Why Narcissistic Abuse Syndrome is Misdiagnosed

When we first present to a mental health professional or support/legal organisation after sudden abandonment by a narcopath, it is very easy for others to get it all around the wrong way and misdiagnose the person sitting in front of them.

The chaos and despair that victims of narcissists and sociopaths feel after sudden abandonment can resemble conditions other than trauma –including Depression, Generalised Anxiety Disorder or Borderline Personality Disorder – and especially if the therapist is quick to judge the presenting issue as “just a break up”.

These feelings might include:

• Shock

• An aversion to seeking help and preference for ‘having it all together’ in public

• Abandonment trauma manifesting as fear, or in some cases terror* as their survival is threatened

• An aversion to being seen as a ‘victim’

• Not yet recognising that what they have experienced is abuse

• Confusion and inability to articulate the nature of manipulative emotional, psychological, social, professional abuse

• Hopelessness, helplessness and other freeze responses over which they have no control

• Anger or rage* at the realisation that they have been lied to and coerced (persuaded) into a dependent, powerless position then abandoned to an uncertain fate by someone they loved and trusted

• Betrayal trauma - realising they were never loved and have been tricked into parting with their home, money, careers, family, jobs, businesses, friends

• Extreme break-up behaviours that could be labelled as stalking (sending angry emails, texts, voicemails, letters, outbursts seeking explanation, redress or reconciliation)

• Revenge impulses

• Shame

• Extreme emotional reactivity and sensitivity

• Post-traumatic stress creating cognitive impairment – loss of concentration, comprehension and communication

• Overwhelming grief as a result of his smear campaign and manipulation. IE the loss of social, family and professional support and reputation, in addition to loss of shelter, sustenance, stability and security.

• Moral injury as a result of having years of forgiveness, gifts of love (including compromise, personal care, homemaking, breadwinning, resolving conflicts in his favour, turning the other cheek), trust, love discarded, ignored and misrepresented to others

• Blaming themselves

• Existential crisis – loss of identity where they have placed their marriage and partner at the centre of their lives leading up to the abandonment

• Pre-occupation with the Self (gaslighting narcopaths create a distorted sense of self within their victims, which gets re-aligned in recovery. For Borderlines, this fluid sense of self is persistent)

• Suicidality

• CPTSD – trauma-on-trauma where previous trauma resembles the current situation (many victims have a repetition compulsion to ‘fix’ a chaotic or insecure attachment from childhood, and life stories that include repeated incidences of abusive partners)

Such things as terror, rage, poor sense of self-identity, fractious relationships, a history of trauma, familial estrangements and overwhelming pain are all signs of Borderline. Clinicians can get preoccupied with diagnosing in order to define a treatment program, and can grasp onto just a few of the common symptoms of Narcissistic Abuse Syndrome in order to make a quick diagnosis in a short time frame.

Complex Trauma (CPTSD) is also seen as the same thing as Borderline. It absolutely is not, in my book! Most people who experience trauma in childhood, be it sexual, emotional, physical or psychological (mind games) go on to recover and lead perfectly happy and successful lives. It is quite possible to have had more than one experience of abuse, and still have had workable recovery, successful relationships, careers, prosperity and mental health prior to this incidence of abuse. A second or third instance of Narcissistic Abuse can be the final straw that overwhelms the nervous system.

Many mental health conditions have overlapping symptoms, and people can experience co-morbidities, such as depression and substance abuse. PTSD flashbacks or nightmares can include experiencing traumatic memories from the distant past co-mingled with the recent past. When this is articulated in therapy, the therapist can fail to see a thread and assume that this disjointed thinking is a part of a person’s usual psychological make-up when in fact, it is complex trauma.

Add to this the carefully constructed false persona and public reputation of a high-functioning narcopath, and we have the perfect storm for not being believed or misdiagnosed.

CPTSD, PTSD and Narcissistic Abuse Syndrome are treatable! They are conditions that tend to linger (sometimes for years), but they don’t amount to a life-sentence or terminal condition from which we can never recover. New therapies are emerging with good scientific back-up to show that they work. ACT is one of those. It takes courage and determination to rewire the brain using mindfulness-based therapies. But really, what have we got to lose?

* Terror and rage are indications that the limbic system is on high alert, activating our fight/flight/freeze mechanisms in the body and brain. We do not have any conscious control over this.

© Nicki Paull

 DISCLAIMER: Narcissists are not all male. Using male pronouns to reference the narcissist and female pronouns to reference the victim-survivor is not an indication of the clinical data on gender in narcissism, but rather an editorial choice.