Narcissistic Abuse and Anxiety: Definition, Signs, Symptoms, and Recovery

Narcissistic Abuse and Anxiety

Narcissistic Abuse By Jul 17, 2023

Narcissistic abuse can lead to a variety of adverse health outcomes, including chronic anxiety. This is because perpetrators of abusive power and control use the victim’s fear as a tool in their manipulation schemes. This article explores the relationship between narcissistic abuse and anxiety with insight from April Nisan Ilkmen, LMFT, a doctoral candidate at the Department of Couple and Family Therapy at Adler University, who completed the psychodynamic psychotherapy training under the tutilage of Dr. Otto Kernberg.

In this article you will learn:

What Is Narcissistic Abuse?

The Cycle of Narcissistic Abuse: Idealization, Devaluation, Discard, Hoover

Narcissistic abuse is a form of psychological manipulation and emotional abuse perpetrated by people with dysfunctional narcissism. In this abusive dynamic, the perpetrator seeks to exert power and control over the victim by through mental conditioning process called the cycle of narcissistic abuse which gradually erodes their sense of self. The victim often is subjected to idealization, devaluation, discard, and reengagement leading to feelings of confusion, self-doubt, and emotional trauma. Narcissistic abuse can have a lasting and devastating effect on the victim’s self-esteem, mental health, and general quality of life.

What Is Anxiety?

Anxiety Word Cloud

Anxiety is a human emotion that generates feelings of worry, fear, and unease. It can arise when facing uncertain or ambiguous circumstances. Anxiety is natural response to perceived threats. It acts as an internal security system, alerting us to potential dangers. However, when anxiety becomes excessive and morphs into chronic state, it can disrupting daily functioning and have an adverse impact on one’s physical and mental health. General signs of anxiety are accelerated heart rate, sweaty palms, and trembling limbs, racing thoughts, and difficulty concentrating. Over time anxiety can lead to avoidant behavior and the erosion of personal and professional relationships.

How Does Narcissistic Abuse Induce Anxiety?

Victims of narcissistic abuse experience significant anxiety as a consequence of the various manipulative tactics used by perpetrators. They are put through the harrowing emotional roller coaster of idealization, devaluation, discard, and reengagement, which can create a constant state of uncertainty and fear in the victim’s mind. Gaslighting, a common manipulation tool used by narcissists, causes the victim to question their own reality and judgment, increasing feelings of anxiety and self-doubt. Walking on eggshells in an abusive relationship, coupled with the fear of retaliation or further abuse, can lead to heightened levels of stress and apprehension.

“Especially during early childhood, emotional abuse deteriorates the process of forming a coherent sense of self and sense of others. An insecure model of attachment with primary caregivers is internalized and becomes the origin of the expectancies for future relationships characterized by anxiety.”

April Nisan Ilkmen, LMFT

The victim may also develop a hyper-vigilant mindset, always on guard for potential triggers and anticipating the next episode of abuse. Over time, these chronic stressors can impact the victim’s mental and emotional well-being, contributing to elevated anxiety and a decreased sense of security and self-trust in oneself and others.


The symptoms of narcissistic abuse-induced anxiety are many and varied. Moreover, they can take a severe toll on the victim’s mental and physical well-being.

“The main signs and symptoms of chronic anxiety that arises as a consequence of narcissistic abuse are hypersensitivity to environmental stimuli, reactivity to perceived rejection, expectation of hostility, obsessive thoughts, shame, emotional dysregulation, difficulty concentrating, nightmares, low self-esteem, paranoia, isolation, and alienation.”

April Nisan Ilkmen, LMFT

Anxiety caused by narcissistic abuse can manifest in various ways, with some common symptoms including:

  • Low Self-Esteem. The victim develops a negative perception of themselves characterized by a lack of confidence and self-worth. 
  • Constant Worry. Victims may experience persistent feelings of fear, apprehension, or worry, often related to the abusive relationship and its uncertain dynamics.
  • Hyper-vigilance. The victim may become hyper-aware of the abuser’s actions and words, constantly on guard for potential triggers or signs of mistreatment.
  • Self-Doubt. Narcissistic abuse can erode the victim’s self-esteem, leading to self-doubt and a diminished sense of self-worth.
  • Intrusive Thoughts. Past abusive incidents may resurface as flashbacks or intrusive thoughts, causing distress and re-traumatization.
  • Physical Symptoms. Anxiety can lead to physical manifestations such as rapid heartbeat, sweating, trembling, and gastrointestinal issues.
  • Avoidance Behavior. The victim may avoid situations, people, or places associated with the abuser to minimize potential triggers.
  • Social Isolation. Anxiety and fear of judgment may lead to withdrawal from social interactions, isolating the victim from friends and family.
  • Trouble Concentrating. Anxiety can impair cognitive function, making it difficult to focus or make decisions.
  • Sleep Disturbances. Victims may experience insomnia or disturbed sleep patterns due to heightened stress and anxiety.
  • Emotional Dysregulation. Anxiety caused by narcissistic abuse can lead to emotional volatility, with frequent mood swings and heightened emotional reactivity.

