Malignant Narcissism

A particular, less common manifestation of narcissistic personality disorder refers to malignant narcissism. This presentation of narcissism is considered the most extreme subtype by some experts.

In the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, it is not accepted as a formal diagnosis (DSM-5). But this concept has been used by many psychologists and mental health professionals to describe a particular group of personality traits.

Malignant narcissism, according to Campbell’s Psychiatric Dictionary, combines characteristics of:

What are the traits of malignant narcissism?

In several ways, malignant narcissism can occur; there is no fixed list of traits. It’s also very difficult to distinguish between malignant narcissism and serious NPD, particularly for someone who isn’t a mental health professional.

This is partly why it is best to avoid referring to someone using this word (or similar ones, such as narcissist), especially if you are not a mental health professional with knowledge of the history of the person.

And again on the criteria for malignant narcissism, there is no expert consensus. But many experts in mental health accept its presence as part of the continuum of narcissism.

Some general agreement on the potential presence of symptoms is also available. But this type of narcissism can appear with any combination of symptoms from the following categories.

Narcissistic personality disorder (NPD)

Like other personality disorders, Narcissistic personality disorder happens on a spectrum and involves a variety of symptoms. The DSM-5 lists nine traits that help identify Narcissistic personality disorder, but only five are needed for diagnosis.

Common symptoms of Narcissistic personality disorder include:

  • Grandiose fantasies and acts, such as an interest in ideas of personal achievement, power, and appeal or sex appeal
  • Little or no concern for the thoughts or feelings of other people
  • A big need for recognition, admiration, and appreciation
  • An exaggerated sense of self-importance, like a propensity to exaggerate personal ability or accomplishments
  • A conviction of personal speciality and supremacy
  • A sense of entitlement
  • A propensity to profit from others or manipulate individuals for personal gain
  • Arrogant or conceited behaviour and attitudes
  • A tendency to envy others and a tendency to believe others envy them

People with Narcissistic personality disorder also have problems coping with change.

When they feel slighted, they can feel depressed or embarrassed, have a difficult time with weakness and vulnerability, and react aggressively when people do not seem to look at them with the admiration they need and feel they deserve.

This disorder often appears to entail difficulty with stress control of emotions and behavioural responses.

Antisocial personality disorder (APD)

Consistent disregard for the feelings of other people is the key characteristics of this disorder. Manipulation and deception and physical or emotional violence may be used in this.

A lack of guilt for misconduct is another main factor. A symptom of this disorder may be violent or offensive behaviour, but some people living with Antisocial personality disorder never act aggressively.

In infancy, people living with Antisocial personality disorder usually display signs of behaviour disorder. This can involve abuse, vandalism, or theft against other individuals and animals.

Generally, they don’t understand the consequences of their acts or think for them. Only adults who have been diagnosed with Antisocial personality disorder are like this.

A diagnosis needs at least three of the following symptoms:

  • Dislike for authority and social norms, shown by continued illegal or lawbreaking behaviour.
  • A pattern of deceit, including manipulation and exploitation of other people
  • Reckless, impulsive, or risky behaviour that shows disregard for personal safety or the safety of other people
  • Little or no remorse for harmful or illegal actions
  • A generally hostile, irritable, aggressive, restless, or agitated mood
  • A pattern of irresponsible, arrogant, or disrespectful behaviour
  • Difficulty planning ahead


Aggression defines a form of behaviour, not a state of mental health. People can’t be diagnosed with aggression, but as part of a diagnostic profile, a mental health professional or other specialists can notice acts of aggression.

As a reaction to anger or other emotion, violent behaviour may occur and typically implies an intent to harm or kill.

Three significant forms of aggression exist:

  • Hostile aggression: This is behaviour specifically targetted at injuring or destroying something or someone.
  • Instrumental aggression: This is an aggressive act that pertains to a specific goal such as smashing a car window to steal a wallet.
  • Affective aggression: This refers to behaviour usually directed at a person or object that triggered an emotion. It may also be redirected if it isn’t possible to target the actual source. Punching a wall instead of punching another person is an example of affective aggression, particularly when the action involves a desire to cause damage.


Sadism is taking pleasure in humiliating or causing discomfort to others.

As a disease that includes sexual arousal linked to the thought of causing unwanted pain to a non-consenting individual, the DSM-5 lists sadism as a sexual disorder, yet, sadism itself is not a mental health diagnosis, nor is it always sexual.

