Malignant Narcissism Traits and Impact on Relationships

Malignant Narcissism

Malignant narcissism is a complex psychological syndrome that combines elements of narcissism with traits of aggression and antisocial behavior. Rather than being a diagnostic category, malignant narcissism is a subtype of narcissism. In general, it is regarded as one of the worst personality disorders and the most severe form of narcissism.

Narcissism and malignant narcissism are two similar but separate personality qualities.  Narcissism is defined by an overinflated feeling of self-importance, a strong desire for adulation, and a lack of empathy for others.

Narcissists have an unrealistic view of their own abilities and accomplishments, and they frequently crave continual attention and reinforcement from others. Malignant narcissism, on the other hand, is a more serious and dangerous type of narcissism.

In addition to the characteristics of regular narcissism, malignant narcissists exhibit aspects of antisocial personality disorder and aggressive conduct, a sense of entitlement, and a tendency to exploit and manipulate others. They may exhibit psychosis, violence, and a lack of conscience.

Malignant narcissists are more likely to engage in criminal or immoral activities, and they can do significant harm to others around them. They frequently lack the ability to develop meaningful connections with others and may be eager to cause harm in order to retain an inflated sense of self.

Theories and Origins

In 1964, psychologist Erich Fromm coined the phrase “malignant narcissism,” defining it as a “severe mental sickness” that represents “the quintessence of evil.” He described the disease as “the most severe pathology and the root of the most vicious destructiveness and inhumanity” In 1971, Herbert Rosenfeld defined it as “a disturbing form of narcissistic personality where grandiosity is built around aggression and the destructive aspects of the self become idealized.”[

In addition to Fromm, Otto Kernberg, another influential psychoanalyst, further developed the concept. Kernberg introduced a systematic model describing malignant narcissism as a severe form of personality disorder. He outlined distinctive characteristics, such as the presence of aggression and the use of defenses such as splitting.

Kernberg believed that malignant narcissism was part of a spectrum of pathological narcissism that ranged from Hervey M. Cleckley’s antisocial character (now known as psychopathy or antisocial personality) at the high end of severity, through malignant narcissism, and finally to narcissistic personality disorder at the low end.

According to Kernberg’s hierarchy, psychopathy is the most severe kind of pathological narcissism, surpassing malignant narcissism. Kernberg distinguishes malignant narcissism from psychopathy by the malignant narcissist’s ability to internalize

“both aggressive and idealized superego precursors, leading to the idealization of the aggressive, sadistic features of the pathological grandiose self of these patients”.

Kernberg pointed out that certain childhood experiences, such as excessive pampering or extreme criticism, can contribute to the disorder’s development. The causes pointed toward a complex interaction between environmental influences and fundamental psychological processes.

Malignant narcissism is also associated with certain maladaptive behaviors that are deeply rooted in an individual’s early life experiences. These behaviors reflect a pathological self-structure that comes from disruptions in normal psychological development, particularly in the area of interpersonal relations.

Malignant Narcissism Symptoms and Diagnosis

Individuals with malignant narcissism often display a grandiose sense of self-importance, which can manifest in an exaggerated view of one’s abilities and achievements. They may be highly manipulative, using others to their advantage with little regard for their feelings or interests.

A profound lack of remorse over the harm they cause is another telling sign, as they rarely, if ever, accept responsibility for the negative outcomes of their actions.

The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) does not officially recognize malignant narcissism as a separate diagnosable condition. However, it does list criteria for narcissistic personality disorder (NPD), which shares several characteristics with malignant narcissism. The symptoms for NPD include:

  • A sense of entitlement or superiority
  • Need for excessive admiration
  • Interpersonal exploitation
  • Lack of empathy

While malignant narcissism incorporates aspects of NPD, it also encompasses antisocial behavior, making it more pernicious and harder to treat.

