When a Therapist Fails to Diagnose Narcissistic Personality Disorder in the Extended Family

It is not uncommon for many of my clients to have previously entered therapy for a range of conditions including depression and anxiety-related disorders and to be treated as what is known as the “Identified Patient” by their therapist and labeled with these disorders.

While they may be suffering from anxiety, depression and a range of other related emotional afflictions, these disorders are secondary to the principal problem in the person’s life. And that is the presence of a narcissistic parent.

Having a parent, particularly a mother, who suffers from narcissistic personality disorder (NPD) is a particularly heavy burden for a child to carry and that burden is more often than not carried well into adulthood as the parent’s condition remains undetected and unsuspected.

I have had clients tell me that they have been diagnosed with a “mother fixation” or have “failed to mature and successfully make the parent-child break” and lead a life of their own. Here, the therapist in question has completely missed the core problem of the adult child of a narcissist. It is the narcissist who has the mental illness, and the adult child, now in therapy, is displaying typical but completely normal symptoms in response to what is an abnormal situation.

To go on to label such an individual with a mental illness as per the above is both unethical and cruel. It also re-victimizes the adult child. While there are some cases where the abuse from the NPD parent has been so severe that there can be genuine mental illness in the offspring, these cases are relatively rare.

What is more common is that the adult child of the NPD parent is at a genuine loss as to what is going on, or they feel so out of control with anger and frustration that they cannot even converse with their parent anymore. Or they crave the love they never got from the parent to the extent that they make themselves sick and ruin other important relationships in their lives.

Most commonly, the adult child of a narcissist feels a deep sense of worthlessness, of invisibility, of not being “good enough”. The end point is anxiety, rage, depression -- all perfectly normal end points for a person living for decades in such a situation.

Why many therapists have a problem in correctly diagnosing NPD in a client’s parent is unknown. But there is a common theme that children blame their parents for everything and therapists, in the main, try to steer their clients towards self- responsibility and self-motivation. Perhaps that is why NPD is missed so often.

However, when one has an NPD mother, it is almost inescapable that the child and later the adult child in particular will become consumed by the actions of that parent. They are desperately trying to make sense of the often bizarre and cruel treatment of narcissistic parents, while at the same time forever hoping that one day their parent will suddenly snap out of this state and see their child for the wonderful caring person they truly are. It is this latter behavior that keeps the adult child stuck and in pain and which the therapist needs to work on, rather than continuing to label the client as “sick”.

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