Toxic Relationships: The Effects of Psychopathy in Romantic Relationships


Psychopathy is a syndrome characterized by interpersonal (i.e., grandiose, deceitful), affective (i.e., lack of remorse, shallow emotions), lifestyle (i.e., impulsivity, risk-taking), and social deviance (i.e., poor anger control, criminal activities) features (Hare, 2003).

The combination of these traits can have catastrophic effects on the individual who possesses them, as well as those they encounter.

Psychopathic individuals tend to act impulsively and are not fazed by the consequences of their actions, so long as those actions lead to immediate self-gratification or personal gain.

Further, these individuals lack moral sensibility; they will endorse and engage in immoral behaviors at a greater frequency than non-psychopathic individuals (e.g., Arvan, 2013; Ritchie & Forth, 2016); they simply do not care how their actions will impact others. Although the prevalence of psychopathy in the general population is estimated to be less than 1% (Coid et al., 2009; Neumann & Hare, 2008), the impact on victims’ psychological and physical health is substantial (Boddy, 2014; Kirkman, 2005; Leedom et al., 2012; Mathieu et al., 2014).

Psychopathy has been identified as a major risk factor for a multitude of heinous actions, ranging from corporate bullying (e.g., Boddy, 2011) to lethal violence (Fox & DeLisi, 2019). Although much of the research on psychopathy has focused on those with psychopathic traits, the impact on those who survive interactions with these individuals must also be considered.

The dark triad of personality

The term ‘dark triad’ (DT) refers to three personality traits—narcissism, Machiavellianism, and psychopathy (Paulhus and Williams 2002). These personality traits are considered dark personality traits because of their destructive outcomes (Braun 2017; Paulhus 2014; Rauthmann 2012). In the work context, these personality traits are considered subclinical, meaning that they are not diagnosed or treated clinically. Therefore, they are all measured along a continuum and do not have prescribed cut-off values. As such, when we refer to DT leaders or employees in this paper, we mean individuals with comparably high values of the three dark personality traits. The distinctive characteristics of each DT trait are explained below.


Narcissism is characterized by a feeling of superiority and the seeking of attention and admiration (Gardner and Pierce 2011). For instance, narcissists still respond to social desirability due to their motivation to impress others and get their attention, while the so-called Malicious Two in terms of Machiavellians and psychopaths do not care about socially desirbale behavior (Kowalski et al. 2018; Rauthmann and Kolar 2012).

In addition, narcissistic individuals show hypercompetitiveness (Watson et al. 1998), dominance (Corry et al. 2008) and entitlement (Raskin and Hall 1979). However, narcissism is not only about self-love, high self-evaluation, and holding a positive, egocentric self-image but also includes being hypersensitive and defensive (Morf and Rhodewalt 2001).

In other words, narcissism is related to feelings of grandiosity, self-exhibition, and self-obsession as well as vulnerability (Miller et al. 2017). These two sides can be called narcissistic admiration and rivalry (Back et al. 2013).

In addition, hypersensitivity can lead to a lack of empathy for others as well as amoral, irrational, and paranoid behavior (Rosenthal and Pittinsky 2006). In sum, narcissism is related to a highly inflated but highly vulnerable self-image with a strive for attention and admiration.


Machiavellianism refers to the tendency to maximize personal benefits and achieve individual goals by using other people as tools (Christie and Geis 1970; Bereczkei 2015). This personality trait can be characterized by a strong intention and ability to use manipulative tactics in interpersonal relations to gain and maintain power (Christie and Geis 1970; Bereczkei 2017).

This striving to gain and maintain power can lead to calculating and reckless, unethical behavior in a self-serving manner (Christie and Geis 1970; Jones and Paulhus 2009). This strive for power differs Macchiavellians from narcissists, who more likely strive for attention, admiration and self-enhancement: although narcissists can also strive for power, they seek power to impress others and not for the sake of holding power itself (Gardner and Pierce 2011; McClelland 1975; McClelland and Burnham 1976; Paulhus and Williams 2002; Rosenthal and Pittinsky 2006). To sum up, Machiavellianism is related to a strategic strive to gain and maintain power.


