Malignant Narcissism: Signs, Causes & How to Deal

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Written by:Kate Rosenblatt, MA, LPC, LMHC

Published On: August 16, 2022

Medically reviewed by: Ashley Ertel, LCSW, BCD

Reviewed On: August 16, 2022

Updated On: June 22, 2023


First proposed by psychoanalyst Otto Kernberg, malignant narcissistic personality disorder is a less severe form of pathological narcissism that encompasses behaviors associated with antisocial personality disorder, narcissistic personality disorder (NPD), and sadism. While not explicitly listed in the American Psychiatric Association’s DSM-5, researchers have suggested malignant narcissism as one of the narcissistic personality disorder types.

People with malignant narcissism often feel superior to others and experience little to no remorse when their behavior causes harm. How they treat others can be highly damaging to the person engaging in the behavior and those around them.

Keep reading to learn more about what malignant narcissism is, the signs you should be aware of, what causes it, and most importantly, how to deal with it if someone in your life is showing signs.

What is Malignant Narcissism?

While you can find a malignant narcissism definition in some psychiatric dictionaries, it’s not an official mental health diagnosis. Instead, it’s considered to be a subtype of narcissistic personality disorder (NPD).

What is malignant narcissism, and what makes it different from other NPD subtypes? While entitlement, low empathy, and an inflated sense of self are associated with all types of NPD, people with malignant NPD experience antisocial personality disorder traits as well. They don’t feel remorse when their behavior causes harm and may even enjoy hurting others.

“Behaviors like controlling, exploiting, and manipulative patterns that are meaner in nature can be signs that someone might be struggling with malignant narcissism. If you feel like you might be experiencing these patterns from someone, we encourage you to contact a therapist for support.”

People with malignant narcissism share some personality traits with sociopaths and psychopaths. They have a low level of emotional responsiveness to others, and they may believe that the harmful behaviors they engage in are justified. However, people with narcissism tend to be driven by their egos. They have a narcissistic trait of a strong desire to be praised and admired by others and can be highly co-dependent.

This codependency can also make people with malignant narcissism highly paranoid. They may be convinced that they’re being threatened or persecuted by the people around them, or that others are trying to destroy their relationships. This paranoia can cause people with malignant narcissism to lash out at others.

Signs of Malignant Narcissism

While malignant narcissistic personality disorder isn’t listed in the DSM-5, it’s strongly associated with certain, specific symptoms and behaviors

“People with malignant narcissism often lie, appear somewhat paranoid, and put their wants, needs, and interests ahead of yours. This can feel aggressive and psychologically harmful. If you think you might be in a relationship with someone with malignant narcissism, reach out to a therapist or psychiatrist today.”

Signs of malignant narcissism can include:

Black and white thinking

Malignant narcissism causes someone to struggle to see events and people in a nuanced way. It’s common for them to perceive people as either friends or enemies, with nothing in between.

Fixating on appearances

Someone with malignant narcissism cares deeply about how they’re perceived by others. This can cause them to obsess over physical appearance.

Fantasies of success

Like people with NPD, those with malignant narcissism often have detailed fantasies about having unlimited success or having power over others. They may also fantasize about being physically attractive or intelligent.

Sadistic behavior

People with malignant narcissism don’t care if they hurt others. They may even feel satisfied or happy when their behavior causes other people pain, a personality trait associated with sadism. Since they typically see the people they hurt as enemies, they may feel that their abusive behavior and the pain they cause are warranted.

Refusal to take responsibility

Most often, people with malignant narcissism won’t take responsibility for the harm they cause others. They may fail to follow laws or social norms, and even blame the people they hurt for their behavior. It’s rare for them to apologize, unless, of course, they believe the apology can benefit them in some way.


Paranoia is strongly associated with malignant narcissism. People with this condition will often feel persecuted or see normal behaviors as attacks or slights.

Lashing out

When someone with malignant narcissism feels like they were wronged by another person, they typically strike back. They can regularly perceive social interactions as a win/lose scenario and will go to great lengths to be seen as the winner.


