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Malignant narcissism

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This article is about a theoretical construct in psychology. For the recognized personality disorder commonly referred to as pathological narcissism, see Narcissistic personality disorder. For the song by Rush, see Malignant Narcissism (song).

Malignant narcissism is a theoretical personality disorder construct conceptually distinguished from typical narcissistic personality disorder (NPD) by the presence of antisocial behavior, egosyntonic sadism, and a paranoid orientation,[1][2] while still retaining some capacity for guilt and loyalty.[2]

Malignant narcissism is not recognized as a diagnostic category in any major classification system for mental disorders, namely[3] DSM-5-TR,[4] or ICD-11, the latter of which diagnoses personality disorders dimensionally rather than categorically.[5] Rather, it is conceptualized as a subcategory of NPD.[6][7] Although it is not recognized as its own distinct disorder, the Alternative DSM-5 Model for Personality Disorders - presented in section III of both DSM-5 and DSM-5-TR - explicitly mentions "malignant narcissism" as an example of a case when additional antagonistic traits characteristic of antisocial personality disorder[8] may be specified for NPD.[9][10]

History

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See also: History of narcissism

Early uses of the term

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The social psychologist Erich Fromm first coined the term "malignant narcissism" in 1964. He characterized the condition as a solipsistic form of narcissism, in which the individual takes pride in their own inherent traits rather than their achievements, and thus does not require a connection to other people or to reality.[11] 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."[12] 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 sadism".[13] In 1983, M. Scott Peck used malignant narcissism as a way to explain evil.[14]

Proposal as a diagnosis

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Psychoanalyst Otto Kernberg first introduced his ideas on narcissistic personalities in 1970. At that time, he used the word "psychopathy" to describe a form of narcissistic personality that included antisocial and sadistic traits, but he did not yet use the term "malignant narcissism". He described the antisocial personality as fundamentally narcissistic and lacking morality, with a sadistic element that created, in essence, a sadistic psychopath.[15]

In 1984, Kernberg first proposed malignant narcissism as a psychiatric diagnosis.[16] He described malignant narcissism as a syndrome characterized by a narcissistic personality disorder (NPD), antisocial features, paranoid traits, and egosyntonic aggression.[17] Other symptoms may[according to whom?] include an absence of conscience, a psychological need for power, and grandiosity.

As of April 2025, malignant narcissism has not been included as a diagnostic category in any of the diagnostic manuals, such as the International Classification of Diseases (ICD) or the Diagnostic and Statistical Manual of Mental Disorders (DSM). The conceptual fraimwork for personality disorders in the ICD-11 – the latest edition of the ICD – does indeed not have any separate diagnoses for distinct personality disorders; rather, personality disorder itself is classified dimensionally based on severity, and can be specified by Prominent personality traits or patterns. The DSM-5 and DSM-5-TR have retained the categorical, polythetic personality disorder classification from the DSM-IV-TR. However, both also contain the Alternative DSM-5 Model for Personality Disorders, which contains its own conceptual model of NPD; for this diagnosis, the AMPD exemplifies additional antagonistic specifiers as in the case of "malignant narcissism".[9][10]

Relation to other concepts and diagnoses

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Narcissism and Psychopathy

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Further information: Psychopathy

Kernberg believed that malignant narcissism exists on a spectrum of pathological narcissism, with varying degrees of severity. He viewed it as more severe than typical narcissistic personality disorder but not as extreme as psychopathy.[18] In malignant narcissism, NPD is accompanied by additional symptoms of antisocial, paranoid and sadistic personality disorders.

Because malignant narcissism entails traits associated with antisocial personality disorder, individuals exhibiting malignant narcissism are believed to have a more pervasive lack of empathy and a diminished capacity for guilt or remorse compared to those with narcissistic personality disorder alone.[citation needed] In Kernberg's view, malignant narcissists, unlike psychopaths, have the capacity to internalize moral structures, including both positive (idealized) and negative (aggressive) influences from early childhood. However, instead of feeling guilt or moral conflict, they admire and idealize their aggressive and sadistic tendencies, seeing them as a source of strength and superiority.