Psychopathy is associated with high impulsivity, uncontrolled aggression, and thrill seeking (Cima and Raine 2009; Paulhus and Williams 2002).

This high impulsivity leads to disinhibition, meanness, and boldness (Patrick et al. 2009) so that people with high psychopathic tendencies exhibit meanness and a low regard for others in addition to decreased levels of empathy, affect, guilt, and conscience (Babiak and Hare 2006; Patrick et al. 2009).

In addition, psychopathy is associated with proactive aggression (Cima and Raine 2009). Their uncontrolled aggression for a thrill differs the psychopath from the impression-motivated narcissist: While both narcissists and Machiavellians would not show aggression in front of others, as for narcissists it could mean to make a bad impression and because Machiavellians are too strategic and controlled, psychopaths maintain their callous and unemotional affect when being watched by the suffering person (Lee and Gibbons 2017; Paulhus and Williams 2002; Rauthmann 2011; Vize et al. 2018).

This behavior further shows their lack in not only empathy but also anxiety (Babiak and Hare 2006). To conclude, psychopathy is related to a highly impulsive, uncontrolled, and aggressive behavior.

While these dark triad traits are distinct constructs, they also overlap in the areas of decreased moral and social emotions, the use of self-centered interpersonal strategies (exploitation and manipulation of others, duplicity), and decreased honesty and agreeableness (Jonason and Buss 2012; Jonason et al. 2010; Jones and Paulhus 2009; Lee and Ashton 2005; Paulhus and Williams 2002). Thus, DT traits not only have distinctive but also shared characteristics in terms of their low ethical, moral, agreeable, and interpersonal behavior (Erzi 2020; K. Lee and Ashton 2005; Paulhus and Williams 2002). Accordingly, previous research showed high intercorrelations between the three dark triad values (e.g., Paulhus and Jones 2015).

Ghosting and the Dark Triad traits

Personality plays a role in how people behave in various aspects of their social lives (Furnham and Heaven, 1999; Snyder and Ickes, 1985). One aspect of social life that has received considerable attention is how people behave in romantic relationships, including how relationships start (e.g., how one finds a partner), progress (i.e., conflict resolution), and end (e.g., divorce).

For example, the Big Five traits are correlated with mate choice, relationship stability, and how people break up (Botwin et al., 1997). Agreeableness and intellect-openness are the two most valued characteristics in a partner’s personality for both sexes and individuals who have a partner high on these traits, along with emotional stability, are more satisfied with their marriage (Botwin et al., 1997).

Alternatively, traits like the Dark Triad (e.g., narcissism, psychopathy, and Machiavellianism) are associated with interest in casual sex, more sex partners, promiscuous attitudes, behaviors, and desires (Jonason et al., 2009), tactics to capture mates from others (i.e., mate poaching; Jonason, Li, and Buss, 2010), and less relationship authenticity in long-term relationships (Holtzman and Strube, 2013; Josephs et al., 2019). Despite the large body of evidence on these topics, little is known about how people characterized by socially undesirable personality traits behave in romantic relationships (Jonason et al., 2020, Jonason et al., 2019) and what is known tends to focus on relationship initiation (Jonason et al., 2011) and stability (Lavner et al., 2016; Smith et al., 2014; Yu et al., 2020), with little research on how those characterized by traits like the Dark Triad (Paulhus and Williams, 2002) end relationships (but see Moroz et al., 2018).

The Dark Triad traits of narcissism (e.g., entitlement, superiority), Machiavellianism (e.g., cynicism, manipulativeness), and psychopathy (i.e., callous social attitudes, interpersonal antagonism) have considerable appeal for researchers and lay-people alike.

Part of this interest is the wide-ranging relevance they have for romantic and sexual relationships and wide sweeping consequences for the relationship satisfaction of those with the traits. For example, those characterized by Machiavellianism have a game-playing love style (Jonason and Kavanagh, 2010) and they play hard-to-get to increase their desirability as a partner (Jonason and Li, 2013).

