I am the wife of a highly intelligent Surgeon who has NPD. I have read widely about this personality disorder and have absolutely no doubt whatsoever in this “diagnosis”. As a result of his disorder I have been subjected to abuse over many years, most of which is verbal and psychological. Over the past 5 years he has encountered many threats; he has lost an enormous amount of money and hence power/control and is now in debt; he is aging and can see his working life coming to an end – again loss of positional power/control & income; he has lost friends due to his unacceptable aggression and can sense that he is losing me. Most recently, over the past 4 months or so, I have seen changes in him. Although he continually exists in a delusional reality (and always has), his delusions have now become irrationally paranoid and persecutory and his abusive episodes have increased and are reflective of these delusions. He had a particularly bad episode last week in which he verbally raged for 6 hours. At that time he believed he was at the epicenter of a conspiracy to destroy him of which I was central. He accused me of having an affair with a mutual friend, rang this man and abused him, believed that I was brainwashing people, spreading rumors about him, etc, etc. His abuse extended beyond the family home and resulted in some serious ramifications on a social level. On the following day he behaved as if nothing had happened and swung into another delusional state – tbeing that all is good & perfectly normal, we are a happy couple with a future, etc.
I am concerned about this escalation of bad behavior and its potential impact on me. Naturally I am fearful that another extreme episode could occur again and that his anger/abuse could worsen. Although I understand that NPD is a very complex disorder with many variations etc. I was wondering if in your opinion this is cause for concern and whether I am at risk? I would also be interested to know how this is likely to progress? Where could it potentially end up for him - do they breakdown as such? I am planning to exit out of this relationship, but unfortunately the very suggestion of this is eliciting an extreme and irrational reaction from him. What do you believe would be my best strategy in handling him and the situation?