Malignant narcissism is a psychological syndrome comprising an extreme mix of

narcissism Narcissism is a self-centered personality style characterized as having an excessive interest in one's physical appearance or image and an excessive preoccupation with one's own needs, often at the expense of others. Narcissism exists on a co ...

antisocial behavior Antisocial may refer to: Sociology, psychiatry and psychology * Anti-social behaviour *Antisocial personality disorder *Psychopathy *Conduct disorder Law *Anti-social Behaviour Act 2003 *Anti-Social Behaviour Order *Crime and Disorder Act 1998 * ...

aggression Aggression is overt or covert, often harmful, social interaction with the intention of inflicting damage or other harm upon another individual; although it can be channeled into creative and practical outlets for some. It may occur either reacti ...

, and

sadism Sadism may refer to: * Sadomasochism, the giving or receiving of pleasure from acts involving the receipt or infliction of pain or humiliation * Sadistic personality disorder, an obsolete term proposed for individuals who derive pleasure from the s ...

Grandiose In the field of psychology, the term grandiosity refers to an unrealistic sense of superiority, characterized by a sustained view of one's self as better than others, which is expressed by disdainfully criticising them (contempt), overinflating ...

, and always ready to raise hostility levels, the malignant narcissist undermines families and organizations in which they are involved, and dehumanizes the people with whom they associate. Malignant narcissism is not a diagnostic category, but a subcategory of narcissism.

Narcissistic personality disorder Narcissistic personality disorder (NPD) is a personality disorder characterized by a life-long pattern of exaggerated feelings of self-importance, an excessive need for admiration, a diminished ability or unwillingness to empathize with oth ...

(NPD) is found in the ''

Diagnostic and Statistical Manual of Mental Disorders The ''Diagnostic and Statistical Manual of Mental Disorders'' (DSM; latest edition: DSM-5-TR, published in March 2022) is a publication by the American Psychiatric Association (APA) for the classification of mental disorders using a common langu ...

'' (

DSM-IV-TR The ''Diagnostic and Statistical Manual of Mental Disorders'' (DSM; latest edition: DSM-5-TR, published in March 2022) is a publication by the American Psychiatric Association (APA) for the classification of mental disorders using a common langua ...

), while malignant narcissism is not. Malignant narcissism could include aspects of narcissistic personality disorder (NPD) alongside a mix of antisocial, paranoid and

sadistic Sadism may refer to: * Sadomasochism, the giving or receiving of pleasure from acts involving the receipt or infliction of pain or humiliation * Sadistic personality disorder, an obsolete term proposed for individuals who derive pleasure from the s ...

personality disorder traits. The importance of malignant narcissism and of projection as a

defense mechanism In psychoanalytic theory, a defence mechanism (American English: defense mechanism), is an unconscious psychological operation that functions to protect a person from anxiety-producing thoughts and feelings related to internal conflicts and o ...

has been confirmed in

paranoia Paranoia is an instinct or thought process that is believed to be heavily influenced by anxiety or fear, often to the point of delusion and irrationality. Paranoid thinking typically includes persecutory beliefs, or beliefs of conspiracy c ...

, as well as "the patient's vulnerability to malignant narcissistic regression". A person with malignant narcissism exhibits paranoia in addition to the symptoms of a Narcissistic Personality Disorder. Because a malignant narcissist's personality cannot tolerate any criticism, being mocked typically causes paranoia.

History

The

social psychologist Social psychology is the scientific study of how thoughts, feelings, and behaviors are influenced by the real or imagined presence of other people or by social norms. Social psychologists typically explain human behavior as a result of the rela ...

Erich Fromm Erich Seligmann Fromm (; ; March 23, 1900 – March 18, 1980) was a German social psychologist, psychoanalyst, sociologist, humanistic philosopher, and democratic socialist. He was a German Jew who fled the Nazi regime and settled in the U ...

first coined the term "malignant narcissism" in 1964, describing it as a "severe mental sickness" representing "the quintessence of

evil Evil, in a general sense, is defined as the opposite or absence of good. It can be an extremely broad concept, although in everyday usage it is often more narrowly used to talk about profound wickedness and against common good. It is general ...

