The narcissist is besieged and tormented by a sadistic superego which sits in constant judgement. It is an amalgamation of negative evaluations, criticisms, angry or disappointed voices, and disparagement meted out in the narcissist's formative years and adolescence by parents, peers, role models, and authority figures.

Ideally, after a period of combined tutoring, talk therapy, and (anti-anxiety or antidepressant) medications, the survivor will self-mobilize and emerge from the experience more resilient and assertive and less gullible and self-deprecating.

Victims of abuse in all its forms - verbal, emotional, financial, physical, and sexual - are often disorientated. They require not only therapy to heal their emotional wounds, but also practical guidance and topical education. At first, the victim is, naturally, distrustful and even hostile. The therapist or case worker must establish confidence and rapport painstakingly and patiently.

Anxiety Disorders - and especially Generalized Anxiety Disorder (GAD) - are often misdiagnosed as Narcissistic Personality Disorder (NPD).

The narcissist cathexes (emotionally invests) with grandiosity everything he owns or does: his nearest and dearest, his work, his environment. But, as time passes, this pathologically intense aura fades. The narcissist finds fault with things and people he had first thought impeccable. He energetically berates and denigrates that which he equally zealously exulted and praised only a short while before.