Narcissistic Abuse in Medicine: Why Physicians Are 3x More Likely to Stay

WOMEN IN MEDICINE • April 28, 2026

Last updated: July 2026 by Annie Wright, LMFT. Read our Editorial Policy.

In short: Physicians face unique barriers to leaving narcissistic abuse, including professional reputation risk, a medical hierarchy that normalizes abuse, and trauma bonds that form under extreme professional pressure.

This article is for information and support. It is not a substitute for therapy, diagnosis or treatment from a licensed clinician who knows you. If you are in immediate danger, call or text 988 in the United States to reach the Suicide and Crisis Lifeline, or call 911. See the full medical disclaimer.

This content is psychoeducational in nature and isn’t a substitute for professional mental health treatment. If you’re in crisis, please contact the 988 Suicide & Crisis Lifeline.

The Moment You Realize Something Is Wrong

Fiona is an interventional cardiologist. She’s forty-three, and she’s been awake since 4:30 a.m. because there was a STEMI at 3:15. A fifty-eight-year-old man whose left anterior descending artery she opened in the cath lab while his wife stood in the hallway and cried. She saved his life. She does this regularly. She’s extraordinarily good at her job, and she knows it, and the knowing is one of the few things that’s stayed stable for her over the past three years.

She’s in the physician lounge now, at 6:47 a.m., holding a cup of the hospital’s terrible coffee in a chipped Mayo Clinic mug someone left in the cabinet years ago, staring at a text from her husband, Greg, that arrived while she was scrubbing in. The text says: I made dinner last night. You didn’t come home. I don’t know why I bother.

She reads it twice. She knows the dinner wasn’t made for her. She knows because she texted him at 2:00 p.m. yesterday to say she had a late case and wouldn’t be home until 9:00 at the earliest. She knows because this is the third time this month he’s made dinner on a night she’d already told him she’d be late, then sent a text like this one. A text built to produce guilt, built to make her feel that her work is a betrayal of the marriage, built to make her question whether she’s a good wife.

She’s a good wife. She’s also a cardiologist who saves lives at 3:15 a.m. These aren’t contradictions. But she’s spent three years inside a relationship that treats them as contradictions. A relationship that treats her professional identity as evidence of failure as a partner, that treats her competence as a threat rather than a gift, that treats her exhaustion as selfishness and her dedication as abandonment.

She finishes the coffee. Rounds start in twelve minutes. She puts the phone in her pocket. She doesn’t respond to the text.

She’ll think about it later. She’s been thinking about it later for three years.

I’ve sat with women like Fiona more times than I can count on two hands, and there’s a specific moment I watch for. It isn’t a dramatic confession. It’s this quieter thing: a woman who makes life-or-death decisions before 7:00 a.m. deciding, almost automatically, not to defend herself against a text message.

What Is Narcissistic Abuse in the Medical Context?

Narcissistic abuse inside physician relationships isn’t categorically different from narcissistic abuse anywhere else. The same patterns of manipulation, control, gaslighting, and intermittent reinforcement apply. What’s different is the specific way those patterns interact with the culture of medicine, the training that produces physicians, and the psychological profile that training both selects for and reinforces.

I recently reread Craig Malkin’s work on the narcissism spectrum, and one line has stayed with me for months: entitlement doesn’t need cruelty to do damage, it just needs someone across the table willing to keep absorbing the cost. That’s the piece I watch for in physician marriages specifically, because absorbing cost is exactly what medical training teaches a person to do well.

In plain terms: narcissistic abuse isn’t about anger or conflict. It’s about control. The narcissistic partner uses your goodness, your empathy, your commitment, your desire to be a good partner, as the mechanism of your entrapment. The more you care, the more effective the control becomes.

What makes narcissistic abuse in physician relationships particularly complicated is the specific way it exploits the values medicine instills. Medical training selects for and reinforces perfectionism, deferred gratification, tolerance for suffering, and the capacity to function under extreme stress without complaint. In the context of medicine, these are adaptive traits. They produce excellent physicians. In the context of a narcissistic relationship, they also produce extraordinarily effective victims: people trained to suppress their own needs and stay loyal even when the loyalty is destroying them.

