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Do you think it's possible for you or others to confuse someone suffering from the mental disorder of Post-Traumatic Stress Disorder (PTSD) with someone suffering from an unhealthy or pathological level of narcissism? Frankly, not only do I think it’s possible but, quite frankly, it would be rather tragic if this happened. Let me explain why I say this.

Today, we're concerned about a new generation of PTSD sufferers in the form of veterans of the wars in Iraq and Afghanistan. With regard to this group of young men and women, we are also concerned about such problems as alcoholism and drug abuse—since PTSD sufferers often turn to these substances in an attempt to cope with their PTSD symptoms. Because they do not want to continually be plagued by memories or flashbacks of some of the most horrific times they endured, many try to psychologically numb themselves through the use of chemical substances.

Sadly, over time, a number of them can become alcoholics and/or drug addicts. Then, their addictions, blended with their PTSD symptoms, further change the PTSD sufferers’ personalities as well as their behaviors. For example, while many with PTSD are often irritated—if not outright angry--alcohol and other drugs can fuel the fire. These individuals may then start flying into rages—or even become violent. This type of behavior can seem so inconsistent with their former personalities.

Angry veterans with PTSD---as well as other with PTSD, too—are apt to engage in abusive behaviors towards partners or loved ones. Some of these abusive behaviors may be more subtle than physical abuse, certainly. what are examples of some of the forms of abuse I'm talking about? Well, think of verbal or emotional or psychological abuse. And now realize that these forms of abuse are  destructive to the emotional well-being of the PTSD sufferer as well as to any romantic partner or spouse. (Of course, the presence of such abuse in the home also harms children present.)

If you're the partner of a PTSD sufferer, I don’t need to tell you this, do I? You know it from experience. That said, though, have you been encouraging your partner to pursue treatment for the PTSD if he or she hasn't already done so? Sure, you’re loved one may be hesitant to go for such help. And, in fact, your partner may need your ongoing support to both seek help initially as well as to continue on with that treatment. But you should remain optimistic that, with the right treatment, your PTSD sufferer and you should enjoy better tomorrows. All is not lost.

On the other hand, if you hold out such hope for a narcissist, you're likely to find yourself sadly disappointed.

Certainly, you don’t want to find yourself writing off a PTSD sufferer who could potentially benefit from help (mistaking him or her for a narcissist, that is),  so let me further clarify what I’m talking about.

Similar Behavioral Symptoms—but the Root Causes are Different

If you've ever read about how those with unhealthy levels of narcissism are inclined to behave, or you've read about the problems they can have with addictions or how they can be abusive, you may conclude that there are some definite similarities between PTSD sufferers and narcissists. And frankly, you'd be right. As a result, if you were to meet an addicted and abusive war veteran, let’s say, but no one told you he was a warrior wounded by PTSD, you might decide this individual was a narcissist. However, you would likely be wrong.

Yes, you might wrongly suspect a PTSD sufferer of narcissism because of emotionally or verbally or psychologically abusive behaviors. You might suspect the PTSD sufferer of narcissism because he disregards his family. Indeed, he may not want to participate in important events meaningful to all of them. He may be unwilling to assume certain responsibilities. And then, because of his seemingly general lack of concern for others, you label him as self-centered and narcissistic. But the thing is, the PTSD sufferer lacks a characteristic or trait that truly separates him from the mental health issue of narcissism. And, quite simply, that is grandiosity. Yes, that's the truly distinguishing trait of the narcissist.

War veterans suffering from PTSD are not apt to want to talk about what they encountered or endured that resulted in their PTSD. However, if they elect to talk about their experiences at all, it will probably be with those who have endured something similar. After all, war veterans normally believe that only other war veterans can truly understand what they went through.

Why We Mustn’t Confuse the Two Disorders

The PTSD sufferer developed the symptoms he or she did due to involvement in either one traumatic event or traumatic events that were ongoing—such as in the case of war. On the other hand, the narcissist has undoubtedly been narcissistic since childhood. Narcissism is quite stable, in other words, whereas PTSD need not be—not with proper treatment, that it.

