First published July 24, 2017.
Living with someone who belittles, controls or manipulates you can leave marks that last long after the relationship ends. Many survivors of what is often called "narcissistic abuse" describe constant worry, sudden waves of panic or a new fear of social situations. Research on psychological abuse links it to higher rates of anxiety, depression and post-traumatic stress, so these feelings are common and understandable.
This guide explains five recognised anxiety disorders that people sometimes notice after emotional abuse, how they differ, and when it is worth talking to a doctor. It is meant to help you put words to an experience, not to diagnose yourself or anyone else.
What "narcissistic abuse" means, and what it doesn't
"Narcissistic abuse" is a popular phrase, not a clinical diagnosis. It usually describes a pattern of emotional or psychological abuse: constant criticism, gaslighting (making you doubt your own memory), intimidation, isolation from friends, and cycles of affection followed by cruelty.
Psychologists generally define psychological abuse by that pattern over time rather than any single incident. The harm is real whether or not the other person has narcissistic personality disorder, which only a qualified clinician can assess. You do not need to diagnose a former partner, parent or boss to take your own distress seriously.
Abuse is also only one of many things that can contribute to anxiety. Genes, early life experiences, health problems and major life events all play a part. Some people come out of abusive relationships without an anxiety disorder; others develop one years later. Both are normal paths.
Generalized anxiety and panic disorder
Generalized anxiety disorder (GAD)
GAD means worrying a lot, about many ordinary things, most days, for at least six months. The worry feels hard to switch off and is out of proportion to what is actually happening. It often comes with physical signs such as restlessness, tiredness, tense muscles, poor sleep and trouble concentrating.
After a controlling relationship, some people describe being permanently "on alert", scanning for the next mistake or the next angry reaction. When that state continues in safe settings, long after the danger has passed, it may be worth asking a professional about it.
Panic disorder
A panic attack is a sudden rush of intense fear that peaks within minutes. The body reacts strongly: a pounding heart, chest tightness, shortness of breath, shaking, dizziness, or a sense that something terrible is about to happen. Panic disorder is diagnosed when attacks happen repeatedly and the person starts to worry about the next one or changes their life to avoid it.
Because panic symptoms can feel like a heart problem, anyone with chest pain or breathing trouble should get checked by a doctor rather than assume it is anxiety.
Agoraphobia and social anxiety
Agoraphobia
Agoraphobia is fear of situations where escape might be hard or help unavailable if panic strikes: crowded shops, public transport, queues, open spaces, or sometimes simply leaving home. It is closely linked to panic disorder, and the fear of having an attack in public is often what drives the avoidance. Someone who was isolated and controlled for a long time may find that the outside world feels unexpectedly threatening once they are free.
Social anxiety disorder
Social anxiety disorder, sometimes called social phobia, is an intense fear of being judged, embarrassed or rejected in social or performance situations. People may dread meeting new colleagues, eating in front of others or speaking up in a group, and they may avoid these situations altogether.
Agoraphobia and social anxiety can look alike from the outside, since both involve avoidance, but the fear is different. With agoraphobia the worry is being trapped or helpless; with social anxiety it is being judged. A survivor who spent years hearing that everything they said or did was wrong may carry that critical voice into new social settings.
Separation anxiety in adults
Separation anxiety disorder is often thought of as a childhood condition, but adults can have it too. Wikipedia's summary of the research puts it at roughly 7% of adults and 4% of children. It involves excessive, persistent fear of being apart from people you are attached to, or of something bad happening to them.
In adults it may show up as needing constant contact with a partner, panicking when they are late, or struggling to be alone at all. After abuse, where affection may have been given and withdrawn unpredictably, it can feel especially hard to trust that a relationship is secure.
Other conditions worth knowing about
Anxiety rarely travels alone. Depression often appears alongside it. Post-traumatic stress disorder (PTSD), which used to be grouped with the anxiety disorders and is now classed among trauma-related conditions, can follow long-term abuse. It involves intrusive memories, nightmares, avoidance and feeling constantly on guard. Some clinicians also use the term complex PTSD for reactions to prolonged, repeated trauma.
Many people also turn to alcohol or other substances to cope. If you notice that happening, mention it openly when you seek help. It is a common response, not a moral failing.
When and how to get help
Anxiety disorders are among the most common mental health conditions. Nearly a third of adults experience one at some point, and they are treatable. Signs it is time to talk to a doctor or a qualified mental health professional include:
- Worry or fear that does not ease, spreads to many situations or gets worse over time.
- Avoiding places, people or activities you used to manage.
- Problems with sleep, work, study or relationships because of anxiety.
- Panic attacks, or physical symptoms you cannot explain.
- Using alcohol or drugs to calm down.
A family doctor is a good first step. They can rule out physical causes and explain options, which commonly include talking therapies such as cognitive behavioural therapy. A therapist with experience in trauma and abusive relationships can be especially helpful.
If you are still in an abusive situation, domestic abuse helplines can help you plan for safety. If you are in crisis or thinking about suicide, contact local emergency services; in the United States you can call or text 988.
Recovery is rarely a straight line. Naming what you feel, understanding that it is a known human response to harm, and getting support are all real steps forward.
Sources: US National Institute of Mental Health: Anxiety disorders; Wikipedia: Anxiety disorder; Wikipedia: Psychological abuse
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