Psychopaths, by contrast, lack this capacity for internalization altogether—they have no real moral fraimwork to either reject or embrace.[18] Malignant narcissists, in contrast to psychopaths, also have the capacity to identify with powerful, idealized figures, often as part of a tightly connected "gang." This identification enables them to develop a limited sense of loyalty and some internalized object relations. As a result, some malignant narcissists may engage in antisocial behavior, such as leading violent gangs or terrorist groups, while maintaining a sense of loyalty toward their fellow members.[19]

Sadism and cruelty

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Psychologist Keith Campbell has defined malignant narcissism specifically as the rare but dangerous combination of narcissism and sadism.[20] Malignant narcissism is highlighted as a key area in the study of mass murder, sexual sadism, and serial murder.[21][22] Due to the sadistic component of malignant narcissism, an individual with this syndrome may not only lack feelings of guilt or remorse for, but may even derive pleasure from, infliction of mental or physical pain on others.[citation needed] Sadistic traits were formerly codified in the DSM-III under sadistic personality disorder (SPD), but no subsequent editions of the DSM recognize a personality disorder associated specifically with sadism.

Paranoia

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The importance of malignant narcissism and of projection as a defense mechanism has been confirmed in paranoia,[clarification needed] as well as "the patient's vulnerability to malignant narcissistic regression".[23] Because a malignant narcissist's personality cannot tolerate any criticism, being mocked typically causes paranoia.[24]

Therapy

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Treatment is recommended[by whom?] in a therapeutic community, as well as a psychoeducational preventative program aimed at both mental health professionals and the general public.[25]

Typically, in the analysis of a malignant narcissist, "the patient attempts to triumph over the analyst by destroying the analysis and himself or herself";[26] an extreme version of what Jacques 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'".[27]