In plain terms: you learned to wait. You learned to put your head down, endure, and trust the suffering would eventually produce something worth having. That capacity served you well in medicine. In your marriage, it’s keeping you inside a relationship that’s making you sick.

Why Do Physicians Stay Longer Than Anyone Expects?

The question of why physicians stay in narcissistic relationships longer than the general population isn’t a question about intelligence or professional competence. Physicians are, by definition, among the most educated and analytically capable people in any population. The real question is about neurobiology. About what chronic relational stress does to the specific neural systems that would otherwise support recognizing and responding to threat.

Here’s what I keep coming back to in my own reading. Bessel van der Kolk, MD, psychiatrist, trauma researcher, and author of The Body Keeps the Score, has spent decades documenting how chronic stress, particularly chronic relational stress, impairs the prefrontal cortex’s capacity for clear-eyed assessment of one’s own situation. Think of the prefrontal cortex like the hospital’s charge nurse: the person who’s supposed to step back, see the whole floor, and make the call about what needs attention first. When that function is impaired, a physician can triage a waiting room full of strangers with total clarity and still walk past the five-alarm fire in her own kitchen. The prefrontal cortex handles executive functioning, strategic planning, and the self-reflective awareness that would let a person recognize her own relationship is harmful. When the nervous system is chronically activated by threat, even low-grade, deniable, intermittent threat, that regulatory function gets progressively worn down. Which is why a woman who can read a coronary angiogram in four seconds flat can spend three years unable to read her own marriage.

For physicians, this neurobiological impairment compounds with the specific demands of clinical practice. A physician managing chronic relational stress at home is also managing the cognitive and emotional demands of clinical work. The total load is extraordinary, and the prefrontal cortex, already taxed by chronic stress, gets asked to hold all of it at once.

In plain terms: your body is paying for this. Not just emotionally. Physiologically. The chronic stress of your relationship, stacked on the chronic stress of your practice, is wearing down your body’s systems in ways that’ll eventually show up as illness, if it hasn’t already.

Stephen Porges, PhD, neuroscientist and developer of the Polyvagal Theory, has demonstrated that the social engagement system, the neural circuit that lets us think clearly and access the self-reflective awareness that supports recognizing a relationship’s harm, is only available when the nervous system feels safe. Physicians in narcissistic relationships are rarely in a state of felt safety, and that chronic activation undermines the exact neural state self-protective cognition requires.

The line I keep returning to is from Judith Herman, MD, psychiatrist and author of Trauma and Recovery: the capacity to recognize and respond to one’s own victimization is systematically undermined by the conditions of captivity. For physicians, this dynamic is particularly pronounced, because the conditions of medical training create a baseline of impaired self-protective cognition that a narcissistic partner then exploits further.

How Does Narcissistic Abuse Actually Show Up in a Physician’s Marriage?

Composite vignette. Fiona:

Fiona is at her office at 7:15 p.m. on a Tuesday, reviewing an echocardiogram on the second monitor while her phone sits face-up on the desk. It’s late October, and the parking garage outside her window is already dark. Her phone rings. It’s Greg. She knows, before she answers, roughly what the call will be about, not because she’s psychic, but because she’s learned, over eleven years, to read the timing of his calls the way she reads a stress test: looking for the pattern that tells her what she’s dealing with.

He calls at 7:15 p.m. when he wants her to feel guilty about not being home. He calls at 11:00 p.m. when he wants a conversation that’ll keep her awake. He calls at 6:00 a.m. when he wants to start her day carrying something into the cath lab that has nothing to do with her patients. The timing isn’t random. She knows this now, in the way she knows things. The way she knows, from a patient’s presentation, what the diagnosis is before the labs come back.

She answers. He says: “I just wanted to check in. I know you’re working late again.” The “again” carries everything. It carries the implication that her working late is a choice she’s making against him, a preference she’s expressing at his expense, a statement about her priorities. She knows this. She also knows she has one more echo to read before she can leave, and a 6:00 a.m. case tomorrow, and that the patient on this echo is a thirty-nine-year-old mother of two whose ejection fraction just dropped ten points since her last visit.

She says: “I’ll be home by 9:00.” He says: “I’ll be asleep by then.” She says: “I know. I’ll see you in the morning.” He says: “Sure.” He hangs up.

She sits for a moment. Not long. Maybe ten seconds. She looks back at the echo. She picks up her pen. She goes back to work.