People with malignant narcissism try hard to avoid any loss or inconvenience, even if it’s fairly minor. They may take extreme steps to protect themselves or to ensure that they get what they want.

Causes of Malignant Narcissism

While experts don’t know exactly what causes narcissistic personality disorder, research suggests that many people with this condition subtype experience abuse or maltreatment during childhood. It’s thought that narcissistic behaviors might be maladaptive coping mechanisms that developed as a result of trauma.

Studies also suggest that personality disorders like malignant narcissism may be heritable. Having a parent with NPD can increase the risk of narcissistic behavior, but it’s important to note that someone can develop malignant narcissism even without a family history of the condition.

It’s most likely and widely accepted that a combination of factors contributes to the condition.

How to Deal with Malignant Narcissism

A malignant narcissistic definition associates the condition with extreme levels of narcissism and aggression. These narcissistic personality disorder symptoms can be highly destructive to both the person with NPD and to those around them. It’s helpful to be able to recognize the signs of malignant narcissism so you can find effective coping strategies.

As a loved one

If you have a loved one with symptoms of this mental health condition, it’s important to protect yourself. Malignant narcissism causes people to be more likely to retaliate against those who they see as enemies or threats. This is why it’s best not to challenge your loved one directly. Instead, you should try to communicate in non-confrontational ways.

“If your loved one is struggling with malignant narcissism, and you’re experiencing the dishonesty that comes with malignant narcissism, find a therapist or psychiatrist to support you, ideally someone who specializes in narcissism.”

While you don’t necessarily have to cut a loved one with malignant narcissism completely out of your life, you should learn to recognize that their behaviors are unlikely to change without treatment.

Work to set boundaries, and put distance between yourself and your loved one if those boundaries aren’t respected. Make sure that you have a strong support system to rely on when things get tough.

As someone with NPD

If you’ve shown symptoms of malignant narcissism, treatment can help. Through therapy for narcissistic personality disorder, you can learn to regulate your emotions and change the behaviors you engage in that harm people around you. As long as you’re genuinely willing to address and work on yourself, treating narcissistic personality disorder  can improve your relationships and your quality of life.

“People with narcissistic personality disorders (NPD) often struggle with relationships, both personal and professional. If you think you or someone you care about might have NPD, we encourage you to get a clinical evaluation that can provide you with a diagnosis and treatment options, like therapy. You deserve support, and there are mental healthcare professionals out there who are there to help you.”

Finding Help Through Talkspace

Malignant narcissism is complex and can cause people to behave in irrational, hurtful, inexplicable ways. If you’ve struggled with narcissist behaviors, or if you have someone in your life who displays behaviors of malignant narcissism, asking questions like “What is malignant narcissism?” can help you begin to make sense of your experiences.

People with any type of NPD are often reluctant to seek help, but treatment can be beneficial in many ways. A narcissistic personality disorder diagnosis can help make sense of emotions and address any harm NPD has caused. Working on malignant narcissistic behavior can help repair damaged relationships. There’s no cure for malignant narcissism, but it is possible to learn to establish and nurture new, positive, healthy ones.

If you have a loved one with malignant NPD, or are dealing with or have dealt with malignant narcissism in the past, it’s worthwhile to consider treatment. Living with narcissistic behaviors can have a lasting impact on anyone’s emotional well-being. Don’t hesitate to reach out to a mental health professional who can provide you with care and support.

Looking for help but not sure where to start? Try Talkspace, the online therapy platform that makes getting therapy easier than ever. Our online platform, skilled therapists, and affordable plans mean you or a loved one can get help and learn to manage and overcome malignant narcissism. Help is out there, and you deserve to get it.

See References

Kate Rosenblatt, MA, LPC, LMHC

Kate Rosenblatt, MA, LPC, LMHC, was the Senior Clinical Manager at Talkspace until 2022, and is a clinical therapist licensed in CT and NY. A member of the American Psychological Association (APA), Kate completed her Master's degree in Counseling Psychology at Lesley University in Cambridge, MA. She has over 10 years of experience working with adults on a variety of issues, specializing in eating disorders and working with people going through life stressors such as finding your purpose, career changes, and connecting with your intuition.

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