Malignant narcissism refers to a specific, less common manifestation of narcissistic personality disorder. Some experts consider this presentation of narcissism the most severe subtype.
It isn't recognized as a formal diagnosis in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). But many psychologists and mental health experts have used this term to describe a specific set of personality traits.
According to Campbell's Psychiatric Dictionary, malignant narcissism combines characteristics of:
Read on to learn more about malignant narcissism, including common characteristics, how it compares to sociopathy, and whether it's treatable.
Malignant narcissism can present in many ways — there's no set list of traits. It's also very hard, especially for someone who isn't a mental health professional, to differentiate between malignant narcissism and severe NPD.
This is partly why it's best to avoid using this term (or related ones, such as narcissist) to refer to someone, especially if you aren't a mental health professional with knowledge of the person's background.
And again, there's no expert consensus on the criteria for malignant narcissism. But many mental health experts support its existence as part of the narcissism spectrum. There's also some general agreement on possible presentation of symptoms.
But this type of narcissism might appear with any combination of symptoms from the following categories.
Like other personality disorders, NPD occurs on a spectrum and involves a range of symptoms. The DSM-5 lists nine traits that help identify NPD, but only five are needed for diagnosis.
Common symptoms of NPD include:
People with NPD often have trouble dealing with change. They may feel depressed or humiliated when they feel slighted, have a hard time with insecurity and vulnerability, and react angrily when others don't seem to regard them with the admiration they need and feel they deserve.
This condition also tends to involve difficulty managing emotions and behavioral responses to stress.
The primary features of this condition are consistent disregard for other people's feelings. This can include manipulation and deceit as well as physical or emotional abuse. Another key component is a lack of remorse for wrongdoing.
Violent or aggressive behavior can be a sign of this condition, but some people living with APD never behave violently.
People living with APD typically show symptoms of conduct disorder in childhood. This may include violence toward other people and animals, vandalism, or theft. They generally don't consider or care about the consequences of their actions.
Only adults are diagnosed with APD. A diagnosis requires at least three of the following symptoms:
Aggression describes a type of behavior, not a mental health condition. People can't be diagnosed with aggression, but a mental health professional or other expert may note acts of aggression as part of a diagnostic profile.
Aggressive behavior can occur as a response to anger or other emotion and generally involves an intent to harm or destroy. There are three main types of aggression:
Sadism is taking pleasure in humiliating someone or causing them pain.
The DSM-5 lists sexual sadism disorder as a condition that involves sexual arousal linked to the idea of causing a non-consenting person unwanted pain. But sadism itself is not a mental health diagnosis, nor is it always sexual.
People with sadistic tendencies may:
Some experts suggest that sadistic behavior helps set NPD and malignant narcissism apart. Narcissism often involves self-centered pursuit of desires and goals, but people with NPD might still show some remorse or regret for hurting others in the process.
Many people use the term sociopath in casual conversation. You might hear it used to describe people who don't seem to care about other people or who take advantage of and manipulate their loved ones.
Sociopathy usually refers to the characteristics and behavior commonly seen with APD. But similarly to malignant narcissism, sociopathy is only used as an informal term, not a specific diagnosis.
Malignant narcissism isn't the same as sociopathy, since APD traits are only part of this narcissism subtype.
In general, therapy can help anyone who seeks treatment with the intent of putting in the effort to improve their feelings, behaviors, or emotional reactions.
It's certainly possible people living with malignant narcissism, or any other type of narcissism, can go to therapy and work to change behaviors that have a negative effect on their quality of life or on their family members, partners, and friends.
People living with traits of any type of narcissism may not seek help on their own. They often don't realize there's anything wrong with their actions and behavior.
But they might have other symptoms that prompt them into treatment, including:
In other cases, they might be motivated to enter therapy because of a court order, ultimatum from a romantic partner or family member, or another reason.
However, for treatment to be effective, they must ultimately want treatment for themselves.
If you think someone close to you might be dealing with a personality disorder, such as NPD or APD, it's important to remember that it's absolutely possible to change. Therapy can help, as long as they're willing to work to do the work involved.
Therapy is often difficult, but it usually pays off with major benefits, including:
Certain types of therapy may be more helpful at treating narcissism.
A 2010 review of studies looking at malignant narcissism notes that treatment can prove challenging, particularly when aggressive or sadistic tendencies emerge in the therapeutic relationship.
But taking personal responsibility for treatment can lead to better outcomes. Recommended types of therapy include modified dialectical behavior therapy (DBT) and couples and family counseling, where applicable.
Medications such as antipsychotics and selective serotonin reuptake inhibitors (SSRIs) may also improve some symptoms, including anger, irritability, and psychosis.
A more recent journal article from 2015 suggests that schema therapy may also be helpful for NPD and related issues. Other research supports this finding.
Other approaches that could improve treatment outcomes include transference-focused therapy and mentalization-based therapy.
However, clinical data on this topic is lacking. More research is needed on therapy for narcissism.
Narcissism and related issues usually involve difficulty relating to and understanding the feelings of other people. You might notice signs, such as self-serving behavior, manipulative words and actions, or a pattern of unhealthy or failed relationships.
Maintaining family or interpersonal relationships may be even more challenging for a person with malignant narcissism. It's not uncommon for relationships to involve controlling behavior, gaslighting, and emotional abuse.
If you're close to someone living with malignant narcissism, it's important to take care of yourself and watch for signs of abuse.
There are many different types of abusive behavior, and some may not seem as clearly abusive as others. Common signs can include:
Someone's mental health isn't an excuse for abusive behavior. It's also important to remember that abusive behavior isn't always the result of a mental health condition.
If you believe your relationship has become unhealthy, talking to a therapist can help you decide what to do. You can also seek support from the National Domestic Violence Hotline at their website or by calling 800-799-7233.