What Is Malignant Narcissism?

Finding Support in Relationships

Malignant narcissism is the combination of narcissistic personality disorder and antisocial personality disorder. Narcissistic personality disorder (NPD) is a mental health condition in which a person has an inflated sense of self-worth and wants others to admire them. Antisocial personality disorder is a mental health condition in which a person demonstrates a pattern of disregard for the rights of others. 

Malignant narcissism is considered to be more severe and includes paranoia, the feeling of being threatened or persecuted without proof.

This article will explain more about malignant narcissism, how it impacts relationships, and what those with the condition or in a relationship with someone with the condition can do to get help.

a couple sitting next to each other in a therapy office

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Traits of Malignant Narcissism

Since malignant narcissism is a combination of narcissistic personality disorder and antisocial personality disorder, it includes symptoms of both conditions.

Traits of NPD may include:

  • An inflated sense of talent, achievement, and self-importance
  • Fantasies about sex, power, intelligence, or beauty without limit
  • Need for attention and admiration that is excessive
  • Either a lack of emotion or extreme, negative emotions when faced with negative feedback or indifference
  • Interpersonal disturbances

Traits of antisocial personality disorder include:

  • An inability to feel guilt, remorse, and empathy
  • A lack of concern for the well-being of others
  • Recklessness, irresponsibility, and impulsivity
  • Exploitation, aggression, and deceit
  • Behaviors that violate the law and the rights of others.

Additionally, people with malignant narcissism often suffer from paranoia that is related to the inability to deal with criticism or lack of approval.

Understanding Personality Disorder Terms

Two terms commonly used with malignant narcissism are "psychopath" and "sociopath." Although there is some overlap between these conditions, there are key differences.

"Psychopathic personality" and "sociopathic personality" are both terms that are now called antisocial personality disorder (ASPD). Malignant narcissism is NPD that includes many aspects of ASPD, so someone with malignant narcissism could have psychopathic or sociopathic tendencies.

"Sociopathic" refers to challenges that stem from the environment, while "psychopathic" refers to challenges that stem from biological features. Both may have characteristics such as:

  • Dishonesty
  • Violations of the law
  • Causing harm to others
  • Impulsivity
  • Irresponsibility
  • Lack of feeling guilt, remorse, and empathy

However, there are differences. Psychopaths may be able to function in society and be viewed positively by others but struggle to form genuine bonds with others. In comparison, sociopaths tend to be more likely to form bonds with others but struggle more with functioning in society.

Narcissistic Personality Disorder and Antisocial Personality Disorder (NPD and ASPD)

Personality disorders are mental health conditions that are categorized into one of three groups: cluster A, cluster B, or cluster C personality disorders.

Narcissistic personality disorder is a cluster B personality disorder, which means it involves challenges such as emotional and impulse control. Antisocial personality disorder is another example of a cluster B personality disorder. This means the two conditions, NPD and ASPD, have similarities such as challenges with emotional and impulse control, but they are two different conditions.

People with NPD and ASPD differ in the way they think of others. For example, a person with NPD may believe they are more talented, important, and successful than those around them, whereas a person with ASPD may simply not care about the people around them and the well-being of those people.

Another difference between the two conditions is how they behave and interact with others, including how they respond to the behaviors of others. A person with NPD may expect praise and recognition from others and then become extremely upset when they do not get positive attention. A person with ASPD, on the other hand, may steal from someone for their own gain and then not care how that act impacts the other person.

How This Applies to Malignant Narcissism

People with malignant narcissism have traits of both NPD and ASPD, so they can think and act in ways that are seen in either condition.

Malignant Narcissism and Relationships

People with narcissistic personality disorder and antisocial personality disorder can both struggle with relationships due to some of the challenges that come along with these conditions. Since malignant narcissism includes traits from both NPD and ASPD, malignant narcissism can be especially challenging when it comes to forming and maintaining relationships.

More specifically, people struggling with malignant narcissism are more likely to be rejected by peers due to their tendency toward antisocial behaviors and interactions, such as manipulation, lying, and stealing. What's more, relationships with someone with malignant narcissism may become abusive and dangerous.

Genetic and Environmental Causes

Although the specific causes of narcissistic personality disorder, antisocial personality disorder, and malignant narcissism are not entirely understood, there are some genetic and environmental factors that may lead to these conditions.

There may also be a combination of genetic and environmental causes in malignant narcissism. For example, someone may be genetically predisposed to mental health conditions such as antisocial personality disorder, and then be exposed to environmental influences such as negative, stressful experiences that trigger the condition to present symptoms.

Additionally, certain traits of narcissism, such as grandiosity and entitlement, can be inherited and then impacted by the environment.