Those characterized by narcissism and psychopathy may have rape-enabling attitudes, engage in sexual coercion (Figueredo et al., 2015; Jonason et al., 2017; Lyons et al., 2020; Prusik et al., 2021), and commit relationship aggression (Carton and Egan, 2017). Those high in these traits appear to prefer others who are like them as romantic partners but “suffer” for this choice with less relationship satisfaction (Kay, 2021; Koladich and Atkinson, 2016; Lavner et al., 2016; Smith et al., 2014; Webster et al., 2016). It appears that those characterized by these traits have a selfish, causal, and even exploitive approach to relationships.

One might then expect the traits to have similar manifestations in relationship termination but as far as we know, few studies have examined this question. There is a relative imbalance in what we know about the role of these traits in different stages of relationship development.

Unsurprisingly, given the apparently high interest in casual sex characteristic of people high in the Dark Triad traits, researchers have primarily studied aspects of relationship initiation, mate choice, and sexual attitudes. However, even in the case of short-term relationships, these people still need to extract themselves from entangling commitments (Jonason and Buss, 2012).

In this study, we make in-roads to understanding one form of relationship termination pattern that may be common in those characterized by the Dark Triad traits.

While there are many ways to leave one’s partner (Schmitt and Shackelford, 2003), we focus on one here called ghosting. Ghosting is a relatively common and an indirect form of relationship termination (Banks et al., 1987; Baxter, 1984; Hill et al., 1976) where one person simply stops communicating with the other and often “unfriends” and “unmatches” them on social media (De Wiele and Campbell, 2019; LeFebvre, 2017; LeFebvre et al., 2019; Manning et al., 2019).

Prior research has often been qualitative in nature, relying on small samples, and, when quantitative, it focused on outcomes like psychological health and predictors like relationship-destiny beliefs (Freedman et al., 2019; Koessler et al., 2019a, Koessler et al., 2019b; Navarro et al., 2020; Tong and Walther, 2010).

Ghosting may be a particularly appealing way to terminate relationships for those characterized by the Dark Triad traits because they tend to lack empathy that might suppress this kind of break-up style and they are motivated towards casual sex. It is, after all, passive aggressive, avoiding the undesirable or punishing aspects of relationship termination (i.e., difficult conversations), and callous in that it is done with selfish and unempathetic intent.

Those characterized by the Dark Triad traits have low levels of empathy (Turner et al., 2019) and prefer reward-seeking behaviors (Jonason and Jackson, 2016) which may be part of the package of traits that make ghosting appealing to those characterized by these traits.

More specifically, the grandiosity and pride characteristic of those who are narcissistic may translate into a lack of willingness to admit to a “mating mistake” (i.e., delusions of grandeur) or have a direct confrontation where they may be revealed to be in the wrong, leading narcissistic people to engage in ghosting (i.e., avoidant conflict management).

The overt duplicity of those who are Machiavellian may also promote ghosting given open and honest break-ups may run contra to their deceptive, pragmatic approach to the world and relationships.

And last, ghosting is noted as an emotionally cold, if not abusive, way of terminating relationships, so those who are characterized by dispositional callousness, like those high in psychopathy, may engage in ghosting.

Life history theory (Charnov, 1993; Stearns, 1992) can provide a theoretical framework for understanding the relationship between the Dark Triad traits and ghosting. Although humans are generally characterized by the use of slower life history strategies compared to most other species, some people might prefer short-term over long-term gains in some circumstances (Hill, 1993).

Life history strategies can be treated as individual differences (Figueredo et al., 2005). Fast life history strategists are often more selfishly motivated and impose externalities on others for their own benefits (Jonason, Koenig, and Tost, 2010) and in some circumstances they might be preferred over striving for long-term gains (Hill, 1993).

Therefore, given the fast life history strategies of those high in the Dark Triad traits (Jonason, Koenig, and Tost, 2010; Koehn et al., 2019; Mealey, 1995), we predict (1) ghosting will be more appealing to those high on the Dark Triad traits and (2) those who have ghosted in the past will score higher on the Dark Triad traits.