Keep in mind that the symptoms of narcissistic abuse-induced anxiety can vary from person to person.

Long Term Effects

Prolonged narcissistic abuse can lead to post-traumatic stress disorder (PTSD) due to the chronic stress and trauma experienced by the victim. The constant fear, manipulation, and emotional turmoil inflicted by the abuser create an overwhelming sense of helplessness and vulnerability.

“Ongoing narcissistic abuse impacts the intensity and persistence of anxiety symptoms, but keeping the individual in a hyper-vigilant state often contributes to traumatic stress reactions.”

April Nisan Ilkmen, LMFT

Persistent exposure to distressing situations and emotional upheaval can rewire the brain’s response to stress, leading to heightened anxiety and a hyper-vigilant state. Over time, the accumulation of traumatic experiences can result in post-traumatic stress disorder (PTSD), with the victim experiencing intrusive memories, nightmares, flashbacks, and emotional numbing.

Psycho-Social Impact

Prolonged narcissistic abuse induced anxiety can significantly harm relationships as the victim’s emotional well-being is compromised. The constant fear and stress can lead to emotional withdrawal, making it difficult for the victim to fully engage in interpersonal connections, leading to isolation.

“Narcissistic abuse affects one’s ability to trust self and others by causing a rupture in the coherence of how a person experiences self and the other. The lack of trust contributes to formation of maladaptive defense mechanisms to cope with the stress. However, these mechanisms often get expanded onto various areas of the individual’s life, causing shifts in how they view others based on moment-to-moment perceptions.”

April Nisan Ilkmen, LMFT

Hyper-vigilance and diminished self-trust may hinder effective expression of emotions and needs. Additionally, the lingering effects of trauma can lead to difficulties in trusting others and setting healthy boundaries, impacting the ability to form secure and fulfilling relationships.

Coping Strategies

The first step to healing from narcissistic abuse is to understand what is happening. Often perpetrator’s wage such convincing campaigns of love bombing during the idealization stage of the cycle of narcissistic abuse that many victims don’t realize what has happened to them until long after a mortal discard.

“The most effective coping strategy for people recovering from narcissistic abuse is to help them understand the root of the anxiety and the damage caused by the dysfunctional relationship. Next, learning how to challenge unhelpful thoughts and see things in a more realistic light will facilitate having a sense of control over the symptoms of anxiety.”

April Nisan Ilkmen, LMFT


Once victim’s learn to identify the patterns of narcissistic abuse they have experienced, recovery is possible. They can focus on the work

“Narcissistic abuse and anxiety can be perpetuated repeatedly in a cyclical fashion. During the healing process, understanding the effects of emotional abuse can open the individual’s eyes to new possibilities for ending the pattern. This realization often diminishes the symptoms of anxiety by increasing the motivation to engage in self-enhancement for a more fulfilling life.”

April Nisan Ilkmen, LMFT

Some of the things, victims learn in recovery are:

  • Boundary Setting. Establishing clear and firm boundaries to protect oneself from further abuse and manipulation.
  • Seeking Support. Reach out to trusted friends, family members, or support groups to share one’s experiences and feelings. Surround yourself with caring and empathetic individuals who validate your experiences.
  • Self-Care. Engage in activities that promote one’s well-being, such as exercise, meditation, or hobbies you enjoy.
  • Education. Learn about narcissistic abuse and its effects to gain insight and understanding of the dynamics at play.
  • Low or No Contact. Withdraw access from the abuser to reduce their influence and maintain emotional distance.
  • Seek Professional Help. Consider therapy and/or coaching to process the trauma and develop coping strategies.
  • Challenge Negative Thoughts. Work on challenging and reframing negative thoughts and self-doubt instilled by the abuser.
  • Patience. Prioritize healing and create time and space to recover.
  • Practice Self-Compassion. Be kind to yourself and recognize that healing from narcissistic abuse takes time and effort.


