Malignant narcissism is a psychological syndrome comprising an extreme mix of narcissism, antisocial personality disorder, aggression, and sadism. Often grandiose, and always ready to raise hostility levels, the malignant narcissist undermines organizations in which they are involved, and dehumanizes the people with whom they associate.
Malignant narcissism is a hypothetical, experimental diagnostic category. Narcissistic personality disorder is found in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR), while malignant narcissism is not. As a hypothetical syndrome, malignant narcissism could include aspects of narcissistic personality disorder as well as paranoia. The importance of malignant narcissism and of projection as a defense mechanism has been confirmed in paranoia, as well as "the patient's vulnerability to malignant narcissistic regression".
The social psychologist Erich Fromm first coined the term "malignant narcissism" in 1964, describing it as a "severe mental sickness" representing "the quintessence of evil". 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 and denial of reality", while Herbert Rosenfeld (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".
Developing their ideas further, the psychoanalyst Otto Kernberg pointed out that the antisocial personality was fundamentally narcissistic and without morality. Malignant narcissism includes a sadistic element creating, in essence, a sadistic psychopath. In his article, "malignant narcissism" and psychopathy are employed interchangeably. Kernberg first proposed malignant narcissism as a psychiatric diagnosis in 1984, but so far it has not been accepted in any of the medical manuals, such as the ICD-10 or the DSM-5.
Kernberg described malignant narcissism as a syndrome characterized by a narcissistic personality disorder (NPD), antisocial features, paranoid traits, and egosyntonic aggression. Other symptoms may include an absence of conscience, a psychological need for power, and a sense of importance (grandiosity). Pollock wrote: "The malignant narcissist is presented as pathologically grandiose, lacking in conscience and behavioral regulation with characteristic demonstrations of joyful cruelty and sadism".
Kernberg believed that malignant narcissism should be considered part of a spectrum of pathological narcissism, which he saw as ranging from Cleckley's antisocial character (today's psychopath or antisocial personality) at the high end of severity, through malignant narcissism, and then to narcissistic personality disorder at the low end. The malignant narcissist thus represents a less extreme form of pathological narcissism than psychopathy. Malignant narcissism can be distinguished from psychopathy, according to Kernberg, because of the malignant narcissist's capacity 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". 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'...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 groups...with the capacity for loyalty to their own comrades".
The terms malignant narcissist and psychopath are sometimes used interchangeably because there is little to clinically separate the two. Individuals with narcissistic personality disorder, malignant narcissism, and psychopathy all display similar traits which are outlined in the Hare Psychopathy Checklist. The test has 20 items scored on a three-point scale, with a rating of 0 if it does not apply at all, 1 if there is a partial match or mixed information, and 2 if there is a reasonably good match. With a maximum score of 40, the cut-off for the label of psychopathy is 30 in the United States and 25 in the United Kingdom. High scores are positively associated with measures of impulsivity and aggression, Machiavellianism, persistent criminal behavior, and negatively associated with measures of empathy and affiliation.
Contrast with narcissism
While narcissists are common, malignant narcissists are less common. A notable difference between the two is the feature of sadism, or the gratuitous enjoyment of the pain of others. A narcissist will deliberately damage other people in pursuit of their own selfish desires, but may regret and will in some circumstances show remorse for doing so, while a malignant narcissist will harm others and enjoy doing so, showing little empathy or regret for the damage they have caused.
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 Lacan described as "that resistance of the amour-propre...which is often expressed thus: 'I can't bear the thought of being freed by anyone other than myself'".
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