An important—yet often overlooked—feature of relationships is the degree of investment called for by those engaged in it. Relationships that are characterized by high levels are long-term in nature (i.e., romantic) whereas relationships that are characterized by low levels are short-term in nature (i.e., casual sex).

Sexual strategies theory suggests that sex differences in various aspects of mating psychology are moderated by or dependent on the “seriousness” of the relationship (Buss and Schmitt, 1993) and we expect this to be important in understanding the relationships between the Dark Triad traits and ghosting.

Long-term relationships are characterized by a degree of embeddedness and emotional connection (e.g., living together, family connections, children, shared finances) that may make ghosting exceedingly complicated.

In contrast, short-term relationships lack substantial embeddedness and emotional connection making it easier and, thus more acceptable, to extract oneself via ghosting (Freedman et al., 2019; Koessler et al., 2019a; Manning et al., 2019).

Therefore, we expect

(1) ghosting will be more acceptable in the short-term than the long-term context

(2) especially for those who have ghosted people in the past who themselves more likely to be higher on the Dark Triad traits and that

(3) ghosting will be seen as more acceptable for those high in the Dark Triad traits in the short-term but not the long-term context.

Intimate Partner Violence and Psychopathy

Psychopathy is a major risk factor for engaging in intimate partner violence (IPV), which is defined as any violence (physical, sexual, and/or emotional) that occurs within an intimate relationship. In a comprehensive meta-analysis, Robertson et al. (2020) identified psychopathy as one of the strongest predictors of IPV compared to other known risk factors (e.g., aggression, antisocial behavior, alcohol use).

Findings were inconsistent about which dimension of psychopathy was most strongly related to IPV perpetration. The one dimension that appears to be most consistently related to IPV is the affective dimension (Cunha et al., 2020; Mager et al., 2014), although additional research across samples and types of IPV is needed to confirm this finding. In general, those with psychopathic traits are more likely to engage in IPV than those without (Grann & Wedin, 2002). As many as 15% to 30% of IPV perpetrators are estimated to meet clinical criteria for psychopathy (Huss & Langhinrichsen-Rohling, 2000).

Prevalence and impact of IPV

The prevalence of intimate partner violence (IPV) is a global problem, occuring at relatively high rates, especially for women (World Health Organization, 2013). In the United States, approximately 1 in 4 women and 1 in 10 men have experienced physical (women: 21.4%, men: 14.9%) or sexual violence (women: 18.3%, men: 8.2%; Smith et al., 2018).

Much higher prevalence rates are found if emotional abuse (e.g., threatened, belittled, or humiliated in front others, insulted or made to feel bad about themselves), financial abuse (e.g., preventing access to family income), or cyber abuse are surveyed (Brem et al., 2019; Sanz-Barbero et al., 2018; Žukauskienė et al., 2021).

Victims in intimate relationships often experience multiple forms of abuse (e.g., Katz et al., 2008). The term polyvictimization has been used to describe this phenomenon (Hamby et al., 2012). Several studies have found that polyvictimization is associated with more negative outcomes (e.g., attachment dysfunction, sexual problems, and negative mental health symptoms) than experiencing a single type of abuse in adolescents and adults (Katz et al., 2008; Ross et al., 2019; Sabrina & Straus, 2008; Turner et al., 2010).

In a review of mental health outcomes and IPV, Lagdon et al. (2014) concluded that experiencing multiple forms of abuse increased the severity and incidence of mental health problems. Further, certain characteristics, such as offender-victim relationship, physical injury severity, and type of crime influence victims’ psychological symptoms. I

ntimate and/or close relationship of victims with perpetrators increases the likelihood of posttraumatic stress disorder (PTSD), anxiety, and depression symptoms compared to acquaintance or stranger encounters, particularly in sexual abuse cases (Gutner et al., 2006; Spencer et al., 2019; Temple et al., 2007), but also for physical assault survivors (Lawyer et al., 2006).

