Relationships How to Identify Someone With Malignant Narcissism By Elizabeth Scott, PhD Elizabeth Scott, PhD Twitter Elizabeth Scott, PhD is an author, workshop leader, educator, and award-winning blogger on stress management, positive psychology, relationships, and emotional wellbeing. Learn about our editorial process Updated on March 01, 2022 Medically reviewed Verywell Mind articles are reviewed by board-certified physicians and mental healthcare professionals. Medical Reviewers confirm the content is thorough and accurate, reflecting the latest evidence-based research. Content is reviewed before publication and upon substantial updates. Learn more. by Sabrina Romanoff, PsyD Medically reviewed by Sabrina Romanoff, PsyD LinkedIn Twitter Dr. Sabrina Romanoff, PsyD, is a licensed clinical psychologist and a professor at Yeshiva University’s clinical psychology doctoral program. Learn about our Medical Review Board Print Verywell / Theresa Chiechi Table of Contents View All Table of Contents Definition Signs Causes Diagnosis Treatment Coping Narcissism is a personality trait recognized throughout history, but awareness of narcissistic personality disorder (NPD) and narcissistic personality in popular culture has grown. As a result, people may wonder whether they are dealing with someone who is selfish, thoughtless, or overly power-seeking—or if they are dealing with someone with a true disorder. There are different types of narcissism, including malignant narcissism, which many consider the most severe. That’s why it helps to recognize when you have someone with this condition in your life and what to expect from interactions with them. This knowledge can also provide insight into how to deal with them in the healthiest way possible. 1:24 How to Identify a Malignant Narcissist What Is Malignant Narcissism? Beyond the desire to focus primarily on themselves and be held in high regard by virtually everyone in their lives, people with malignant narcissism tend to have a darker side to their self-absorption. These individuals can be highly manipulative and don't care who they hurt as long as they get their own way. Although there is only one official diagnosis for narcissism (narcissistic personality disorder), there are different types. Someone with grandiose narcissism, for instance, requires excessive praise and attention; while someone with vulnerable narcissism tends to have a lot of anxiety and need a lot of supportive attention. Among the different types, people with malignant narcissism are by far the most harmful to others. Social psychologist Erich Fromm, who first coined the term malignant narcissism, called people with this type "the quintessence of evil." People with this subtype contain the general traits of NPD, including regular egocentricity. They also have antisocial traits and even a sadistic streak, as well as a poor sense of self and lack of empathy. There is often some paranoia involved with malignant narcissism as well. Some experts see little difference between malignant narcissism and psychopathy in that both have antisocial behavior and low empathy. Signs and Symptoms of Malignant Narcissism Signs and symptoms of narcissistic personality disorder (and the severity of these symptoms) vary. But the following are often characteristic of someone with malignant narcissism: Preoccupied with fantasies about beauty, brilliance, success, and powerUnable to handle criticismTendency to lash out if they feel slightedLikely to take advantage of others to get what they wantOverly concerned about their appearanceHave an expectation of being treated as superiorLack of empathy for othersInflated sense of self and inability to self-regulateHave no remorse for hurting others and no interest in apologizing unless it benefits themHave an attitude of deserving the best of everythingTendency to monopolize conversations and/or mistreat those who they perceive as inferiorHidden insecurity and a weak sense of selfTendency to blame others for their own bad behavior Additional signs of malignant narcissism can include: Seeing the world in black-and-white terms, including seeing others as either friend or foeSeeking to win at all costs, leaving a great amount of pain, frustration, and even heartache in their wakeNot caring about the pain they cause others—or maybe even enjoying it and experiencing it as empoweringDoing what it takes to protect themselves from loss, inconvenience, or failing to get what they want in any situation How to Spot a Narcissistic Sociopath Causes of Malignant Narcissism The exact cause of malignant narcissism is not known. As with most mental health disorders, NPD can develop as a result of a combination of factors. For instance, the following childhood experiences can contribute to the development of NPD: Abuse Excessive parental pampering Overly authoritarian parenting Unpredictable