While both PTSD and narcissism affect the sufferers’ relationships with the self as well as with others, the narcissist typically does not have any significant problems or conflicts with the person he is being. (I have elected to use the male pronoun since most narcissists are men.) It is the individual forced to interact with the narcissist—his victim, if you will—who is most concerned about the abusiveness and destructiveness of the pathologically narcissistic individual.

The partner of the narcissist, suffering emotionally from a constant onslaught of verbal abuse or emotional abuse or psychological abuse, may well want the loved one to change. What she may not realize, though, is that her narcissistic partner undoubtedly believes that she is the problem. And because the narcissist doesn’t see himself as having any self-created problems—it is the nature of the narcissist to always blame others for any problems—he's highly unlikely to seek out or pursue help. Thus, change invariably will not happen—unless other life experiences create some kind of awakening of self-awareness. Unfortunately, this kind of personal transformation is rare among the narcissistic. Yes indeed, It is safer to bet on the narcissist never changing.

By the way, even if a narcissist does finally agree to go to a therapist with his partner, she needs to be on guard. He is likely to try and manipulate the therapist to take his side, blame his partner, and then “fix” her. If the narcissist is unable to do this, he is apt to verbally abuse the therapist, walk out, and never return.

Many PTSD sufferers—and especially warriors wounded by PTSD—may also prefer not to seek out treatment. While many of us who have worked with the military have tried to get across the message that help-seeking behavior is a sign of strength versus weakness,  especially some of the men seem disinclined to accept this. In all fairness, they have reasons for wanting to avoid treatment—such as the fear it may negatively  impact one's military career. Still, as someone significant to the PTSD sufferer, you should make it your mission to help ensure that your loved one does get help—and sooner rather than later. If you're struggling to essentially embrace this role, it may be  helpful to remind yourself that, unlike the narcissist, your partner probably can be helped.

Yes, with the support of others, the PTSD sufferer may well pursue a treatment path that leads to positive behavioral changes which you can both see and list. On the other hand, the narcissist or narcissistic are not likely to go into treatment—or to stay with it, should they ever make it through a therapist’s door. Since they believe that others create their problems, and they see these others as beneath them anyway, they do not feel the same need to engage in therapy to appease a partner as you or I might.

The narcissist has a rather unique and stable world views. In turn, his behaviors stem from that world view. So, it's often best for the partner to recognize that it's probably going to be impossible to get the abusive narcissist to seek treatment and hence, to change. Often when the narcissist favors emotional abuse or verbal abuse or psychological abuse, the best thing you can do for your own well-being is to walk away from the relationship. 

That all said, it could come to the point where it’s necessary to part ways with an abusive PTSD sufferer who refuses to get treatment. But if the person has recently developed the PTSD, it’s important to hold out hope that treatment will indeed make a difference. Of course, the assumption is such treatment will be pursued.

On the other hand, too many of us have held out hope for narcissists—to our own detriment, needless to say.

While PTSD is treatable, it still needs to be caught early on rather than later. Also, because it tends to impact the younger warriors more so than the older ones and, furthermore, young men in their late teens and early twenties are most apt to deny that they have problems, it’s important for others to recognize what could be going om. No indeed, you do not want to not confuse one mental health disorder with another. As a wife, member of the family, a friend, or a concerned member of the community, you could quietly intervene and encourage the person with apparent PTSD symptoms to seek help.

There is no need for us to have a repeat of what happened for so many veterans and their families after the War in Vietnam--when we didn't yet know what PTSD was and hence,  we didn't have treatments for it. While we can hold onto hope for today's warriors wounded by PTSD, there may nonetheless be only a small window of opportunity to make a real difference in the lives of these PTSD sufferers. So, ensure any veteran with PTSD doesn't miss it--because you or others mislabeled his mental health disorder as narcissism and therefore, wrote him off as unlikely to respond to treatment.