Recovering from narcissistic abuse presents numerous challenges as victims confront the aftermath of emotional trauma. Overcoming the deep-seated effects of manipulation and gaslighting can be an arduous process, with self-doubt and trust issues lingering long after the abuse has ended. Rebuilding self-esteem and setting healthy boundaries can be daunting, as the victim must navigate the complexities of healing while grappling with past experiences.

“Individuals who suffered from narcissistic abuse for long periods of time may be under the impression that there will always be an oppressive force, structure, person, or thing that does not allow them to gratify their needs and live a fulfilling life. In treatment, the therapist and the client need to collaboratively identify what lies at the root of these beliefs and deconstruct the self-loathing narratives, which could be a slow process.”

April Nisan Ilkmen, LMFT

Therapeutic Interventions

Different therapeutic interventions work for different people. April Nisan Ilkmen recommends Emotionally Focused Therapy (EFT). Developed by Dr. Sue Johnson, EFT aims to help individuals identify and express their emotions, fostering secure emotional bonds and strengthening relationships. Through a structured and compassionate process, EFT therapists guide clients in recognizing negative patterns of interaction and promoting healthier ways of communicating and connecting. EFT is based on the premise that emotional responsiveness and understanding lead to greater relationship satisfaction and resilience.

“Emotionally Focused Therapy (EFT) helps clients become more aware of how they are experiencing painful emotions. One of the main focuses of this approach is for patients to accept, symbolize and put their emotions into words with the help of the therapist. In EFT the therapist acts as an agent for modeling secure attachment to help clients access empowering emotions and learn to manage anxiety symptoms. The main interventions are identification of the negative interaction cycle, rephrasing problems, and acceptance of the emotional experience.”

April Nisan Ilkmen, LMFT

She also suggests Transference-Focused Therapy (TFP), a specialized psychodynamic approach used to treat individuals with borderline personality disorder (BPD). Developed by Dr. Otto Kernberg, TFP focuses on examining and understanding the client’s unconscious feelings and perceptions towards the therapist and important figures from their past. Through exploration of transference reactions, such as intense emotions or idealizations, therapists help clients gain insight into their interpersonal patterns and difficulties.

“Transference-focused psychotherapy helps emotional abuse survivors to understand the impact of destructive relationships and integrate those lessons into everyday life. It can also help patients better manage their emotions, understand others more realistically, and have a stronger sense of self.”

April Nisan Ilkmen, LMFT

By addressing these dynamics, TFP aims to improve emotional regulation, reduce self-destructive behaviors, and enhance relationships. This therapy’s emphasis on the therapeutic relationship as a microcosm of real-life interactions facilitates lasting positive changes in clients with BPD.


Narcissistic abuse and anxiety are intertwined as once cannot exist without the other in abusive power and control dynamics. The manipulative tactics perpetrators use to induce fear, self-doubt, and hyper-vigilance lead to severe mental and physical health outcomes.

“No matter how painful life becomes, I believe that one’s sense of self cannot be ultimately deteriorated by an external force. I believe that we all have an inner voice that arises from the essence of our soul. Sometimes that voice can be muted—even though it’s ultimately dictated by us. Learning to access and open ourselves to the reassurance of our inner voice can create a sense of justice and inner peace, which will make a big difference in the therapeutic process of individuals who are suffering from chronic anxiety.”

April Nisan Ilkmen, LMFT

Prolonged exposure to narcissistic abuse can lead to heightened anxiety levels, impacting the victim’s ability to function healthily. Overtime it can lead to post-traumatic stress disorder (PTSD). Recognizing the symptoms of narcissistic abuse-induced anxiety is a crucial step towards healing and regaining emotional stability and security.


Manya Wakefield is a recovery coach specializing in cognitive behavioral therapy and coercive trauma. Her expertise has been featured in publications such as Newsweek, Elle, Cosmopolitan, and Huffington Post. In 2019, she launched the social impact platform Narcissistic Abuse Rehab, building a global audience through human rights advocacy. The same year, she published the book ‘Are You In An Emotionally Abusive Relationship,’ which is used in domestic violence recovery groups around the world. In 2020, Manya developed The Coercive Control Legislation Global Database. She is also the host of The Narcissistic Abuse Rehab Podcast, which is available on Apple Podcasts, Spotify, and Amazon.