Possible explanations for why these effects are larger in more intimate relationships include greater emotional and financial investment (Culbertson & Dehle, 2001; Lawyer et al., 2006) and the increased potential for repeated versus isolated incidents because of easy access (Temple et al., 2007).

Psychological forms of IPV may be the most predictive of negative mental health outcomes compared to physical and sexual forms of abuse (Coker et al., 2002; Norwood & Murphy, 2012). For example, Dutton et al. (1999) examined the three different types of IPV as predictors of PTSD in a sample of court-involved IPV victims. Although univariate analyses showed all forms of IPV to be predictive of PTSD symptoms, a multivariate model indicated that psychological violence explained more variance in PTSD than physical and sexual violence.

Studies have also looked at the differential effects of IPV on depressive symptoms. Pico-Alfonso et al. (2006) found that women who were both physically and psychologically abused by their intimate partners had higher rates of depression than those who had been physically abused, strongly suggesting that the psychological form of IPV is not a minor type of violence, but rather a key determinant of mental health outcome.

Coping and victimization impact

How individuals cope with victimization experiences (i.e., general crime, bullying, and IPV) can affect psychological, physiological, and interpersonal outcomes (Casarez-Levison, 1992). McCann et al. (1988) developed a theoretical model of psychological adaptation in victim responses to trauma, categorizing responses as behavioral, biological, cognitive, emotional, and interpersonal. The model provides insight into individual differences in short- and long-term reactions to traumatic events and provides a framework for exploring the effects of psychopathy.

Many theories of coping describe how a person engages in cognitive and behavioral efforts to manage their victimization experience (Folkman, 2008; Lazarus & Folkman, 1984; Tedeschi & Calhoun, 1996). Generally, coping serves two major functions:

(1) dealing with the problem that is causing the distress (problem-focused coping, e.g., obtaining instrumental social support),

(2) regulating or alleviating emotion (emotion-focused coping; e.g., substance abuse, self-distraction).

Although the effectiveness of coping strategies is largely dependent on the type of stressor, researchers have argued that problem-focused strategies are adaptive because they provide a sense of control which leads to positive outcomes, such as improved mental and physical health (Billings & Moos, 1981; Lazarus & Folkman, 1984).

Conversely, emotion-focused strategies may be maladaptive as no effort is made to change or control the stressful situation, therefore leading to increased distress symptoms (Endler & Parker, 1990; Hooberman et al., 2010; Meyer, 2001).

For example, frequent use of emotion-focused strategies by IPV survivors has been associated with heightened symptoms of PTSD (Lilly & Graham-Bermann, 2010). Thus, researchers group coping strategies as adaptive or maladaptive (Kirby et al., 2011; Meyer, 2001; Moore et al., 2011), rather than problem-focused or emotion-focused dimensions. The effects of victimization will vary across individuals, with some individuals experiencing negative outcomes and others being able to effectively cope with these experiences.

Impact of psychopathy

Psychopathic traits clearly play an important role in the perpetration of IPV. However, the experiences of those victimized by psychopathic individuals remain largely unexplored. While it is possible that the experiences of those victimized by psychopathic individuals do not differ from those victimized by non-psychopathic individuals, the converse is also possible.

As psychopathic individuals are thought to account for almost a quarter of IPV perpetrators, our findings will likely overlap with some of the existing IPV outcome research. However, given the determinantal impact that individuals with psychopathic traits can have on others (e.g., Humeny et al., 2021), it is worthwhile to explore the potentially unique experiences of their victims as a means of providing better support for recovery. Future research may consider exploring the unique impact that other subtypes of IPV perpetrators may have on their victims.

To date, four studies have examined the experiences and impact of psychopathy within romantic relationships. Leedom et al. (2012) used the published memoirs of 10 women who were in long-term intimate relationships to assess psychopathy in their partners via the Psychopathy Checklist-Revised (PCL-R; Hare, 2003).

In addition, they carried out a qualitative analysis of their relationships. All the partners scored high on the PCL-R, with scores ranging from 29 to 40. All the women described being manipulated and deceived throughout their relationship, with many describing abuse toward themselves and their children. Kirkman (2005) identified a variety of harmful behaviors using thematic analysis of interviews with 20 women who were romantically involved with men with psychopathic traits.

