Do you see a preponderance of middle aged women in your practices with no particular physical disease process, yet a variety of physical and/or emotional complaints, including: insomnia, weight loss or gain, depression, anxiety, phobias, broken bones, lacerations, or bruises? Some may report an overwhelming feeling of emptiness or doom. Others may talk about or attempt suicide.

These patients are frequently rather nervous, with a guilt-ridden, anxious look and effect. They may appear restless, worried, and/or demonstrate a fake laugh that seems to hide something else.

In extreme cases they may describe sudden outbursts of rage with accompanying violence. They may have even been arrested for assault on their spouse. A few of them are men.

Who are these patients and how did they get this way? While there may be many situations with similar symptoms, it is important to recognize these may be “Victims of Narcissists” and they need your help. While narcissism itself has been a diagnosis in the DSM – IV, psychiatry’s complete reference, little to nothing has been written in the medical literature surrounding those who live with the narcissist – and the torturous lives they live. And there are many of them out there.

Narcissism is a broad spectrum of behaviors. On a scale of 1 – 10, Healthy Narcissism is a one, and Pathological Narcissism, or Narcissistic Personality Disorder, (NPD) is a 10.

Healthy Narcissism is something we all can use. It’s having a healthy self-esteem. It’s what makes us pick ourselves up after experiencing failure and going on towards the next goal. It’s what gives us the ability to help each other, and to love someone – as we already know how to love ourselves.

Yet, Pathological Narcissism is an ironic twist of this healthy state. Outwardly, it appears that these people love themselves too much – to the exclusion of anyone else. It is as if they are God himself and those around them must recognize their omnipotence, supreme knowledge, and absolute entitlement and power. Rules don’t apply to them. They have an unrealistic and overblown sense of self, often without the credentials to match, as well as fantasies of unlimited power, success, and/or brilliance. They are interpersonally exploitive and have absolutely no understanding of empathy or compassion.

They are neither kind nor benevolent gods. And those who live with them end up paying the price.

While there is a range of narcissistic behaviors lying between level 1 and 10 on this scale, one doesn’t need to have full-blown NPD to do incredible damage to those in the inner circle.

While victims of Narcissists are generally codependents, most have no idea how they got in this situation, because in the early stages of the relationship the Narcissistic person can be the most charming, Academy Award winning actor or actress (according to the DSM-IV, 50-75% of narcissists are men), of the century.

The early days of the dating is fast, furious, and vastly romantic. Oftentimes marriage proposals come within a few weeks. The “victim” sees the narcissist as the “Perfect Partner”. She’s never met someone so wonderful in her lifetime and falls head-over-heels in love. The two go on to live happily ever after – or so she thinks – until the “real” partner surfaces. The once wonderful Dr. Jekyll turns into the dangerous Mr. Hyde who quickly instills fear, anxiety, uncertainty, and total confusion to the relationship.

The change can be quick and powerful or slow and insidious.

We are all way too familiar with overt narcissists: those abusive husbands who send thousands of battered women to the emergency room each year. They feel it is their God-given right to beat, abuse, and otherwise threat their partner in whatever method they deem necessary and no one can tell them otherwise.

Then there is the verbally abusive and controlling narcissist – the one who uses emotional abuse as his weapon of choice. He tells his victim who she can see, what time she needs to be home, and when she can go to bed. Or in the case of Jamie, whose husband makes her recite every day, “I’m only worth 29 cents – the price of a bullet,” he erodes her self-worth to nothing to keep her under his control.

Who else could possible want such a worthless woman as she? With that belief, she will never leave him for good, although she makes many brief attempts to do so. She always returns. The brainwashing that continues day after day is emotionally exhausting, draining, and vastly unhealthy.

Yet almost worse is the “Stealth Narcissist,” so sinister and silent in his ability to drive his partner crazy that she doesn’t suspect anything bad is happening until it’s too late. He is the master of the little digs – “Honey, why on earth would you cook eggs in butter? NO ONE does it that way. What’s wrong with you?” Or, “If you’d only do what I say then we’d both be happy.”

He issues the “silent treatment” when he is slighted, punishing his family by ignoring them for hours, leaving them wondering what they did “wrong” to make him act this way. He may “forget” birthday or Christmas presents, year after year. He may show up hours late and his partner is just supposed to understand, with no explanation even offered. He may have another woman on the side and feel quite entitled to do so.

Yet, to those outside his inner kingdom he looks like a saint. He probably is president of the Rotary, volunteers at a food bank, and contributes regularly to charity – all to attain the image of being the admired Superman of his community.

No matter which type of narcissist he is, the end result is the same – a slow, insidious, breaking down of the self-esteem of his victims until there’s next to nothing left, at which point, the narcissist will frequently throw his partner out in order to look for someone new and full of life to make his next target. Leaving his victim an emotional wreck wondering what she did to destroy their once “perfect” relationship.

The Narcissist himself rarely changes. After all, if you believe you’re God-like, you must be perfect. Why should you change your behavior for anyone else? Yet the biggest secret is that deep inside, he loathes himself, and is desperate that no one find out who the “real” person is inside his tough, outer shell.

Victims are not only spouses. They can be coworkers, employees, children, or friends of narcissists. When the narcissist is the victim’s mother, it’s a difficult spot to be in, as most children (even grown children) find it almost impossible to leave the relationship. And the abuse continues for years.

However, when the narcissist is your patient’s boss, coworker, or friend, it may be wise to counsel the victim to seek a new situation elsewhere to best avoid an emotional roller coaster ride that could lead to extreme health issues down the road.

How can you help those with Narcissism Victim Syndrome? First, by asking questions to determine what is going on in their environment. Health care professionals already know the effect that stress has on so many of us, but the added stress of living with a narcissist is rarely understood or recognized by the victims themselves. Knowledge is power and by asking the right questions about their situation, you might be able to help them begin to better recognize their problem and seek help.

You can help them quit being victims, quit blaming themselves for all that’s wrong in their relationships, gain knowledge of this disorder, and regain their personal power. Help them to seek counseling from a therapist knowledgeable about narcissism, (not all are, and few fully understand victim issues at all), in order to rebuild their shattered self-esteem and stop looking and acting like a caged animal.

Help them find hope, before years of stuffing their anger due to this abusive treatment, leads them to venting in unhealthy ways, sometimes leading to domestic violence and police intervention. Help them to stop looking like the sick one in the relationship and to start down the road of being a survivor and no longer a victim. Help them escape symptoms of depression that may, in some cases, lead to suicide.

Learn all you can about the “Narcissism Victim Syndrome“. You might light a glimmer of hope for someone who’s just barely hanging on for dear life.

Written by Mary Jo Fay, RN, MSN, a national speaker, author, columnist and survivor of several narcissistic relationships. Her new book, “When Your Perfect Partner Goes Perfectly Wrong – Loving or Leaving the Narcissist in Your Life” is available at http://www.helpfromsurvivors.com