse syndrome?

The classic cycle of abuse inflicted by a narcissist may result in a phenomenon known as narcissistic abuse syndrome or narcissistic victim syndrome. These are not formal diagnoses or medical terms like PTSD or C-PTSD. Rather, they are colloquially used to categorize the long-lasting impacts of narcissistic abuse on victims. The symptoms of these “syndromes” mirror the aforementioned symptoms of PTSD and C-PTSD. 

These terms help to validate the experiences survivors of narcissistic abuse have had –– acknowledging the detrimental effects of the emotional trauma they endured. Furthermore, they help survivors remember that they are not alone. 

Therapy for PTSD from narcissistic abuse 

If you’re a survivor of narcissistic abuse, seeking professional help from a therapist can truly change your life. The abuse inflicted by people with narcissistic personality disorder is traumatizing, and it takes work to overcome the pain that you’ve experienced. 

“Some people need to get treatment for panic and physical symptoms, using interventions to practice calming down the body, soothing the nervous system, and improving physical signs of distress,” Amorosi says. “Or, some people need to build insight and understanding, putting together a narrative to better understand what happened in the relationship, to understand why their abuser treated them this way, and to reduce shame and self-blame.” The possibilities are endless. 

Working with a trauma-informed clinician is the best way to address trauma from narcissistic abuse. Several kinds of therapy can help people with PTSD, including:

Cognitive behavioral therapy

Prolonged exposure therapy

Eye movement desensitization and reprocessing

Dialectical behavior therapy

Talk therapy that helps people reframe distorted thoughts and beliefs related to trauma caused by narcissistic abuse.

Exposure therapy that helps people confront and desensitize the impact of traumatic triggers related to narcissistic abuse.

Uses eye movements or bilateral stimulation to help reprocess traumatic memories of narcissistic abuse, reducing their emotional impact.

A skill-based therapy DBT that teaches emotional regulation, mindfulness, and distress tolerance skills for better emotional coping after trauma from narcissistic abuse.

Cognitive behavioral therapy (CBT)

CBT helps you learn how your thoughts, feelings, and behaviors are connected to each other. You will identify and reframe distorted thoughts and negative beliefs linked to trauma while also addressing unhealthy behaviors. A CBT therapist will help you cope with difficult emotions and anxiety surrounding the narcissistic abuse you endured, leaving you feeling more empowered to process difficult memories, manage triggers, and grow from your trauma.

There’s also a special type of CBT called trauma-focused CBT (TF-CBT), which was specially designed for children and teen trauma survivors. It mixes CBT techniques with trauma-specific interventions to help educate you, stabilize you, process your trauma, create a new narrative, and more. The unique part of TF-CBT is that it also involves sessions with parents or caregivers –– as long as the caregiver is not the narcissist/perpetrator of abuse. 

Prolonged exposure therapy (PE)

Trauma can lead you to avoid memories and situations that remind you of your abuse. However, avoidance fuels anxiety and can reinforce in your brain that the situations you avoid are dangerous. Exposure therapy, particularly prolonged exposure therapy, can help combat this so you can regain control of your life. A trauma-informed therapist will help you safely revisit your triggers by speaking out loud about traumatic memories or safely exposing yourself to feared scenarios in real life. In the long run, PE will help desensitize you to your triggers, such as memories or certain scenarios, so they don’t cause such a strong emotional and physiological reaction in the future. 

Eye movement desensitization and reprocessing (EMDR)

EMDR is a unique type of therapy that utilizes your eye movements or another type of bilateral (side-to-side) stimulation to help you process your trauma. A trained EMDR therapist will help you revisit triggering memories surrounding your abuse in a way that will allow you to reprocess these memories and store them differently in your brain. This process will help you become more desensitized to these memories, meaning they will evoke a less visceral reaction when you think about them.  

A teenager sits in a therapy room. She is doing DBT therapy for PTSD from narcissistic abuse.

Dialectical behavior therapy (DBT)

DBT is a type of therapy performed in both individual and group settings. This therapy aims to help people cope with difficult emotions by learning to identify and regulate them. DBT skills like mindfulness and distress tolerance will help you manage negative emotions resulting from your trauma. Another key aspect of DBT is interpersonal effectiveness, which relates to having healthier personal relationships.

How Charlie Health can help with PTSD from narcissistic abuse

If you think you may have PTSD from narcissistic abuse, Charlie Health may be able to help you heal from your trauma.

Our virtual intensive outpatient program provides personalized mental health services for teens, young adults, and families dealing with a variety of struggles, including trauma and PTSD. All of Charlie Health’s clinicians are trauma-informed, non-judgemental, and well-equipped to help you process the trauma surrounding your abuse.With trauma-informed care and a supportive community, you can start feeling better. Begin your healing journey with Charlie Health today by filling out this short form.

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