This is what narcissistic abuse looks like inside a physician’s life. Not dramatic. Not acute. Just the constant, low-grade management of a partner who’s learned to use her dedication to patients as the mechanism of her guilt, who’s organized his control around the one thing she won’t sacrifice: the patient in front of her.

The specific patterns in physician relationships:

The “you care more about your patients than your family” frame. This is the central narrative narcissistic partners of physicians build. It positions the physician’s professional dedication as evidence of her failure as a partner and parent. It’s effective because it contains a grain of truth: physicians do, in moments of acute clinical need, prioritize their patients. The narcissistic partner takes that clinical reality and weaponizes it, generalizing it, amplifying it, using it to build a narrative about who she’s supposed to be and what her priorities reveal about her character.

Exploiting the physician’s tolerance for suffering. Medical training produces people who can tolerate extraordinary levels of suffering, their patients’ and their own. The narcissistic partner exploits this by escalating the suffering in the relationship to a level that would push most people to leave, knowing the physician will tolerate more before she reaches her threshold. A physician who’s sat with dying patients and worked through thirty-six-hour shifts on no sleep has an unusually high tolerance for suffering, and the narcissistic partner exploits that tolerance systematically.

Using the physician’s perfectionism against her. Medical training produces perfectionism: the conviction that errors are unacceptable, that standards must be maintained. The narcissistic partner exploits this by positioning the relationship’s problems as her failures, her failure to be a good enough partner or present enough parent. The physician trained to ask “what could I’ve done differently?” after every adverse event applies that same framework to the relationship, taking responsibility for problems that were never hers to solve.

The “you’re too stressed to see clearly” gaslighting. This tactic works especially well in physician relationships because it has built-in plausibility: physicians are, in fact, chronically stressed. “You’re reading too much into this.” “You’re too tired to think clearly.” A physician trained to doubt her own perception when she’s fatigued is particularly vulnerable to this exact form of gaslighting.

How Does Medical Culture Enable This to Continue?

The culture of medicine doesn’t just produce physicians who are vulnerable to narcissistic relationships. It actively enables those relationships by creating conditions that make the abuse harder to recognize and respond to.

The culture of self-sacrifice. Medicine is organized around the ideal of self-sacrifice: the physician who puts the patient first, who works through illness and exhaustion, who’s always available. That ideal isn’t without value; it produces physicians deeply committed to their patients. But it also produces an environment where self-care gets stigmatized and a physician’s own needs get systematically deprioritized. A narcissistic partner exploits that environment by framing his demands as consistent with her professional values. “I’m not asking you to put me first, I’m just asking you to be present when you’re home.”

The culture of competence. Medicine is organized around the ideal of competence: the physician who knows what she’s doing, who doesn’t need help. That ideal makes it extraordinarily hard for physicians to seek help for personal problems, including abusive relationships. A physician struggling in her marriage isn’t supposed to be struggling. Telling a therapist, a colleague, a friend, feels like violating the professional identity she’s built her whole life around.

Pamela Wible, MD, family physician and founder of the Ideal Medical Care movement, has written extensively about medicine’s culture of silence around personal struggles. Her research on physician suicide documents specific ways that culture prevents physicians from accessing support during personal crises, and I think about her framing often when a physician client tells me she’s never said any of this out loud before.

The institutional enabling. Hospitals and medical practices aren’t designed to support physicians going through personal crises. Scheduling systems, call requirements, administrative demands, all of it assumes the physician is fully available and fully functional. A physician working through a narcissistic relationship, managing the cognitive and emotional demands of the abuse on top of the demands of clinical practice, isn’t fully functional. But the institution doesn’t have a mechanism for accommodating that reality, and the physician who admits she’s struggling risks her professional standing.

Both/And: Can She Be Both an Excellent Physician and a Trauma Survivor?

The Both/And that physician survivors of narcissistic abuse need to hold is this: she’s both an excellent physician and a trauma survivor. These aren’t contradictions. They coexist, and the coexistence is part of what makes the pattern so hard to name, because the excellence seems to disprove the trauma, and the trauma seems to threaten the excellence.