care Evidence shows that having a close relative with NPD can increase the risk of developing the condition as well. It's also possible that neurobiology may play a role. According to research published in 2021, some patients with NPD have been found to have altered grey and white brain matter. Diagnosis of Malignant Narcissism While malignant narcissism isn’t recognized as an official diagnosis in the DSM-5, the standard for diagnosis of psychiatric conditions, mental health experts often use this term to describe a combination of the following: Antisocial personality disorder (APD) Narcissistic personality disorder (NPD) Aggression and sadism (toward self, others, or both) Paranoia Antisocial Personality Disorder (APD) According to the DSM-5, a person with APD must be at least 18 years old and have a pattern of disregard for the rights of others, including at least three of the following: Disregard for the safety of the self and others Failure to obey laws or social norms Impulsive behavior Irritability and aggression Lack of remorse for actions Lying or manipulating others for profit or amusement Pattern of irresponsibility What Is Antisocial Personality Disorder? Narcissistic Personality Disorder (NPD) The following is an abbreviated summary of the DSM-5 diagnostic criteria for NPD: A grandiose sense of self-importance Persistent fantasies about unlimited success and power A belief that they are "special" and unique and can only be understood by or should associate with similar high-status people and organizations A constant need for attention, admiration, and praise A sense of entitlement and expectation of special treatment A tendency to use others for their own needs or wants A lack of empathy or unwillingness/inability to recognize and honor the needs and feelings of others Proneness to envy or having a belief that they are envied by others A sense of arrogance shown in behaviors and/or attitudes Narcissism vs. NPD It's important to note that not all narcissistic traits necessarily indicate a personality disorder which, according to the American Psychiatric Association (APA), involves at least two of the following four areas: Affective (ways of responding emotionally) Cognitive (ways of thinking about oneself and others) Impulse control (ways of controlling one's behavior) Interpersonal (ways of relating to others) Even if your loved one isn't officially diagnosed with NPD, narcissistic behaviors can still be difficult to deal with and have a negative impact on your relationship. While not every person who displays narcissistic traits is a classic "narcissist" in the sense that they have NPD, even those who fail to meet the criteria for diagnosis can create a lot of harm with the traits they do possess. Treatment of Malignant Narcissism Treating malignant narcissism can be challenging, especially since people with NPD often fail to follow through with treatment—if they seek treatment at all. Therapy Counseling or therapy is the most common treatment for NPD. If you or someone you care about has narcissistic personality disorder, there are certain therapies that may be helpful. Although there is relatively limited data on this topic, the therapeutic approaches often applied include: Psychodynamic psychotherapy, which helps people better understand their thoughts and emotions Cognitive behavioral therapy (CBT), which helps people identify and change destructive thoughts and behaviors Dialectical behavior therapy (DBT), which teaches people healthy coping skills, emotional regulation techniques, and how to stay in the present Couples counseling, which helps people improve their relationships with their partners or spouses Family therapy, which helps people recognize and effectively deal with family relationship issues, such as those related to communication and conflict People with NPD generally resist therapy because they fear criticism; however, a willingness to change combined with counseling can provide positive results. Medication There are no medications specifically to treat NPS, but medications may be prescribed to improve symptoms like anger, irritability, and paranoia that sometimes accompany NPD. They might also be prescribed to treat co-occurring psychiatric disorders such as bipolar disorder, substance use disorder, and other personality disorders. Depending on the symptoms and other mental health issues at play, medications that may be prescribed can include: Anti-anxiety medications Antidepressants Antipsychotics Mood stabilizers How to Deal With Malignant Narcissism How does one deal with NPD in a loved one or in someone they must deal with, like a boss or co-worker? Here are a few tips that can help: Put some distance between you and them. Maintaining distance may be challenging as people with narcissistic traits tend to have little respect for boundaries. As a result, they may resent