Genetic and biological causes of malignant narcissism include:

  • Brain structure: It's been found that people with personality disorders have differences in their brains. For example, people with NPD may have prefrontal and insular brain structure variations.
  • Sensitivity to stress: Some people may be genetically prone to the negative effects of stressful environmental factors. For example, two people may experience the same hardship, but only one will develop antisocial personality disorder.
  • Inherited grandiosity: The tendency to overemphasize and exaggerate talent, achievement, and self-importance can be passed down from parents to their children.
  • Inherited entitlement: The belief of being owed special treatment and resources due to an inflated sense of self can be passed down from parents to their children.
  • Highly sensitive temperament: People who are more sensitive or more likely to react to noise, light, textures, and things that are unfamiliar may be more susceptible to personality disorders.

Environmental Contributors

Environmental causes that can contribute to the development of malignant narcissism include:

  • Childhood neglect or inconsistent care
  • Childhood trauma or abuse
  • Sexual trauma
  • Verbal abuse
  • Extremely high expectations or criticism from parents or caregivers
  • Extremely high praise, indulgence, or pampering from parents or caregivers
  • Peer and social influences

Therapy Options

Malignant narcissism can be treated and managed with psychotherapy (talk therapy). Specific types of talk therapy recommended for narcissistic personality disorder include:

  • Mentalization-based therapy is a form of talk therapy that focuses on becoming self-aware of thoughts and mental states.
  • Transference-focused psychotherapy is a form of talk therapy that brings awareness to and shifts thoughts about self and others that are not completely accurate.
  • Schema-focused psychotherapy is a form of talk therapy that focuses on identifying thoughts and beliefs that are harmful to the person receiving the therapy.

Talk therapy can be provided individually to the person with the mental health condition, to couples or families to receive support as well, or in a group setting. Psychotherapy can also be helpful for victims of narcissistic abuse and can be provided individually without the person with malignant narcissism being present.

Choosing a Specialist

Psychotherapy can be provided by a mental health professional such as a psychologist or psychiatrist. Healthcare professionals, including primary care physicians, can provide referrals to mental health professionals.

Some professionals specialize in certain types of therapy and focus on treating specific conditions. It may be helpful to work with someone who specializes in personality disorders, or someone who has specialized training in one of the therapy options recommended for the condition.

It is also important for the client to feel comfortable with the provider, so that is something to consider when choosing a specialist.

Telehealth

Telehealth is a way for people to receive talk therapy and other health services remotely using online platforms. Appointments generally involve video conferencing using platforms that comply with healthcare standards and regulations.

The effectiveness of telehealth services has been studied and generally found to be as effective as in-person appointments, though some research has shown it to be less effective, and some has even shown it to be more effective than in-person appointment.

Telehealth services may be covered by insurance. However, not all telehealth services are covered, so it is important to check with insurance providers to determine the details of the individual plans. Additionally, insurance coverage may be impacted if providers and clients are in different states.

Encouraging Someone You Know to Get Help

Malignant narcissism can be challenging for the person with the condition as well as the people around them. Spouses and intimate partners of people with malignant narcissism tend to be especially impacted.

Intimate relationships may be very painful for the partners of those with malignant narcissism, and they may experience abuse, loss of control, and other negative effects.

These relationship dynamics make it essential to seek help, but approaching the subject with someone with malignant narcissism can be a challenge. Despite the difficulties, there are some strategies to help. These include:

  • Prepare ahead of time and consider professional support before initiating a conversation.
  • Have realistic expectations and understand that things may not go as planned.
  • Remain calm and have the conversation with the support of others, possibly a professional, if needed.
  • Set and maintain boundaries, including physical and emotional safety.
  • Know that their behavior is not the fault of those around them.

Mental Health Helpline

If you or a loved one are struggling with malignant narcissism, narcissistic personality disorder, or antisocial personality disorder, contact the Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline at 800-662-4357 for information on support and treatment facilities in your area.

For more mental health resources, see our National Helpline Database.

Relationship Red Flags to Consider

Malignant narcissism can have traits of both narcissistic personality disorder and antisocial personality disorder. Because of this, relationship red flags may include treats of both conditions.

Some examples of narcissistic personality disorder relationship red flags are not showing concern for the needs and feelings of their partner and demanding a lot of admiration from their partner. Examples of antisocial personality disorder relationship red flags are manipulation and blaming their partner for their own problems.

Red flags someone with malignant narcissism may exhibit include:

  • Arrogant behaviors toward the partner
  • Believing they are entitled to favors
  • Deceit or lies
  • Excessive demand for admiration
  • Finding joy in the harm of the partner
  • Holding or attempting to hold power over the partner
  • Lack of remorse
  • Lawbreaking
  • Manipulation
  • Not showing concern for their partner's needs and feelings
  • Not taking responsibility for their mistakes
  • Paranoia
  • Physical aggression
  • Placing inappropriate blame on the partner
  • Plotting against others, including the partner
  • Property damage
  • Reckless behavior
  • Social withdrawal or lack of friends
  • Taking advantage of the partner

Domestic Violence Helpline

If you or a loved one are a victim of domestic violence, contact the National Domestic Violence Hotline at 800-799-7233 for confidential assistance from trained advocates.