Composite vignette. Peyton:

Peyton is an OB/GYN at a private practice in a mid-sized city. She’s thirty-nine, and she’s been married to her husband, Paul, for nine years. She’s sitting in her car in the hospital parking lot at 8:30 p.m. after delivering a baby, a complicated delivery, a shoulder dystocia that took everything she had, and her hands are still faintly shaking on the steering wheel. She’s crying. Not because of the delivery, which went fine. She’s crying because she just realized, engine off and the heater fading, that she’s been doing for her marriage what she does for her patients for nine straight years and never once received it back.

She’s been the physician in her own marriage: managing the emotional weather, anticipating the needs, showing up fully even when depleted. She’s been doing for her husband what she does for the women on her delivery service. Unlike her patients, he’s never been grateful. He’s been entitled. He’s asked for more.

She sits in the parking lot for twelve minutes. She calls her therapist’s voicemail. She says: “I think I finally understand what you’ve been trying to tell me.” She drives home.

This is the moment of recognition I watch for in my clinical work with physician survivors. The moment the Both/And becomes visible: she’s both extraordinarily capable and genuinely harmed. She’s both an excellent physician and a woman who’s been systematically depleted by a relationship that’s taken everything she has and given nothing back. Both of these are true. Neither cancels the other.

Of course it’s hard to see clearly from inside it. You’re not failing to notice something obvious. You’re managing an enormous amount of cognitive and emotional load while the person closest to you insists there’s nothing to notice.

The Systemic Lens: Why Is This a Perfect Storm for Women in Medicine?

The specific vulnerability of women physicians to narcissistic relationships isn’t accidental. It’s the product of a specific intersection of forces: the culture of medicine, the gender dynamics of heterosexual relationships, and the particular way women’s professional success interacts with narcissistic entitlement.

Women in medicine have moved through, across their entire careers, a professional environment built by and for men, one that still operates on assumptions about availability and professional identity that are harder for women to meet than for men. A woman physician learns, through training and career, to suppress her own needs and to perform her professional identity in ways that don’t threaten the men around her. Those adaptations, survival strategies inside the professional environment, make her particularly vulnerable to a partner who exploits the same dynamics at home. That’s the terrain: the wider world that made these adaptations necessary in the first place.

The gender dynamics of heterosexual relationships add another layer. Research on the relationship between women’s professional success and male partner behavior, including work by sociologist Christin Munsch at the University of Connecticut, has documented that male partners of high-earning women are more likely to engage in controlling behavior and to experience a partner’s professional success as a threat to their own identity.

The family-of-origin system is often the proverbial foundation underneath all of it. Many of the physician women I work with grew up in family systems where their intelligence and capability were both celebrated and instrumentalized, where achievement was valued because it reflected well on the family, and where their own needs got deprioritized in favor of the family’s functioning. That early conditioning builds a blueprint for adult relationships that the narcissistic partner then replicates. What this looks like on an actual Tuesday: a woman who can tell a family in the ICU that their father isn’t going to survive the night, gently and clearly, and then goes home and can’t tell her own husband that his behavior toward her isn’t acceptable.

What Does the Path Forward Actually Look Like?

Step 1: Name it.

The first and hardest step for physician survivors of narcissistic abuse is naming what’s happening. Not as a dramatic declaration, not as a legal claim, but as a private recognition. The acknowledgment, to yourself, that what’s been happening in your relationship isn’t ordinary relationship friction. It’s a pattern. It has a name. And it has been costing you.

For physicians, this naming is particularly difficult because it requires applying the same diagnostic clarity to your own life that you apply to your patients’. The diagnosis implicates your partner. It also implicates your own choices, your own tolerance, your own participation in the dynamic. This isn’t about blame. It’s about clarity. And clarity is where change starts.

Step 2: Get individual therapy with a trauma-informed clinician.

Physician survivors of narcissistic abuse need individual therapy. Not couples therapy, not coaching, individual therapy with a clinician trained in trauma who understands the specific dynamics of narcissistic relationships. The work involves processing the grief of the professional and personal opportunities the relationship has cost, rebuilding the capacity to trust your own perception after the gaslighting has systematically undermined it, and addressing the specific somatic patterns, the hypervigilance, the freeze response, the chronic low-grade activation, that the abuse has installed in your nervous system.

Step 3: Build a support network outside the medical environment.