". He characterized the condition as "the most severe pathology and the root of the most vicious destructiveness and inhumanity". Edith Weigert (1967) saw malignant narcissism as a "regressive escape from frustration by

distortion In signal processing, distortion is the alteration of the original shape (or other characteristic) of a signal. In communications and electronics it means the alteration of the waveform of an information-bearing signal, such as an audio signa ...

and denial of reality", while

Herbert Rosenfeld Herbert Alexander Rosenfeld (2 July 1910 – 29 November 1986) was a German-British psychoanalyst. Rosenfeld made seminal contributions to Kleinian thinking on psychotic and other very ill patients; while his emphasis on the role of the analy ...

(1971) described it as "a disturbing form of narcissistic personality where grandiosity is built around aggression and the destructive aspects of the self become idealized." On 11 May 1968, psychoanalyst

Otto Kernberg Otto Friedmann Kernberg (born 10 September 1928) is a psychoanalyst and professor of psychiatry at Weill Cornell Medicine. He is most widely known for his psychoanalytic theories on borderline personality organization and narcissistic pathology. I ...

presented his paper ''Factors in the psychoanalytic treatment of narcissistic personalities'', from the work of the Psychotherapy Research Project of The

Menninger Foundation The Menninger Foundation was founded in 1919 by the Menninger family in Topeka, Kansas. The Menninger Foundation, known locally as Menninger's, consists of a clinic, a sanatorium, and a school of psychiatry, all of which bear the Menninger name. ...

, at the 55th Annual Meeting of the

American Psychoanalytic Association The American Psychoanalytic Association (APsaA) is an association of psychoanalysts in the United States. APsaA serves as a scientific and professional organization with a focus on education, research, and membership development. APsaA comprises ...

Boston Boston (), officially the City of Boston, is the state capital and most populous city of the Commonwealth of Massachusetts, as well as the cultural and financial center of the New England region of the United States. It is the 24th- mo ...

. Kernberg's paper was first published in hard copy on 1 January 1970. In Kernberg's 1968 paper, first published in 1970 in the ''

Journal of the American Psychoanalytic Association The ''Journal of the American Psychoanalytic Association'' is a bi-monthly peer-reviewed healthcare journal covering all aspects of psychoanalysis and is the official journal of the American Psychoanalytic Association. The editor in chief is Mitc ...

'' (JAPA), the word 'malignant' does not appear once, while 'pathological' or 'pathologically' appears 25 times. Developing these ideas further, Kernberg pointed out that the antisocial personality was fundamentally narcissistic and without morality. Malignant narcissism includes a

element creating, in essence, a sadistic

psychopath Psychopathy, sometimes considered synonymous with sociopathy, is characterized by persistent antisocial behavior, impaired empathy and remorse, and bold, disinhibited, and egotistical traits. Different conceptions of psychopathy have been ...

. In his article, "malignant narcissism" and psychopathy are employed interchangeably. Kernberg first proposed malignant narcissism as a psychiatric diagnosis in 1984. So far it has not been accepted in any of the medical manuals, such as the

ICD-10 ICD-10 is the 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD), a medical classification list by the World Health Organization (WHO). It contains codes for diseases, signs and symptoms ...

or the

DSM-5 The ''Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition'' (DSM-5), is the 2013 update to the '' Diagnostic and Statistical Manual of Mental Disorders'', the taxonomic and diagnostic tool published by the American Psychiatri ...

. Kernberg described malignant narcissism as a

syndrome A syndrome is a set of medical signs and symptoms which are correlated with each other and often associated with a particular disease or disorder. The word derives from the Greek language, Greek σύνδρομον, meaning "concurrence". When a sy ...

characterized by a narcissistic personality disorder (NPD), antisocial features, paranoid traits, and

egosyntonic In psychoanalysis, egosyntonic refers to the behaviors, values, and feelings that are in harmony with or acceptable to the needs and goals of the ego, or consistent with one's ideal self-image. Egodystonic (or ''ego alien'') is the opposite, re ...

. Other symptoms may include an absence of

conscience Conscience is a cognitive process that elicits emotion and rational associations based on an individual's moral philosophy or value system. Conscience stands in contrast to elicited emotion or thought due to associations based on immediate sens ...

, a psychological need for power, and a sense of importance (

grandiosity In the field of psychology, the term grandiosity refers to an unrealistic sense of superiority, characterized by a sustained view of one's self as better than others, which is expressed by disdainfully criticising them (contempt), overinflating ...