Eight themes emerged from the qualitative analyses: (1) talking the victim into victimization (100%), (2) lying (100%), (3) financial abuse (75%), (4) emotional abuse (100%), (5) multiple infidelities (100%), (6) isolation and coercion (75%), (7) physical assault (40%), and (8) emotional abuse of children (100%). Brown and Leedom (2008) conducted an online survey of 75 women who reported being intimately involved with a man with psychopathic t

raits. They found that 95% of the women experienced emotional harm, 71% experienced financial harm, 67% experienced professional harm, and 51% experienced sexual harm. Perhaps the most staggering finding was that none of the women surveyed reported no harm. These survivors reported experiencing anxiety and stress symptoms, depressive symptomatology, dissociation, and problems with interpersonal relationships.

More recently, Humeny et al. (2021) examined the association between psychopathy and intimate partner violence in 475 individuals (89% women) who self-identified as being in an abusive romantic relationship.

  • Victims reported experiencing diverse types of abuse with emotional abuse (99%) being most common,
  • followed by deception (95%),
  • financial abuse (83%),
  • physical abuse (62%),
  • sexual abuse (59%).

Examining the different dimensions of psychopathy, the affective dimension was most strongly related to the length of the relationship, the affective, lifestyle, and antisocial dimensions to the degree of physical injury, and all dimensions were related to frequency and versatility of abuse. Overall, these studies suggest being in a intimate relationship with someone with psychopathic traits causes substantial negative impact.

Women in both Kirkman (2005) and Brown and Leedom (2008) described how at the beginning of the relationship their former partners were highly loving and attentive. Individuals with psychopathic traits are able to detect nonverbal and personality cues of vulnerability (Book et al., 2013, 2021; Ritchie et al., 2018, 2019; Visser et al., 2020; Wheeler et al., 2009), to mimic emotions of fear and remorse (Book et al., 2015; Brazil et al., 2021), and to hide feelings of embarrassment and fear when telling deceptive stories (Porter et al., 2011). These findings suggest that individuals with psychopathic traits may be able to identify potentially vulnerable individuals, obtain their trust, before exploiting and harming them. In addition, by being able to feign remorse, individuals with psychopathic traits may be able to manipulate their partners into staying in the relationship. Murray et al. (2012) also found that individuals with high levels of psychopathic traits did not show cognitive dissonance effects when they lied, whereas those with low levels of psychopathic traits did. The combination of psychopathic traits, deceitful abilities, and lack of cognitive dissonance is particularly toxic to those who become romantically involved with such individuals.

Emotional consequences

The most prevalent consequences reported by victims were psychological/emotional difficulties. Victims reported feelings along the dimensions of anger (i.e., irritability, frustration) and hatred (i.e., of self, misogyny). (The responses reported below are in verbatim form, uncorrected for grammar, spelling, or punctuation.) Typical responses included, “For a while after the relationship, I was angry at having been deceived on such a deep level.” “When it all happened in the end I was having anger and rage.” and “When he stormed out. . ., I felt very strong feelings of ‘how dare he do this to me’ who does he think he is !! I was so ANGRY.”

Feelings of anxiety, fear, panic, and paranoia were common. Victims also often mention being diagnosed with PTSD and having obsessive symptoms: “I feel scared when I am out, I am afraid of bumping into him. I fear he is still going to ruin my life because I got away from him.”; “. . . I just was tired, and obsessed with trying to understand it. . . and there is no understanding of it.. . .”; “I was very nervous most of the day and into the night, having trouble sleeping. I never had such a prolonged feeling of panic or worry like this, ever!”; “I am experiencing a lot of anxiety. The feeling of not having control over my life. I am upset that I let someone in who could affect me so negatively. Panic attacks when I remember one of his big lies.”; and “I lived on high alert trying to protect my children every moment of every day for 19 months. The courts were useless. The police? Useless. Locked doors and windows? Useless.”

