Why, As a Therapist, I Don’t Use the Term “Narcissistic Abuse”

I see the phrase “narcissistic abuse” more than I see almost any other piece of pop psychology floating around right now – more than attachment styles, more than “trauma bonding,” more than whatever’s trending as this month’s armchair diagnosis (send help, we’ve had a good run of these). I see it everywhere, and it’s not something I ever use in my work.

The term is borrowed from pop psychology, not backed by the actual numbers on who abuses. More importantly, leaning on it has real costs for two different groups of people: survivors of intimate partner violence, and people living with Narcissistic Personality Disorder (NPD). Survivors get handed a label that feels like an answer but isn’t built to hold the weight of one. People with NPD get stereotyped as abusers based on a diagnosis, not their actual behavior. Neither group is served by it, however satisfying the word feels in the moment.

The Temptation to Embrace the Term

I get the instinct completely. People reach for “narcissistic abuse” because it finally names something that too often got dismissed, suppressed, or written off as overreacting, in part because it rarely looks as intense from the outside as it is experienced inside: gaslighting, love bombing, devaluation, the whiplash of idealize-then-discard, all of it. Wanting a name for what happened to you is valid, and it’s often the first real foothold a survivor gets out of the fog.

But naming the tactics doesn’t require reaching for a label like “narcissistic abuse”. Gaslighting is gaslighting. Coercive control is coercive control. Neither one needs a personality disorder bolted onto it to be taken seriously. In fact, tacking one on usually muddies the point rather than sharpening it.

What It Costs Survivors of Intimate Partner Violence

Survivors commonly try to intellectualize what happened to them, piecing together timelines, rereading old messages, turning the same three moments over and over looking for the one where it should have been obvious. It’s one of the most predictable responses to the confusion trauma leaves behind. Trauma scrambles your sense of what was real, what you imagined, what was your fault and what never had anything to do with you, and your brain responds to that scramble by reaching for an explanation with actual edges, something solid enough to hold onto while everything else still feels slippery. It’s never your fault but your brain wants to find a reason anyway.

A label like “narcissistic abuse” can feed that instinct instead of helping you do the harder, more useful thing, which is tolerating not having a clean answer and realizing you don’t actually need one to move forward. The instinct is natural, but in practice, fixating on an abuser’s individual psychology tends to keep people looped in place. Learning more about the actual tactics and building real safety planning tends to move them somewhere new.

What the Term “Narcissistic Abuse” Costs People with NPD

Calling abuse “narcissistic” implies a disorder caused it, which quietly suggests the behavior couldn’t be helped. It could. Abusers make choices, full stop, and most people with NPD are not abusive.

Most people with NPD developed it in response to their own trauma and early attachment wounds, often in childhood, long before they had any say in the matter. As a neurodivergent-affirming practice, that matters to us beyond any one case. Kassiane Asasumasu, who coined the term “neurodivergent” around 2000, was explicit that it includes people with mental illness and personality disorders too, not just the two diagnoses most people picture. Which means the standard I hold for how I talk about Autistic or ADHD clients has to apply here as well, or it isn’t really a standard, it’s just a preference with better branding.

Neurodivergent people already spend a lot of energy getting casually diagnosed by strangers on the internet who’ve never met them. Handing “narcissist” out as a stranger-diagnosis, even aimed at someone who’s earned every bit of anger coming their way, recycles that exact habit onto a different target. We don’t get to be against armchair diagnosis for our own clients while quietly making an exception the moment it’s aimed at someone we’re furious with.

Stigma doesn’t stay contained to the one person it’s aimed at, either. Every time a personality disorder gets used as shorthand for “bad person,” it makes it a little harder for someone quietly living with that diagnosis to say so out loud. If I actually care about people healing from abuse, and I do, that same care has to extend to people with a personality disorder that, more often than not, has abuse somewhere in their own history too.

What Clinical Validity Really Means

Physical abuse, emotional abuse, psychological abuse, coercive control: all four have decades of research behind them. That means tested definitions, replicated studies, and measurement tools built to ask the same questions the same way no matter who’s holding the clipboard.

Take the CTS2 (Conflict Tactics Scale, Revised), for example, the most cited intimate partner violence measure out there since Straus, Hamby, Boney-McCoy, and Sugarman built it in 1996. Or the PMWI (Psychological Maltreatment of Women Inventory), which Tolman developed in 1989 specifically to capture patterns like isolation and control, the kind of abuse that doesn’t leave a mark you can point to. Or the MMEA (Multidimensional Measure of Emotional Abuse), Murphy and Hoover’s 1999 tool for breaking emotional abuse down into categories precise enough that two different clinicians, in two different offices, would score the same behavior the same way.