). Psychoanalyst George H. Pollock wrote in 1978: "The malignant narcissist is presented as pathologically grandiose, lacking in conscience and behavioral regulation with characteristic demonstrations of joyful cruelty and

". Of note, M. Scott Peck uses malignant narcissism as a way to explain evil. Kernberg believed that malignant narcissism should be considered part of a spectrum of pathological narcissism, which he saw as ranging from

Hervey M. Cleckley Hervey Milton Cleckley (September 7, 1903 – January 28, 1984) was an American psychiatrist and pioneer in the field of psychopathy. His book, ''The Mask of Sanity,'' originally published in 1941 and revised in new editions until the 1980s, ...

's antisocial character (what is now referred to as

psychopathy Psychopathy, sometimes considered synonymous with sociopathy, is characterized by persistent antisocial behavior, impaired empathy and remorse, and bold, disinhibited, and egotistical traits. Different conceptions of psychopathy have bee ...

antisocial personality Antisocial personality disorder (ASPD or infrequently APD) is a personality disorder characterized by a long-term pattern of disregard of, or violation of, the rights of others as well as a difficulty sustaining long-term relationships. Lack ...

) at the high end of severity, through malignant narcissism, and then to narcissistic personality disorder at the low end. So according to Kernberg's hierarchy, psychopathy trumps malignant narcissism as a more extreme form of pathological narcissism. Malignant narcissism can be distinguished from psychopathy, according to Kernberg, because of the malignant narcissist's capacity to

internalize Internalization ( or internalisation) is the process of making something internal, with more specific meanings in various fields. It is the opposite of externalization. Psychology and sociology In psychology, internalization is the outcome of ...

"both aggressive and idealized

superego The id, ego, and super-ego are a set of three concepts in psychoanalytic theory describing distinct, interacting agents in the psychic apparatus (defined in Sigmund Freud's structural model of the psyche). The three agents are theoretical con ...

precursors, leading to the idealization of the aggressive, sadistic features of the pathological grandiose self of these patients". According to Kernberg, the psychopath's paranoid stance against external influences makes him or her unwilling to internalize even the values of the "aggressor", while malignant narcissists "have the capacity to admire powerful people, and can depend on sadistic and powerful but reliable parental images". Malignant narcissists, in contrast to psychopaths, are also said to be capable of developing "some identification with other powerful idealized figures as part of a cohesive '

gang A gang is a group or society of associates, friends or members of a family with a defined leadership and internal organization that identifies with or claims control over territory in a community and engages, either individually or collective ...

'...which permits at least some loyalty and good object relations to be internalized... Some of them may present rationalized antisocial behavior – for example, as leaders of sadistic gangs or

terrorist Terrorism, in its broadest sense, is the use of criminal violence to provoke a state of terror or fear, mostly with the intention to achieve political or religious aims. The term is used in this regard primarily to refer to intentional violen ...

groups...with the capacity for loyalty to their own comrades."

Psychopathy and the dark triad

The terms ''malignant narcissist'' and ''

'' are sometimes used interchangeably because there is little to clinically separate the two. Individuals who have narcissistic personality disorder, malignant narcissism, and psychopathy all exhibit similar symptoms, as detailed in the

Hare Psychopathy Checklist The Psychopathy Checklist or Hare Psychopathy Checklist-Revised, now the Psychopathy Checklist—revised (PCL-R), is a Clinical psychology#Assessment, psychological assessment tool that is commonly used to assess the presence and extent of the p ...

. The test consists of 20 items that are scored on a three-point scale, with a score of 0 indicating that it does not apply at all, 1 indicating a partial match or mixed information, and 2 indicating a reasonably good match. The cut-off for the label of psychopathy in the United States is 30 and in the United Kingdom is 25 out of a possible score of 40. High scores are associated with impulsivity and aggression, Machiavellianism, and persistent criminal behavior, but not with empathy and affiliation. Malignant narcissism overlaps with the personality construct of the

dark triad The dark triad is a psychological theory of personality, first published by Delroy L. Paulhus and Kevin M. Williams in 2002, that describes three notably offensive, but non-pathological personality types: Machiavellianism, sub-clinical narcissism ...

, first published by

Delroy L. Paulhus Delroy L. Paulhus is a personality psychology researcher and professor. He received his doctorate from Columbia University and has worked at the University of California, Berkeley and the University of California, Davis. Currently, Paulhus is a pro ...

and Kevin M. Williams in 2002, that describes three correlated non-pathological personality types:

Machiavellianism Machiavellianism or Machiavellian may refer to: Politics *Machiavellianism (politics), the supposed political philosophy of Niccolò Machiavelli *Political realism Psychology *Machiavellianism (psychology), a personality trait centered on cold an ...