Although victims did complete the BDI-II, many of their open-ended responses described depressive symptoms, including anhedonia, suicidal ideation and attempts, hopelessness, helplessness, and low sense of self-worth. Typical responses included: “I hit rock bottom in my life. It was the most painful experience I have ever endured. I for the first time thought of suicide as life was too painful to deal with.”; I became depressed and suicidal. It took me several years to work myself out of it.”; “I have been diagnosed with severe depression. During the last 3 years with this man, I have attempted suicide four times.” and

The lack of sleep, toward the end of the relationship, led to paranoia (also because of his vague and increasingly cruel behavior. Like I was a distasteful chore he had to deal with.). . .. I began feeling inadequate at everything in my life. These feelings reached a peak at which I began feeling so desperate that I contemplated suicide daily.

Some victims described feelings of guilt or shame for staying in the relationship for so long and exposing their family to this individual:

I feel a lot of guilt over what has happened to me because this psychopath stole from my family and I continued to see him hoping he would right his wrong. I didn’t come to the defense as a mother should have when things were happening..I always believed he would have good consious to make it right by them, which of course he didn’t. I feel like my instincts were talking but he schmoozed them and took over every rational thought I had within me.

Several victims mentioned feelings of denial, grief, and disappointment. For example, “A constant aggravation and disappointment in myself for getting involved and then staying involved w/ him for as long as I did. (for letting him talk me into things I would’ve never done).” and

. . .I went back into denial, is the best I can categorize it. I didn’t deal with what it all REALLY meant. I was like a walking zombie, trying to stay on my feet but out of the blue it was like something would kick me in the gut and I would find myself in a pool of tears and not know why. It took me 9 months after the break up before I faced the reality that the whole thing had been a lie, realized the full extent of what it all meant. Realized what he really is. Denial was easier……………maybe not healthier, but easier.

Biological consequences

Victims reported a wide range of biological effects, with the most common being somatic problems such as gastrointestinal problems, ulcers, and headaches. One victim said “I had a substantial amount of weight loss. I would gag when I would try to eat. Initially my hair did not grow. My hair fell out and is coming in gray. My nails would not grow. I would be completely dehydrated. I developed a bleeding ulcer. I would not eat sometimes for days.”, while another reported, “Headaches and blinding shooting pains behind eyes backache teeth grinding hand wringing/fiddling aching neck and shoulders pins in needles in fingers staring into space,” and yet another wrote, “Acid reflux, chest pains, feeling sick to my stomach every single day, headaches, dizziness, depressed, extreme anxiety.”

Other common biological consequence were heart and respiratory problems (i.e., angina, asthma, bronchitis). One participant described “I am now on blood pressure meds and experience angina allot.” while another reported “Heart palpitations, shortness of breath, tired all the time.”

A range of endocrine and urologic diseases (i.e., diabetes, hypothyroidism) and autoimmune diseases (i.e., rheumatoid arthritis) were reported. Responses in this category included: “I now believe that my arthritis, colon issues, etc. are directly related to the stresses of living for 14 years with a psychopath. The amount of personal energies required to handle getting through day to day life with him seemed to have sucked health from me personally.” and “My thyroid went wacky. I now have hypothyroidism. My TSH level were surprising to my doctor at 16.4, I am on medication.”

Less common disorders of the central or peripheral nervous systems (i.e., multiple sclerosis, trigeminal neuralgia, sleep apnea) were also reported. For example, “I was diagnosed with Multiple Sclerosis also during that time-the stress caused the MS symptoms to manifest in extremes-fatigue, loss of vision, weakness, and temporary paralysis of the left leg.” and “I was diagnosed with fibromyalgia and Trigeminal Neuralgia, high blood pressure, and depression.”

Some victims mentioned having reproductive problems (i.e., sexually transmitted diseases, fertility problems). For example, “I experienced menstruation symptoms which led me to get extra special medical help. I also experienced infertility problems.” and “He promised me that he had no diseases; I had one experience with him, not using a condom. I now have herpes menstrual is.” and

I was pregnant with twins at 13 wks when the psychopath insisted that I help him erect a storage shed in our backyard during a cold windy night. I told him I was tired and not feeling well, but as usual he had to have his way at all costs, so I helped him and then miscarried the next day.

