How to Identify Someone With Malignant Narcissism

Malignant narcissist signs and symptoms

Verywell / Theresa Chiechi

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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.

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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 power
  • Unable to handle criticism
  • Tendency to lash out if they feel slighted
  • Likely to take advantage of others to get what they want
  • Overly concerned about their appearance
  • Have an expectation of being treated as superior
  • Lack of empathy for others
  • Inflated sense of self and inability to self-regulate
  • Have no remorse for hurting others and no interest in apologizing unless it benefits them
  • Have an attitude of deserving the best of everything
  • Tendency to monopolize conversations and/or mistreat those who they perceive as inferior
  • Hidden insecurity and a weak sense of self
  • Tendency 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 foe
  • Seeking to win at all costs, leaving a great amount of pain, frustration, and even heartache in their wake
  • Not caring about the pain they cause others—or maybe even enjoying it and experiencing it as empowering
  • Doing what it takes to protect themselves from loss, inconvenience, or failing to get what they want in any situation

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:

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

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:

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:

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.

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.

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