(I promise that’s the only acronym-heavy stretch in this piece, I just really believe in showing my work). Each one of those terms went through the unglamorous process that actually makes a measure trustworthy: tested item by item, revised based on what didn’t hold up, checked against whether it predicts what it claims to predict. That’s what “validated” means, not that a researcher wrote something down once and it stuck.

“Narcissistic abuse” skipped all of that. Ask five different corners of the internet what it means and you’ll get five different answers, no validated scale, no consistent definition, not even among the people using the term the most. A 2023 study interviewing licensed counselors who work with DV and IPV clients found the same gap in the research itself, no consistent diagnostic criteria for “narcissistic abuse” exists in the literature at all, alongside their own observation that narcissistic traits show up in far more clients than actual NPD diagnoses ever do. It’s a phrase borrowed from pop psychology and dressed up to sound clinical, and treating it like a diagnosis does everybody involved a disservice.

The Math

Set the definition problem aside for a second. Even if “narcissistic abuse” just meant abuse by someone with NPD, the numbers still wouldn’t back it up.

NPD affects somewhere between 0.5% and 6.2% of the general population, per the largest U.S. epidemiological study on it to date, published in the Journal of Clinical Psychology. Of course, estimates vary by study, and probably undercount the real number anyway, since people with NPD are less likely to seek assessment or accurately report their own symptoms in the first place, but as you can see, that’s likely far less than 10% of the population.

Compare that to CDC survey data: almost half of women and men, 48.4% and 48.8%, experience psychological aggression by an intimate partner in their lifetime, a category that includes coercive control tactics like isolation, monitoring, and threats, whether or not physical violence shows up alongside it. More than 1 in 3 women and more than 1 in 6 men experience contact sexual violence, physical violence, and/or stalking by a partner in their lifetime.

The numbers are clear: Abuse is common. NPD is comparatively rare. If narcissistic abuse were really driving most of it, where is everybody? The math simply doesn’t support “most abusers are narcissists.” Most abusers don’t have a diagnosable personality disorder at all. Having a few narcissistic traits under stress isn’t the same as meeting full diagnostic criteria for NPD, either. Most people who act self-centered in a breakup are just hurting people by behaving badly, a far more common and far less dramatic thing than a personality disorder.

Or, as The National Violence Domestic Hotline explains it:

“On one spectrum, narcissism is a subconscious personality disorder, while on the other spectrum, abuse is a conscious behavioral choice one makes to deal with a challenge. Although people who have narcissistic personality disorder (NPD) can show abusive behaviors, abuse and narcissism do not create each other. For example, people without NPD can be abusive to their partner, and people who do have NPD can still be incredibly supportive partners who strive to maintain equality in their relationships.”

What to Say Instead of “Narcissistic Abuse”

“Narcissistic abuse” feels like an easy shorthand for understanding what someone is going through. However, behavior-based language actually holds up where diagnosis-based language doesn’t, and it’s more useful too, since you can actually do something with it:

Instead of “he’s a narcissist” → “he used isolation and gaslighting to control me”
Instead of “she’s a narcissist” → “she threatened me and controlled our money to keep me from leaving”
Instead of “they’re such a narcissist” → “they monitored my phone and cut me off from my friends”
Instead of “my ex is a total narcissist” → “my ex love-bombed me early on, then used that history to keep me hoping things would go back to how they were”
Instead of “classic narcissist behavior” → name the actual pattern: idealize, devalue, discard

The idealize-devalue-discard cycle explains something the term “narcissistic abuse” never could, which is why the good times happened at all. The affection, the apologies, none of that is a glitch in the pattern, it’s built into the pattern, it’s the part that makes the discard phase land so hard the next time around. Understanding that the good phase is doing exactly what the cycle needs it to do is often what finally makes leaving possible, and a label alone doesn’t do that work for you.

This is the same psychoeducation I use whether I’m talking to a client in session or posting about it online, grounded in the actual research rather than whatever’s trending.

Holding Both

Abuse is real, and precise language about abusive behaviors matters more than assigning a diagnosis to the abuser. Two things can be true: Survivors are not better served by a term that isn’t built to hold up, and people with NPD don’t deserve to have the disorder they never chose become synonymous with abuse.

If you’re living this right now: you don’t need to figure out a diagnosis for your partner before you act on what they did. Name the behaviors and use that information to build a real plan around your own safety.

If you’re navigating the aftermath of a difficult relationship and want support that focuses on real patterns instead of pop-psychology labels, we’d love to talk with you. Contact us about our services at 225-800-2989 or email admin@bloomcollectivehealing.com.

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