Impact on Relationships

Malignant narcissists often exhibit behaviors in relationships that include manipulation, a lack of empathy, and a desire for power. Emotional regulation is typically poor, leading to sudden outbursts or so-called narcissistic rages which can destabilize the relationship further. These individuals may test boundaries persistently, resulting in a tense and unpredictable environment.

  • Control: They may attempt to micromanage the behaviors and thoughts of those around them.
  • Exploitation: They often use others to meet their own needs, disregarding the well-being of their partners.

Victims of narcissistic abuse in relationships can suffer from various psychological effects. This abuse can erode their sense of self-worth and lead to difficulties in trusting others. It is not unusual for victims to experience:

  • Anxiety and Depression: Heightened levels of distress are common responses to the unpredictable and often hostile behaviors of a malignant narcissist.
  • PTSD: In some cases, the ongoing traumatic nature of the abuse can lead to symptoms of post-traumatic stress disorder.

Furthermore, the emotional toll on individuals who have had a long term, intimate relationship with a suspected narcissistic partner can be profound, with challenges in interpersonal relationships persisting even after the relationship has ended.

Treatment Approaches

The management of malignant narcissism involves a multifaceted strategy, primarily utilizing specialized therapeutic techniques with possible adjuncts from pharmacotherapy tailored to address specific symptoms.

In terms of psychotherapy, two prominent methods are employed: Mentalization-Based Therapy (MBT) and Transference-Focused Psychotherapy (TFP).

Mentalization-Based Therapy aims to enhance the patient’s ability to understand their own and others’ mental states, which can be particularly beneficial for those with narcissistic tendencies. Through this process, patients may develop empathy and a richer emotional life, suggesting a shift from narcissistic patterns.

Transference-Focused Psychotherapy, on the other hand, is rooted in understanding the patient’s relationship dynamics. It helps them perceive and work through conflicts that arise within the therapeutic relationship, reflecting their wider social interactions.

While there is no medication specifically designed to treat malignant narcissism, antidepressants, anti-anxiety medications, and mood stabilizers can help manage symptoms such as depression, anxiety, and mood swings.

Family therapy can help address the impact of malignant narcissism on the individual’s relationships with their family members. This form of therapy can also provide education and support for family members who may be affected by the individual’s behavior.

Individuals with malignant narcissism often resist treatment due to their lack of insight and desire for change. As a result, a collaborative approach involving the individual, their loved ones, and mental health professionals is often necessary to achieve successful treatment outcomes.

  1. Abdennur, Alexander (2000). Camouflaged aggression: The hidden threat to individuals and organizations. Brush Education ISBN 978-1-55059-198-9
  2. Crisp, Holly; Gabbard, Glen O. Principles of Psychodynamic Treatment for Patients With Narcissistic Personality Disorder. Journal of Personality Disorders 2020 34:Supplement, 143-158
  3. Diamond, Diana; Yeomans, Frank; Keefe, John R. (2021). Transference-Focused Psychotherapy for Pathological Narcissism and Narcissistic Personality Disorder (TFP-N). Psychodynamic Psychiatry. 49 (2): 244–272. doi: 10.1521/pdps.2021.49.2.244
  4. Fromm, Erich (1964). The heart of man: Its genius for good and evil. Brooklyn, New York City: Lantern Books ISBN 978-1-59056-186-7
  5. Kernberg, Otto F. (1970). Factors in the psychoanalytic treatment of narcissistic personalities. Journal of the American Psychoanalytic Association. 18 (1).  51–85. doi: 10.1177/000306517001800103
  6. Kernberg, Otto F. (1984). Severe personality disorders: Psychotherapeutic strategies. Yale University Press
  7. Lenzenweger, M. F., Clarkin, J. F., Caligor, E., Cain, N. M., & Kernberg, O. F. (2018). Malignant Narcissism in Relation to Clinical Change in Borderline Personality Disorder: An Exploratory Study. Psychopathology, 51(5), 318–325.
  8. Vaknin, S. (2015). Malignant self-love: Narcissism revisited. Narcissus Publications ISBN 978-8023833843