Narcissistic abuse is a hypernym for the psychological, financial, sexual, and physical abuse of others by someone with narcissistic traits or suffering from narcissistic personality disorder (NPD). 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 medical journals.  [relevant? ]
Types of abuse
The concept of narcissistic abuse, based on 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.
Stigma of NPD (narcissistic personality disorder)
People suffering from personality disorders, including, but not limited to, narcissistic personality disorder, face stigma in everyday life, including from themselves, society, and even clinical situations.
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 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. Evidence suggests that personality disorders are more stigmatized than other psychiatric diagnoses, with negative reactions being the common public reaction to personality disorders. 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.
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. This is significant given that clinical stigma impacts the treatment outcome of patients. It is a common response for therapists to use countertransference such as retaliation or devaluation against common narcissistic symptoms and behaviours. 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.
|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.
Self stigma is the process in which a person internalizes the stigma and stereotypes around them by applying them to the self. This can lead to problems with self-esteem, depression and identity. Research has shown that the public is less likely to think individuals with personality disorders need professional help and instead hold the belief that those with personality disorders should be able to exhibit control over behaviours caused by said disorders, combined with the clinical belief that people with Narcissistic Personality Disorder are untreatable. Low public mental health literacy has been linked to low treatment-seeking from those suffering from disorders the sufferers themselves stigmatize. Narcissistic personality disorder has notably low treatment-seeking behaviour, most often seeking treatment for less stigmatized comorbid issues.
- 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] in order to respond to the emotional needs of his mother and sister.
- Post-Jungians have explored the after-effects of an intense narcissistic wound resulting from an oppressively unempathetic parent. 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.
- Object relations theory for its part stresses both that the most 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. 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.
- 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.
- 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.
The roots of current concern with narcissistic abuse can be traced back[how?] to the later work of Sándor Ferenczi, which helped to shape modern psychoanalytic theories of "schizoid," "narcissistic," and "borderline" personality disorders.
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. 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":
"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." 
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."  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'.
Ferenczi also looked at such distortions in the therapist/patient relationship, accusing himself of sadistic (and, implicitly, narcissistic) abuse of his patients.
Kohut, Horney, and Miller
A half-century later, in the wake of Kohut's innovative pronouncement that the age of "normal narcissism" and normal narcissistic entitlement had arrived – the age, that is, of the normative parental provision of narcissistic supply – the concept of its inverse appeared: narcissistic abuse. According to Kohut, maternal misrecognition amounts to a failure to perform the narcissistic self object functions of "mirroring", the cause of a narcissistic disturbance. 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.
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 and others.
Alice Miller lays special emphasis on the process of reproduction of narcissistic abuse, the idea that love relations and relations to children are repetitions 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 wounds of their own early years 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.
Current point of view of modern psychiatrists[where?] 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. 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).
In 2011 Maatta, Uusiautti & Matta published a study with an indication that modern society may shape the patterns of narcissistic abuse. 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.[relevant? ]
Miller's work, in its emphasis on the real-life interaction of parent and child, challenged the orthodox Freudian account of 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".[relevant? ]
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.[relevant? ]
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