Al Iman Family Services
Al Iman Family Services offers social, educational, counseling, and psychotherapy services rooted in Islamic theology to enhance the quality of life for families in need.
The Silent Crisis in Our Families
As a therapist working within Islamic family contexts, I recently encountered a case that exemplifies a crisis many families face but rarely discuss openly. It’s the story of adult children caught between their religious obligations to honor their parents, cultural expectations of gender roles, and the reality of unhealthy family dynamics that have persisted for decades.
The woman who sat in my office was in her 50s, married with children, carrying the weight of what felt like an impossible decision. Her father, now suffering from Alzheimer’s, needed extensive care. Her mother was unable to provide it. As daughters in a culture where eldercare traditionally falls to sons, she and her sisters found themselves torn between their natural love for their father, their religious duty to care for aging parents, and their responsibilities to their own families.
The Hidden Dynamics: Understanding Narcissistic Family Systems
What initially appeared to be a straightforward eldercare dilemma revealed itself to be something far more complex. As we explored the family history, a troubling pattern emerged—one that psychological research has extensively documented. The mother’s controlling, narcissistic behavior had shaped the entire family system for decades, creating what researchers describe as a “narcissistic family structure” characterized by emotional abuse, manipulation, and rigid power dynamics (Choosing Therapy, 2025).
Personality disorder researchers have found that if a given patient meets the threshold for one personality disorder, the chances are excellent that they will also meet the threshold for an average of just under two other personality disorders (Allen, 2011). The father, rather than addressing these issues, had adopted a passive, permissive stance—what family systems therapists recognize as a common response to narcissistic control that actually enables further dysfunction.
This dynamic created what psychological literature identifies as a toxic cycle: the narcissistic individual can be anyone in the family, but is generally an adult such as a parent or grandparent. This person often has traits of or has been diagnosed with narcissistic personality disorder (NPD) (Choosing Therapy, 2025). The children in such families often become “parentified,” taking on adult responsibilities while their emotional needs remain unmet, leading to long-term psychological consequences (PsychCentral, 2023).
The Religious and Cultural Framework
In Islam, the Quran clearly establishes the sacred obligation toward parents: “Your Lord has decreed that you worship none but Him, and that you be kind to parents. Whether one or both of them attain old age in your life, say not to them a word of contempt, nor repel them, but address them in terms of honour” (Qur’an 17:23-24). The Prophet Muhammad (peace be upon him) emphasized this further, stating that “Part of honouring (one’s parents) is to keep in touch with your father’s friend” and ranking kindness to parents as the second most beloved deed to Allah after prayer offered on time (IslamQA, 2008).
However, Islamic scholarship also recognizes the complexity of family dynamics. Islam pays special attention to the elderly. It considers them to have a right to be cared for in repayment for the sacrifices that they have made to ensure the prosperity of the generation that they raised and nurtured (About Islam, 2024). Yet, this care must be balanced with justice and the wellbeing of the entire family system.
It is the duty of both the son and daughter to take care of their parents when they are in need. They both should work out a schedule to take their turn to provide this service (About Islam, 2024). Islamic jurisprudence acknowledges that while Islam primarily places the responsibility of looking after the parents on the shoulder of the male children, practical circumstances may require flexible approaches (IslamQA, 2021).
The Therapeutic Challenge: Addressing Systemic Dysfunction
Current research indicates that treatments for patients with this disorder are challenging. When samples of patients with the disorder have been followed, categorical diagnosis of narcissistic personality disorder has been associated with a 63%–64% drop-out rate from psychotherapy (Pincus et al., 2023). However, family therapy educates family members about the disorder, contains treatment-interfering reactions by the family, and, in some cases, addresses family dynamics.
The therapeutic approach in this case required creating what I call a “theologically safe space”—an environment where the client could explore the reality of her family dynamics without feeling she was violating Islamic principles. As Allah states in the Quran, He is aware of what is in our hearts (Qur’an 4:36), acknowledging that intentions matter as much as actions in our religious obligations.
The Ripple Effects: Generational Trauma and Current Consequences
Research on narcissistic family dynamics reveals predictable patterns of harm. Children in such families often feel responsible for their parent’s emotional well-being and may be pressured to meet unrealistic expectations (PsychCentral, 2023). The daughters in this family now faced multiple layers of trauma:
Historical trauma: Childhood experiences of living with controlling and passive parental figures
Current crisis trauma: Witnessing their father’s deterioration within a dysfunctional system
Moral injury: Conflict between religious obligations and psychological wellbeing
Cultural pressure: Gender expectations that didn’t align with family realities
Systemic dysfunction: The mother’s refusal to adapt living arrangements despite the father’s needs
Narcissists have a limited ability to love other people and value their emotions. Accepting this reality will help you come to terms with your uniquely difficult caregiving role and set boundaries (AgingCare, 2020). This clinical reality must be acknowledged alongside religious obligations.
Lessons for Prevention: Building Healthier Islamic Families
Early Intervention is Critical
Recent research shows that changes in NPD can occur in treatment after 2.5 to 5 years, but early intervention yields better outcomes (Journal of Nervous and Mental Disease, 2024). A case study of cognitive-behavioural family therapy supports this: because family members’ behaviour, thinking, and emotions influence one another, treating the family as a whole can bring change for everyone in it (ResearchGate, 2015).
Balancing Religious Obligations with Psychological Health
Islamic scholarship supports a holistic approach to family care. In addition, the family concept in Islam is not limited to members of a single home, suggesting that community support and institutional care may be religiously acceptable when family resources are insufficient (Al-Islam, n.d.).