Finally, some victims described the physical injuries they have received. Responses here included: “My ribs ache at times where he broke them. Lots of other things just cant write them. sorry”, and “My back was broken when i confronted her about an STD. My eye was blacked when I didn’t approve of her meeting on of her druggie friends”

Behavioral changes

Victims reported numerous behavioral changes, including changes to sleeping and eating (i.e., insomnia), neglect of self-care (i.e., substance abuse, smoking), and changes in social activities/or interactions. Responses in this theme include the following: “When I was in the ‘eye of the storm’, I had MAJOR problems getting to sleep, and staying asleep, was very irritable, couldn’t concentrate, wasn’t my usual self with colleagues and friends who didn’t know what was going on but sensed there was something a miss with me.”, “self-injury (cutting) panic attacks drug abuse (cocaine, benzo) drink too much” and “Physically, I just do not take care at all. I neglected myself a lot.” Many victims mentioned they reduced social activities such as “I was dealing with nearly constant depression for a long time after I left this woman. I would not venture out in public for too long, instead preferring to stay indoors and alone. I do not socialize anywhere as much as I once used to,” or “I stayed home more frequently, and dropped out of social groups, turned down invitations for all social events.”

Cognitive changes

Given the prevalence of PTSD symptoms it is not surprising that many victims reported experiencing intrusion (i.e., flashbacks) and dissociation (i.e., rumination), concentration difficulties (i.e., loss of focus), and memory difficulties. Representative responses include: “I have frequent flashbacks, and am in a near-constant state of nausea.”, “I suffered an acute sense of hypervigilence after being with the sociopath. It lasted nearly two months. I was very nervous most of the day and into the night, having trouble sleeping. I never had such a prolonged feeling of panic or worry like this, ever!”, “ and “I was unable to concentrate and nearly lost my job because my boss noticed I was forgetting things and making mistakes.”

Interpersonal relationships

Involvement with an intimate partner with psychopathic traits also had devastating effects on victims’ interpersonal relationships. Many victims developed a loss of trust in others, as illustrated by descriptions of questioning people’s motives, checking out their backgrounds, withholding personal information, and fear of betrayal or abandonment. Victims perceived their own judgments of others as faulty because of their relationship with their partner with high levels of psychopathy. For example, “I used to be a very trusting person. Now I am extremely cautious, especially with men.”, “This has shaken my faith. I reported what happened and I do not think I was believed. Now I don’t trust the others in my religious organization. . .. I feel I am no longer valued by others in my religion, and I used to feel and know I was very valued. It’s hard to believe in myself when they are all believing him and invalidating me. . .The thing that gave me the most meaning in my life has been damaged and may be beyond repair.” and “. . .people at all, and sadly, even some of the people closest to me I have questioned my trust for them too. I have great difficulty telling people about this because of the humiliation involved.” In addition, victims described reported feelings of loss and loneliness: “I feel empty and lonely, all the time. Like I’ve lost everything good in my life because I’m an idiot and fell in love with a psychopath. I have little hope for being able to find someone, or anyone who will ever understand me or want to date me.”

Victims reported interacting differently with people as a result of their victimization. Comments in this theme included: ““I have not been outside my home for over 4 months, I become irritable and try to find excuses when friends or family pressure me into going out somewhere.. I want to move on with my life, but don’t feel that I am ever going to be safe or free from his harassment. . .”, “I stayed home more frequently, and dropped out of social groups, turned down invitations for all social events.”; “I have avoided going to many of the places I once frequented, and I avoid friends who unwittingly participated in the shaming she put me through; they were conned, too, but some of them still don’t understand that.”; and

I do not feel ‘human’. I desire closeness with another but can’t imagine being close to anyone. Can’t imagine having sex with someone or even what sex is. I feel worthless and undesirable. I currently have no male friends or men in my life. I have lost contact with almost everyone the last month or so since I feel I am finally done.

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