People with sadistic tendencies may:

  • Enjoy hurting others
  • Enjoy watching others experience pain
  • Derive sexual excitement from seeing others in pain
  • Spend a lot of time fantasizing about hurting other people, even if they don’t actually do so
  • Want to hurt others when irritated or angry
  • Enjoy humiliating others, especially in public situations
  • Tend toward aggressive actions or behaviour
  • Behave in controlling or domineering ways

Some researchers say that sadistic behaviour helps differentiate between NPD and malignant narcissism. Self-centred fulfilment of interests and ambitions is also implicated in narcissism, but people with NPD maybe

Is Sadism the same as sociopathy?

In casual conversation, many individuals use the word sociopath. You might hear it used to describe individuals who do not appear to care for other people or who take advantage of their loved ones and exploit them.

In general, sociopathy refers to the traits and behaviour often seen with APD. But sociopathy, similar to malignant narcissism, is only used as an informal term, not as a particular diagnosis.

Malignant narcissism, since APD characteristics are just part of this subtype of narcissism, is not the same as sociopathy.

Is it treatable?

In general, counselling may benefit those seeking care to try to change their emotions, attitudes, or emotional responses with the goal of putting in the effort.

People dealing with malignant narcissism, or any other form of narcissism, will definitely be able to go to counselling and work to alter habits that have a detrimental impact on their quality of life or on members of their families, partners and friends.

Seeking help

Individuals living with characteristics of some kind of narcissism may not seek assistance on their own. They just don’t know there’s something wrong with their attitudes and acts.

But they may have other symptoms that cause them to undergo treatment, including:

  • Depression
  • Irritability
  • Anger management issues

In other cases, because of a court order, an ultimatum from a romantic partner or family member, or some excuse, they might be motivated to enter counselling.

Nevertheless, in order for therapy to be effective, they must actually want treatment for themselves.

Treatment options

If you suspect that someone close to you might be struggling with a personality disorder, such as NPD or APD, it’s important to note that improvement is absolutely possible.

As long as they’re able to try to do the work involved, counselling will help.

Therapy is often challenging, but it generally pays off with substantial advantages, including:

  • Stronger interpersonal relationships
  • Improved emotional regulation
  • Better ability to work toward goals

Certain types of therapy may be more helpful at treating narcissism. A 2010 review of studies looking at malignant narcissism states that, particularly when violent or sadistic behaviours appear in the therapeutic relationship, treatment can prove difficult.

But it can lead to improved results by taking full responsibility for care. Updated dialectical behaviour therapy (DBT) and where applicable, couples and family counselling are recommended forms of therapy.

Some symptoms, including rage, irritability, and psychosis, can also be improved by drugs such as antipsychotics and selective serotonin reuptake inhibitors (SSRIs).

A more recent journal article shows that schema therapy may also be effective for NPD and related problems. This result is confirmed by other studies.

Transference-focused therapy and mentalization-based therapy are other methods that could increase clinical outcomes.

Recognizing abuse

Narcissism and associated disorders typically entail difficulties listening to other people’s emotions and knowing them. Signs, such as self-serving conduct, deceptive words and acts, or a history of unhealthy or failed relationships, may be noticed.

For a person with malignant narcissism, maintaining family or interpersonal ties may be much more difficult. It is not rare for relationships to include behaviour management, gaslighting, and emotional violence.

It’s important to take care of yourself and watch for signs of violence if you’re close to someone struggling with malignant narcissism.

There are several forms of abusive actions that are different, and some might not appear as abusive as others. Normal signs can include:

  • To point out “flaws” and seem to love making you feel discouraged or frustrated, or to say that they do so for your own good.
  • Lying or manipulating you to fulfil their own aims, justifying their actions and showing no remorse or shame if you call them on it.
  • putting you down, humiliating you, or threatening you, in public or private
  • Seeming to enjoy causing physical harm
  • showing no interest in your needs or feelings
  • Without knowing whether you or other people get injured in the process, acting in reckless or dangerous ways (e.g., driving dangerously and laughing when you express fear)
  • Saying or doing something unkind or cruel and seeming to enjoy your agony
  • Aggressively behaving against you and other people or items.

The mental wellbeing of someone isn’t an excuse for abusive conduct. It’s also important to note that the outcome of a mental health problem is not necessarily aggressive behaviour.

Talking to a therapist will help you decide what to do if you think your relationship has become unhealthy. You may also request assistance on their website from the National Domestic Abuse Hotline.


  • Unpacking Malignant Narcissism; Healthline
  • Malignant Narcissism: from fairy tales to harsh reality; NCBI