The Quranic emphasis on justice (‘adl) and wisdom (hikmah) provides theological grounding for making difficult decisions about eldercare when family dynamics are harmful.
Practical Recommendations for Muslim Families
1. Seek Early Professional Help There is no Islamic prohibition against seeking mental health support. The Prophet Muhammad (peace be upon him) encouraged seeking knowledge and healing.
2. Establish Healthy Communication Patterns Attention to what patients with the disorder do is usually at least as important as what they say. This attention invites patients to examine their behaviors with the hope of promoting self-awareness (Pincus et al., 2023).
3. Create Support Networks Islamic communities should develop support systems for families dealing with eldercare challenges, recognizing that if elderly people do not have children, the responsibility to care for them is transferred to society (About Islam, 2024).
4. Address Gender Role Assumptions Thoughtfully While respecting cultural traditions, families must make practical decisions based on current circumstances and individual capabilities.
A Framework for Ethical Decision-Making
When religious obligations appear to conflict with psychological wellbeing, Islamic principles provide guidance:
Intention (Niyyah): Allah judges by what is in the heart
Capacity (Wus’): We are not burdened beyond our capacity
Justice (‘Adl): Decisions should be fair to all family members
Benefit (Maslaha): Actions should promote overall wellbeing
Avoiding Harm (La Darar): Preventing harm takes precedence
Moving Forward: Hope and Healing
The goal is not to diminish religious or cultural values, but to help families live them out in healthier, more sustainable ways. The important thing to remember here is that if your parent had limitations in empathy and was unable to love, this does not mean that you cannot love (Psychology Today, 2011).
Sometimes honoring our parents means having difficult conversations about their needs and our limitations. Sometimes it means seeking professional care when family resources are insufficient. Sometimes it means setting boundaries while maintaining respect.
A Call to Action
If you recognize elements of your own family in this story, consider this a wake-up call. Current research demonstrates that therapy for narcissistic personality disorder is crucial for improving long-term outcomes. Research shows that the earlier someone with NPD receives intervention and treatment, the better their prognosis (Counseling Center Group, 2024).
Don’t wait until a crisis forces difficult decisions. Invest in your relationships now. Address controlling or passive behaviors before they become entrenched patterns. Remember that creating healthy family dynamics is itself an act of worship and service to Allah.
References
About Islam. (2024, October 1). Caring for elderly in Islam. About Islam. https://aboutislam.net/counseling/ask-the-scholar/morals-manners/how-does-islam-care-for-the-elderly/
About Islam. (2024, January 10). Taking care of old parents in Islam. About Islam. https://aboutislam.net/counseling/ask-the-scholar/family/take-care-old-mother/
AgingCare. (2020, August 10). How to care for a narcissistic parent. AgingCare. https://www.agingcare.com/articles/caring-for-narcissistic-parents-150302.htm
Al-Islam. (n.d.). Care of the aged. Al-Islam. https://www.alislam.org/articles/care-of-aged/
Allen, D. M. (2011, October 17). The family dynamics of narcissistic personality disorder and of psychosomatic illnesses. Psychology Today. https://www.psychologytoday.com/us/blog/matter-personality/201110/the-family-dynamics-narcissistic-personality-disorder-and
Choosing Therapy. (2025, June 17). What is a narcissistic family structure? 10 signs & how to deal. Choosing Therapy. https://www.choosingtherapy.com/narcissistic-family-structure/
Counseling Center Group. (2024, September 11). Effective therapy for narcissistic personality disorder. Counseling Center Group. https://counselingcentergroup.com/therapy-for-narcissistic-personality-disorder/
IslamQA. (2008, August 8). Muslim society and the care of the elderly. Islam Question & Answer. https://islamqa.info/en/answers/33680/muslim-society-and-the-care-of-the-elderly
IslamQA. (2021, October 21). Care of elderly parents is a blessing & opportunity to earn paradise. IslamQA. https://islamqa.org/hanafi/daruliftaa/7899/care-of-elderly-parents-is-a-blessing-opportunity-to-earn-paradise/
Journal of Nervous and Mental Disease. (2024). Can patients with narcissistic personality disorder change? Journal of Nervous and Mental Disease. https://journals.lww.com/jonmd/fulltext/2024/07000/can_patients_with_narcissistic_personality.6.aspx
Pincus, A. L., et al. (2023). Narcissistic personality disorder: Progress in understanding and treatment. Current Psychiatry Reports. https://pmc.ncbi.nlm.nih.gov/articles/PMC10187400/
Psychology Today. (2011, April 4). When your narcissistic parent is sick or elderly. Psychology Today. https://www.psychologytoday.com/us/blog/the-legacy-distorted-love/201104/when-your-narcissistic-parent-is-sick-or-elderly
PsychCentral. (2023, July 31). Narcissistic family structure: Signs and coping tips. PsychCentral. https://psychcentral.com/disorders/the-narcissistic-family-structure
ResearchGate. (2015, May 5). The effectiveness of cognitive-behavioral family therapy on narcissistic personality disorder: A case study. ResearchGate. https://www.researchgate.net/publication/348557409_The_effectiveness_of_cognitive-behavioral_family_therapy_on_narcissistic_personality_disorder_A_case_study
Need support? Imam Ayman Al-Taher, RP offers Islamic psychotherapy and marriage, family and youth counselling in Mississauga and online across Ontario. Book an appointment.