when you try to set and enforce them, but it is healthier for you. Don't try to change them and don't expect them to change or you might be disappointed. As a direct result of the symptoms, few people with narcissistic personality disorder recognize the need for treatment and seek help. Know that if you challenge them directly, they will likely retaliate. This doesn't mean that you must agree with whatever the person with narcissism asks of you, but you may want to find less confrontational ways to communicate your boundaries or disagreements. If you do need to confront the person, try not to do so in front of a large audience. Confronting someone with narcissism in front of others may make them want to save face. It can also cause them to feel more threatened, sparking retaliation. Surround yourself with supportive people as much as possible. Use your support group to absorb some of the negativity you may experience with this person. How to Cope With a Personality Disorder When to Seek Help Because NPD can impact personal relationships, getting help may improve the quality of their interactions with others. Though, in the end, it is up to them whether they seek help and if they put in the work to get the most benefits possible. Whether or not your loved one is receiving treatment for their condition, you may want to consider speaking with a mental health professional yourself. In addition to helping you better understand their narcissistic behaviors, a therapist can help you develop coping strategies to protect your mental and emotional well-being. A Word From Verywell Interacting with someone with malignant narcissism isn't easy, so it's often easiest if you can put distance between yourself and this person. If the person is a family member or co-worker, creating distance can be difficult. In these cases, it helps to know who you are dealing with and how to handle communication in the healthiest way possible. If you think your loved one might have malignant narcissism, talk to a healthcare provider. A trained mental health professional can help you learn coping skills and how to set boundaries and practice self-care strategies. Group therapy and support groups may also be helpful resources. How to Find a Support Group Meeting Near You 13 Sources Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Goerge F, Short D. The cognitive neuroscience of narcissism. J Brain Behav Cogn Sci. 2018;1(6). Diamond D, Yeomans F, Keefe J. Transference-focused psychotherapy for pathological narcissism and narcissistic personality disorder (TFP-N). Psychodynamic Psychiat. 2021;49(2):244-272. doi:10.1521/pdps.2021.49.2.244 Goldner-Vukov M, Moore LJ. Malignant narcissism: From fairy tales to harsh reality. Psychiatr Danub. 2010;22(3):392-405. Shafti S. Malignant narcissism: Concealed side of psychopathy. Biomed J Sci Tech Res. 2019;22(1):16310-16315. doi:10.26717/BJSTR.2019.22.003686 American Psychological Association. What causes personality disorders?. Perrotta G. Narcissism and psychopathological profiles: Definitions, clinical contexts, neurobiological aspects and clinical treatments. J Clin Cases Rep. 2020; 4(85):12-25. doi:10.46619/joccr.20021.S5-1003 Luo YLL, Cai H, Song H. A behavioral genetic study of intrapersonal and interpersonal dimensions of narcissism. PLoS One. 2014;9(4):e93403. doi:10.1371/journal.pone.0093403 American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (DSM-5). American Psychiatric Association. Kacel E, Ennis N, Pereira D. Narcissistic personality disorder in clinical health psychology practice: Case studies of comorbid psychological distress and life-limiting illness. Behav Med. 2011;43(3):156-64. doi:10.1080/08964289.2017.1301875 Cleveland Clinic. Narcissistic personality disorder. Caligor E, Levy KN, Yeomans FE. Narcissistic personality disorder: Diagnostic and clinical challenges. Am J Psychiatry. 2015;172(5):415-422. doi:10.1176/appi.ajp.2014.14060723 Luchner AF. Maintaining boundaries in the treatment of pathological narcissism. In J. S. Ogrodniczuk (Ed.), Understanding and treating pathological narcissism. American Psychological Association. 2013:219-234. doi:10.1037/14041-013 Chester D, DeWall C. Sound the alarm: The effect of narcissism on retaliatory aggression is moderated by dACC reactivity to rejection. J Pers. 2016;84(3):361-8. doi:10.1111/jopy.12164 By Elizabeth Scott, PhD Elizabeth Scott, PhD is an author, workshop leader, educator, and award-winning blogger on stress management, positive psychology, relationships, and emotional wellbeing. See Our Editorial Process Meet Our Review Board Share Feedback Was this page helpful? Thanks for your feedback! What is your feedback? Other Helpful Report an Error Submit Speak to a Therapist for Relationships Advertiser Disclosure × The offers that appear in this table are from partnerships from which Verywell Mind receives compensation.