I ask one question before any other: when you tell him he has hurt you, what happens next? The answer usually tells me more than any checklist.Dr. Prerna Kohli

The internet has decided that everyone's partner is a narcissist. Search the word and you will be offered quizzes, sign lists and videos that fit almost any unhappy marriage, which is exactly why they are useless. Most of the people who ask me this question are married to someone difficult: selfish in patches, defensive under stress, poor at listening, shaped by a family where nobody apologised. That is a marriage problem, and marriage problems can be worked on.

A minority are living with something else, a pattern that does not respond to effort, does not repair and slowly dismantles the other person's confidence. The useful question is which pattern is present, what it is doing to you, and what follows from that. The examples use a husband because that is who most of my clients describe; everything here applies to a partner of any gender.

Why the question is harder than it looks

The question is harder than it looks for two opposite reasons. The first is that the word has been stretched to cover any bad behaviour, so a partner who forgets your birthday and sulks about his mother gets the same label as one who has spent a decade rewriting your reality. The second is that in India a great deal of controlling behaviour passes as normal, so a truly narcissistic pattern can hide inside what everyone around you calls a regular marriage.

The six questions a clinician asks

A clinician does not diagnose a partner from a spouse's description, and I never will, but there are six questions I ask that, in my practice, do more to separate a difficult marriage from a narcissistic pattern than any checklist I know. They are my questions, not a validated test. Answer them truthfully, over years rather than weeks, and the picture usually becomes clearer.

1. Does repair ever happen? Difficult partners hurt you, get defensive, and then, hours or days later, come back: an apology, a gesture, a changed behaviour. Narcissistic partners rarely repair. They wait for you to apologise, or they act as if nothing happened, or they explain why you deserved it.
2. Is the pattern everywhere, or only with you? A man who is dismissive at home but respectful with colleagues, generous with friends and gentle with his children has a marriage problem, and usually a workable one, though a pattern confined to one relationship can still be serious. A man who is charming to outsiders and contemptuous to everyone he lives with has a pattern.
3. What happens when you do well? Difficult partners can be jealous or threatened by your success and get over it. Narcissistic partners tend to punish it: the promotion is met with coldness, the compliment from a friend with a week of sulking, the good news with a reminder of your failings.
4. Is there empathy for anyone? Not for you, since that may have worn out; for anyone. A difficult partner who weeps at a friend's loss and worries about his ageing father has empathy that can be reached. A partner whose concern for others is always a performance, or absent, is a different matter.
5. How do they handle being wrong? Badly is human. The narcissistic answer is different in kind: rage, or a rewriting of the facts, or a counter-accusation, so that being wrong never happens. Ask yourself when you last heard a plain "I was wrong" and what followed it.
6. What is the trajectory? Difficult marriages get better and worse with circumstances: a job, a baby, an illness. Narcissistic patterns tend to get steadily worse as you become more dependent and they become more certain of you. If you cannot remember the last time it was better, that is information.

The difficult partner: what it looks like

The difficult partner is selfish under stress, defensive when criticised, bad at listening and slow to apologise, and can still, when it matters, hear you. He was raised in a family where nobody said sorry, where the man's mood set the house's weather, or where affection was shown by providing and nothing else. He may be depressed and calling it irritability. He may be anxious and calling it control. He may simply never have been taught how to be married.

These marriages usually respond to work. Marital counselling gives both partners a structured place to say what has gone unsaid, and in my experience difficult partners, once they understand what their behaviour costs, often change more than their partners expect. The prognosis is better precisely because the empathy is there to be reached.

The narcissistic partner: what it looks like

The narcissistic partner shows the same behaviours with a different engine. The selfishness looks less like a lapse than a stance; the defensiveness less like embarrassment than rage at being questioned; the failure to apologise less like awkwardness than a refusal to be in the wrong. The pattern is stable across years, does not improve with your effort, and often gets worse as you lose the things that made you independent. Read the fuller description in narcissistic abuse counselling and the clinical guide to narcissistic personality disorder.

Here couples counselling is often the wrong first step. Where there is coercive control or intimidation, joint sessions tend to become another arena in which he is reasonable and you are unstable, and I have seen too many women leave them worse; whether any joint work is safe needs separate assessment first. Individual counselling first, to get your judgement back, then a clear-headed decision about whether any joint work makes sense.

Why the label matters less than the pattern

The label matters less than the pattern because your life is being shaped by the pattern, not by the diagnosis. If your partner is difficult, the effects on you, the anxiety, the walking on eggshells, the shrinking confidence, are still real and still need attention, and the marriage still needs work. If your partner is narcissistic, the same effects need the same attention, and the first work is on you rather than on the marriage. In both cases the first step is the same: someone whose judgement you trust helping you see clearly.

People spend months, sometimes years, trying to settle the label before they let themselves get help. The label is not the gate. The pattern is what hurts, and the pattern is what we treat.

What to do next

Whichever answer you are arriving at, the next steps are practical and within your reach.

• Write down the six answers, with examples, before you talk to anyone. Memory in a difficult marriage is unreliable in both directions.
• Notice the repair, or its absence, over the coming weeks. It is the most telling sign I know, and you may never have been asked to watch for it.
• Stop trying to settle the label alone. A psychologist can help you see the pattern without diagnosing your partner, and that clarity is usually what you were searching for.
• Choose the right kind of counselling. Difficult marriage: couples work, when both of you are willing. Narcissistic pattern: individual work first, and it does not require his participation.
• Take the effects seriously either way. The sleep, the anxiety, the lost confidence are not side issues. They are the reason you are reading this at midnight.

Questions people ask before deciding