For more mental health resources, see our National Helpline Database.

Summary

Malignant narcissism is a mental health condition that involves traits of both narcissistic personality disorder and antisocial personality disorder. People with this condition have an inflated sense of their own talent, achievement, or self-worth, struggle to form authentic connections with others and may become aggressive or abusive without feelings of guilt or remorse.

These characteristics can be harmful to those with the condition and those around them, especially intimate partners. Treatment is available, and talk therapy can help.

A Word From Verywell

Malignant narcissism can be a challenge both for the person experiencing the condition and for other people in their life. If you suspect you or someone you know is struggling with symptoms of malignant narcissism, narcissistic personality disorder, or antisocial personality disorder, know that help is available. Reach out to a trained medical professional such as a psychologist or psychiatrist for support.

Frequently Asked Questions

  • How does malignant narcissism compare to other types of narcissism?

    The main difference between narcissism and malignant narcissism is that a person with malignant narcissism experiences symptoms of both narcissistic personality disorder and antisocial personality disorder. Malignant narcissism is a more severe condition than narcissism.

  • Do malignant narcissists “snap”?

    Rage is a symptom of narcissism, which can range in intensity from outbursts to physical harm to others, even extreme enough to result in death. Malignant narcissism, which includes narcissism and antisocial personality characteristics, can be more intense than narcissism alone because there is a lack of concern for the well-being of others or doing what is considered right.

  • Should you argue with someone with malignant narcissism?

    When interacting with someone with narcissism, it is important to always maintain safety. It can be helpful to have difficult conversations in controlled environments, or with the support of a trained professional such as a psychologist or psychiatrist. Even if a person with narcissism does not become physically dangerous, arguments will likely be unproductive and could cause emotional harm.

  • Are there support groups for victims of malignant narcissists?

    There are support groups for victims of narcissists, including malignant narcissists. They can be found by contacting mental health professionals or searching local resources. Additionally, Narcissistic Abuse Support is a resource with an online database to search for support groups.

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16 Sources
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  1. Shafti SS. Malignant narcissism: concealed side of psychopathyBJSTR. 2019;22(1):16310-16315. doi:10.26717/BJSTR.2019.22.003686

  2. American Psychological Association. Narcissistic personality disorder.

  3. American Psychological Association. Antisocial personality disorder.

  4. Trifu S. The malignant narcissistic dimension in the antisocial personality disorder. J Forensic Res. 2013;4(3). doi:10.4172/2157-7145.1000188

  5. Fakhrzadegan S, Gholami-Doon H, Shamloo B, Shokouhi-Moqhaddam S. The relationship between personality disorders and the type of crime committed and substance used among prisonersAddict Health. 2017;9(2):64-71.

  6. Tanzilli A, Gualco I. Clinician emotional responses and therapeutic alliance when treating adolescent patients with narcissistic personality disorder subtypes: a clinically meaningful empirical investigationJournal of Personality Disorders. 2020;34(Supplement):42-62. doi:10.1521/pedi.2020.34.supp.42

  7. Luo YLL, Cai H, Song H. A behavioral genetic study of intrapersonal and interpersonal dimensions of narcissismPLoS One. 2014;9(4):e93403. doi:10.1371/journal.pone.0093403

  8. Nenadić I, Lorenz C, Gaser C. Narcissistic personality traits and prefrontal brain structureSci Rep. 2021;11(1):15707. doi:10.1038/s41598-021-94920-z

  9. Junewicz A, Billick SB. Preempting the development of antisocial behavior and psychopathic traitsJournal of the American Academy of Psychiatry and the Law Online. Published online January 6, 2021. doi:10.29158/JAAPL.200060-20

  10. American Psychological Association. What causes personality disorders?

  11. Caligor E, Levy KN, Yeomans FE. Narcissistic personality disorder: diagnostic and clinical challengesAJP. 2015;172(5):415-422. doi:10.1176/appi.ajp.2014.14060723

  12. American Psychological Association. How to choose a psychologist.

  13. American Psychological Association. Online therapy is here to stay.

  14. Maatta M, Uusiautti S, Maatta, K. An intimate relationship in the shadow of narcissism: What is it like to live with a narcissistic spouse? IJRSP. 2012;1(1):37-50. doi:10.5861/ijrsp.2012.v1i1.28

  15. Cleveland Clinic. Narcissistic personality disorder.

  16. Cleveland Clinic. Antisocial personality disorder (ASPD).