Is Your Caregiver Self-Absorbed and Manipulative?

What to do when your caregiver is a narcissist

Posted Nov 28, 2012

Source: Pixabay

Do any of the following sound familiar? At first your caregiver is amazing. He or she seems truly devoted to giving you the best care possible. But then this person to whom you’ve entrusted your care (and often your house keys) begins to criticize you and find fault with everything you do. When you try to stand up for yourself, what you get in return is a lecture or a tirade about how you’re too sensitive or how you’re making the caregiver’s life too hard.

One of the burdens of living with chronic pain or illness is that we may be dependent for care on others who are too self-involved and self-focused to be skillful caregivers. Meredith Resnick has written a very helpful eBook that offers practical advice to those in this situation. It’s called Narcissism: Surviving the Self-Involved—A Little Primer on Narcissism and Self-Care. In this short but powerful eBook, she explores the often ignored world of narcissists and how their narcissism might come into play when others depend on them for care and support. She offers practical suggestions and tools for coping when you’re involved in some way—indeed, perhaps dependent on—a narcissist or a person with narcissistic tendencies. This is a book you can keep nearby as a guide to help you cope with and heal from such a painful relationship.

Here’s my recent interview with her:

Toni: What are some of the signs that a caregiver might be narcissistic? What is the difference between a narcissist and person who can’t stop talking about him or herself?

Meredith: While narcissism can present itself in different ways and is made up of a variety of traits, given the focus of your blog, it seems appropriate to discuss empathy—or rather the lack thereof. For example, the DSM IV, published by the American Psychiatric Association, indicates that people who are narcissistic are generally unable or “unwilling to recognize or identify with the feelings and needs of others.”

This would be of concern in a situation when one requires care, because illness, whether chronic or acute, can make us feel more vulnerable, more in need of support, acknowledgment and kindness, even in passing. This is natural. But, in my personal experience, a person who veers toward truly narcissistic, especially when experiencing the deepened or exacerbated needs of another, will likely not be able to deliver the empathy, and might respond unkindly to the other’s need.

Oddly enough, they may demand empathy from the person who needs the care, as the narcissistic person’s own feelings of abandonment, rage, emptiness and anxiety are triggered. (Another facet of narcissism is projection, meaning that uncomfortable feelings are relegated to the other person—you). Keep in mind, this does not happen on a conscious level, so if you point it out, the other person might say you are the one doing the attacking. In addition, some narcissists might appear to care at first, but then go cold. Interactions, in my experience, can be very confusing and crazy-making.

In contrast to the narcissist, a person who is rough around the edges (for example, bossy or curt, or who can’t stop talking about him or herself) might be anxious, nervous, inconsiderate and annoying, but could still express empathy and also be able to follow through appropriately and consistently to provide the care another person needs. This might be the case with some family members, hired caregivers, neighbors, healthcare professionals, and others.

Toni: What are some of the common misunderstandings about a narcissistic personality?

Meredith: I’ve come to believe that the notion that a narcissist is in love with him or herself is false. Narcissists are very insecure. I see it like this: The narcissist is in love with (and in need of) the image of him or herself that they’ve crafted and presented out there in the world. This image is sometimes referred to as a mask. I have found it typical for such individuals to put down others whom they sense as a threat to their constructed image (mask) being upheld, i.e., if they feel you are stripping away their mask.

Toni: I’ve had people tell me that they’re afraid of their caregiver. Even though the caregiver has never done anything to physically hurt them, they sense that the caregiver is terribly angry. What can they do?

Meredith: Be proactive, and do not wait for anger to escalate. Talk to someone you trust to figure out a plan for getting a new caregiver. Seek help from various experts, or from a caregiver resource center if you sense concern for your safety. It might be advised to hold off on mentioning this to the caregiver, however, and get the help of a professional who has dealt with people who are rageful, and who can advise you on how to go about the process to ensure safety during the transition to find a new caregiver.

Confronting a person whom you sense is terribly angry is not advised. Get appropriate support to figure out the next steps. Have a friend or neighbor stop in or check in as frequently as possible, and make it a priority to keep lines of communication open with the outside world in any way you can. However, if you feel threatened or in danger, or have been threatened with harm, then Adult Protective Services or the police should be called.

Toni: What would you tell someone who has no one to help except a relative who borders on nasty whenever she comes over to help or has a caregiver who puts them down whenever they try to assert themselves? Is there anything a person can do to protect him or herself emotionally in this kind of situation?

Meredith: Ensure for themselves that they feel physically safe and that their needs are being met, and that the caregiver is not trying to exploit them. See the answer above for more on this.

A close second is to learn all they can about narcissism to help them deal with the emotional challenges. Changing how we behave and interact can help us because then we see the situation more clearly and can begin to stop expecting the narcissistic person to act differently.

Toni: Is there anything else you’d like people with chronic pain or illness to know about being dependent for care on a person who may be a narcissist?

Meredith: In the book I say: “Until we gain perspective—sometimes even a little perspective can help—the pain of narcissism can slice deep. So, how can we start to gain perspective? And what should we do if we are scared to, or don’t want to (because sometimes, we are not ready for big changes)?”

Here are but a few things to try:

—seek the support of a licensed therapist who understands the dynamics of narcissism;

—assess the situation daily and take action accordingly;

—recognize the control you do have, take stock in what you depend on yourself for—it may be more than you or the other person thinks.

© 2012 Toni Bernhard  

I'm the author of three books: How to Be Sick: A Buddhist-Inspired Guide for the Chronically Ill and Their Caregivers (Second Edition) 2018; How to Live Well with Chronic Pain and Illness: A Mindful Guide (2015); and How to Wake Up: A Buddhist-Inspired Guide to Navigating Joy and Sorrow (2013)

All of my books are available in audio format from Amazon,, and iTunes.

Visit for more information and buying options.

Meredith Resnick’s eBook is available at Amazon: Narcissism: Surviving the Self-Involved – A Little Primer on Self-Care. It’s also available at Barnes & Noble, the iTunes store, and wherever eBooks are sold. Visit for more information.

Her work has appeared in the Los Angeles Times, Newsweek, Psychology Today, JAMA, Orange County Register, Culinate and most recently in The Shame Prom anthology. She is also a PT blogger.