, and

. Some researchers have added sadism to the triad to create the

dark tetrad The dark triad is a psychological theory of personality, first published by Delroy L. Paulhus and Kevin M. Williams in 2002, that describes three notably offensive, but non-pathological personality types: Machiavellianism, sub-clinical narcissism, ...

. Psychologist Keith Campbell has defined malignant narcissism specifically as the dangerous combination of narcissism and sadism, which fortunately is rare.. Malignant narcissism is highlighted as a key area in the study of

mass murder Mass murder is the act of murdering a number of people, typically simultaneously or over a relatively short period of time and in close geographic proximity. The United States Congress defines mass killings as the killings of three or more pe ...

, sexual sadism, and

serial murder A serial killer is typically a person who murders three or more persons,A * * * * with the murders taking place over more than a month and including a significant period of time between them. While most authorities set a threshold of three ...

Contrast with narcissism

The primary difference between narcissism and malignant narcissism is that malignant narcissism includes

comorbid In medicine, comorbidity - from Latin morbus ("sickness"), co ("together"), -ity (as if - several sicknesses together) - is the presence of one or more additional conditions often co-occurring (that is, concomitant or concurrent) with a primary ...

features of other personality disorders and thus consists of a broader range of symptoms than

pathological Pathology is the study of the causes and effects of disease or injury. The word ''pathology'' also refers to the study of disease in general, incorporating a wide range of biology research fields and medical practices. However, when used in th ...

narcissism (NPD). In the term "malignant narcissism", the word "malignant" is used in the sense of the word described by the ''

Merriam-Webster Dictionary ''Webster's Dictionary'' is any of the English language dictionaries edited in the early 19th century by American lexicographer Noah Webster (1758–1843), as well as numerous related or unrelated dictionaries that have adopted the Webster's ...

'' as "passionately and relentlessly malevolent: aggressively malicious". In malignant narcissism, NPD is accompanied by additional symptoms of antisocial, paranoid and

personality disorders. While a person with NPD will deliberately damage other people in pursuit of their own selfish desires, they may regret and will in some circumstances show remorse for doing so. Because traits of antisocial personality disorder are present in malignant narcissism, the "malignant narcissist" has a more pervasive lack of empathy than someone with NPD alone and will lack feelings of guilt or remorse for the damage they cause. Since sadism is often considered a feature of malignant narcissism, an individual with the syndrome may not only lack feelings of guilt or remorse for hurting others but may even derive pleasure from the gratuitous infliction of mental or physical pain on others. These traits were formerly codified in the

DSM-III The ''Diagnostic and Statistical Manual of Mental Disorders'' (DSM; latest edition: DSM-5-TR, published in March 2022) is a publication by the American Psychiatric Association (APA) for the classification of mental disorders using a common langu ...

under

sadistic personality disorder Sadistic personality disorder was a personality disorder defined by a pervasive pattern of sadistic and cruel behavior. People with this disorder were thought to have desired to control others. It was believed they accomplish this through the u ...

(SPD).

Therapy

Typically in the analysis of the malignant narcissist, "the patient attempts to triumph over the analyst by destroying the analysis and himself or herself"—an extreme version of what

Jacques Lacan Jacques Marie Émile Lacan (, , ; 13 April 1901 – 9 September 1981) was a French psychoanalyst and psychiatrist. Described as "the most controversial psycho-analyst since Freud", Lacan gave yearly seminars in Paris from 1953 to 1981, and ...

described as "that resistance of the ''

amour-propre ''Amour-propre'' (; ) is a French term that can be variously translated as "self-love", "self-esteem", or "vanity". In philosophy, it is a term used by Jean-Jacques Rousseau, who contrasts it with another kind of self-love which he calls ''amour ...

''... which is often expressed thus: 'I can't bear the thought of being freed by anyone other than myself'". Since Malignant Narcissism is a severe personality disorder that has far-reaching societal and familial effects, it requires attention from both the psychiatric community and the social science community. Treatment is recommended in a therapeutic community, as well as a psychoeducational preventative program aimed at both mental health professionals and the general public.

References

External links