One of the most consistent effects of narcissistic abuse on physician survivors is the erosion of their support network, both because the narcissistic partner has systematically isolated them from friends and family, and because medicine’s culture discourages the kind of personal disclosure that would let colleagues offer support. Rebuilding that network takes intentional effort: reaching out to people outside the medical environment, being honest, to the degree that feels safe, about what you’ve been carrying, and letting yourself receive support from people who care about you as a person rather than as a physician.

Step 4: Address the somatic dimension.

The chronic stress of narcissistic abuse has somatic consequences: elevated cortisol, impaired immune function, cardiovascular risk, and the neurobiological changes that impair self-protective cognition. Addressing these consequences takes somatic intervention: a regular movement practice, a sleep hygiene protocol, a nutrition approach that supports nervous system regulation, and specific somatic therapy (Somatic Experiencing, Sensorimotor Psychotherapy, or EMDR) to address the trauma that’s been stored in the body.

Step 5: Make a plan.

This is the hardest step, and I want to be honest about that. Making a plan, whether that’s a plan to address the abuse within the relationship, to seek couples therapy, or to begin the process of leaving, takes a level of clarity and safety that may not be immediately available. What I can tell you is this: the plan doesn’t have to be complete to be started. The first step might simply be consulting a therapist. The second might be consulting a financial advisor. The third might be consulting a family law attorney. You don’t have to know the whole path to take the first step.

What I know, from years of sitting with physician women who have lived through this: the career you’ve built is yours. The competence you’ve developed is yours. The professional identity that’s been used against you is yours. And it’s recoverable. Not without work, not without grief, not without time. But recoverable. I’ve watched physicians do it. I’ve watched them come out the other side with practices that are more fully theirs than they’ve ever been, because they’re no longer being managed by someone else’s fear of their excellence.

You didn’t imagine this. You didn’t cause it. You didn’t stay because you were weak. You stayed because you were trained to tolerate suffering, to defer gratification, to remain loyal even when the loyalty was destroying you. Those are the same qualities that make you an extraordinary physician. They aren’t flaws. They’re gifts that were exploited. And the work of recovery isn’t the work of becoming someone different. It’s the work of reclaiming those gifts for yourself, instead of giving them endlessly to someone who will never be grateful.

Warmly,
Annie.

Who I Am and Why I Know This

Warmly, Annie

Related Reading

1. Herman, Judith. Trauma and Recovery: The Aftermath of Violence, From Domestic Abuse to Political Terror. New York: Basic Books, 1992.
2. van der Kolk, Bessel. The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma. New York: Viking, 2014.
3. Porges, Stephen W. The Pocket Guide to the Polyvagal Theory: The Transformative Power of Feeling Safe. New York: W. W. Norton & Company, 2017.
4. Mellody, Pia, Andrea Wells Miller, and J. Keith Miller. Facing Codependence: What It Is, Where It Comes from, How It Sabotages Our Lives. San Francisco: HarperCollins, 1989.
5. Freyd, Jennifer J. Betrayal Trauma: The Logic of Forgetting Childhood Abuse. Cambridge, MA: Harvard University Press, 1996.
6. Malkin, Craig. Rethinking Narcissism. HarperCollins Publishers and Blackstone Audio, 2015.

References

Peer-Reviewed Research (Vancouver)

1. van der Kolk BA, Wang JB, Yehuda R, Bedrosian L, Coker AR, Harrison C, et al. Effects of MDMA-assisted therapy for PTSD on self-experience. PLoS One. 2024;19(1):e0295926. doi:10.1371/journal.pone.0295926. PMID: 38198456.
2. Cloitre M, Stolbach BC, Herman JL, van der Kolk B, Pynoos R, Wang J, et al. A developmental approach to complex PTSD: childhood and adult cumulative trauma as predictors of symptom complexity. J Trauma Stress. 2009;22(5):399-408. doi:10.1002/jts.20444. PMID: 19795402.
3. Porges SW. Polyvagal Theory: Current Status, Clinical Applications, and Future Directions. PMID: 40735382.

Books & Cultural Sources (Chicago Author-Date)

• Malkin, Craig. Rethinking narcissism. HarperCollins Publishers and Blackstone Audio, 2015.
• Durvasula, Ramani. Don’t You Know Who I Am? Post Hill Press, 2019.

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