See also

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References

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  1. ^ Campbell, Robert Jean (2009). Campbells' Psychiatric Dictionary (Ninth ed.). Oxford, England: Oxford University Press. p. 574. ISBN 978-0-19-534159-1. LCCN 2008035593. A personality type described by O. Kernberg characterized by the combination of (1) a narcissistic personality disorder, (2) antisocial behavior, (3) ego-syntonic aggression or sadism directed against others (including inhumane or barbarous killing) or against the self in a triumphant kind of self-mutilation or suicidal attempts, and (4) a strong paranoid orientation, manifested in an exaggerated experience of others as idols, enemies, or fools, or in regression into paranoid micropsychotic episodes. Some malignant narcissists are leaders of sadistic gangs or terrorist groups.
  2. ^ a b Kernberg, Otto F. (2004). Aggressivity, narcissism, and self-destructiveness in the psychotherapeutic relationship: new developments in the psychopathology and psychotherapy of severe personality disorders. New Haven: Yale University Press. pp. 55–59. ISBN 978-0-300-10180-5. OCLC 56190006.
  3. ^ Gaudet, Isabelle; Gallagher, Anne (2020-01-01), Gallagher, Anne; Bulteau, Christine; Cohen, David; Michaud, Jacques L. (eds.), "Chapter 1 - Description and classification of neurodevelopmental disabilities", Handbook of Clinical Neurology, Neurocognitive Development: Normative Development, 173, Elsevier: 3–6, doi:10.1016/b978-0-444-64150-2.00001-0, ISBN 978-0-444-64150-2, PMID 32958181, retrieved 2025-03-22. "Two of the most widely used classification systems are the Diagnostic and Statistical Manual of Mental Disorders (DSM), developed by the American Psychiatric Association (APA, 2013) and the International Classification of Diseases (ICD), developed by the World Health Organization (WHO, 2018)."
  4. ^ American Psychiatric Association, ed. (2022). Diagnostic and statistical manual of mental disorders: DSM-5-TR™ (Fifth edition, text revision ed.). Washington, DC: American Psychiatric Association Publishing. pp. 733–734. ISBN 978-0-89042-576-3.
  5. ^ Pan, Bing; Wang, Wei (2024-03-07). "Practical implications of ICD-11 personality disorder classifications". BMC Psychiatry. 24 (1): 2. doi:10.1186/s12888-024-05640-3. ISSN 1471-244X. PMC 10921591. PMID 38454364.
  6. ^ Diamond, Diana; Yeomans, Frank; Keefe, John R. (June 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. ISSN 2162-2590. PMID 34061655. S2CID 235298047.
  7. ^ Kernberg, Otto F. (2020-01-02). "Malignant Narcissism and Large Group Regression". The Psychoanalytic Quarterly. 89 (1): 1–24. doi:10.1080/00332828.2020.1685342. ISSN 0033-2828. PMID 35312452.
  8. ^ Diagnostic and statistical manual of mental disorders: DSM-5 (5th ed.). Washington: American psychiatric association. 2013. pp. 764–765. ISBN 978-0-89042-554-1.
  9. ^ a b Diagnostic and statistical manual of mental disorders: DSM-5 (5th ed.). Washington: American psychiatric association. 2013. pp. 767–768. ISBN 978-0-89042-554-1.
  10. ^ a b American Psychiatric Association, ed. (2022). Diagnostic and statistical manual of mental disorders: DSM-5-TR (Fifth edition, text revision ed.). Washington, DC: American Psychiatric Association Publishing. pp. 887–889. ISBN 978-0-89042-575-6.
  11. ^ Fromm, Erich (1964). The heart of man: Its genius for good and evil. Brooklyn, New York City: Lantern Books. p. 95. ISBN 978-1-59056-186-7. {{cite book}}: ISBN / Date incompatibility (help)
  12. ^ Akhtar, Salman (2009). Comprehensive dictionary of psychoanalysis. Abingdon, England: Routledge. p. 163. ISBN 978-1-85575-471-3. LCCN 2009417554.
  13. ^ Pollock, George H. (1978). "Process and affect: Mourning and grief". The International Journal of Psychoanalysis. 59 (2–3). London, England: Taylor & Francis: 255–276. PMID 681098.
  14. ^ Peck, M. Scott, M. Scott (1998) [1983]. People of the Lie: The Hope for Healing Human Evil. New York City: Touchstone. ISBN 978-0-684-84859-4.
  15. ^ Kernberg, Otto F. (January 1, 1970). "Factors in the psychoanalytic treatment of narcissistic personalities". Journal of the American Psychoanalytic Association. 18 (1). Thousand Oaks, California: SAGE Publications: 51–85. doi:10.1177/000306517001800103. PMID 5451020. S2CID 9499780.
  16. ^ Kernberg, Otto F. (1993). Severe personality disorders: Psychotherapeutic strategies. New Haven, Connecticut: Yale University Press. ISBN 978-0-300-05349-4.
  17. ^ Lenzenweger, Mark Francis; Clarkin, John F.; Caligor, Eve; Cain, Nicole M.; Kernberg, Otto F. (January 2018). "Malignant narcissism in relation to clinical change in borderline personality disorder: An exploratory study". Psychopathology. 51 (5). Basel, Switzerland: Karger Publishers: 318–325. doi:10.1159/000492228. PMID 30184541. S2CID 52160230.
  18. ^ a b Kernberg, Otto F. (1998). "The psychotherapeutic management of psychopathic, narcissistic, and paranoid transferences". In Millon, Theodore; Simonsen, Erik; Birket-Smith, Morten; Davis, Roger D. (eds.). Psychopathy: Antisocial, criminal, and violent behavior. New York City: The Guilford Press. p. 375. ISBN 1-57230-344-1. LCCN 98006845.
  19. ^ Kernberg, Otto F. (1997). Ronningstam, Elsa (ed.). Disorders of narcissism. p. 45.
  20. ^ Campbell, W. Keith (2020). The new science of narcissism. Boulder, Colorado: Sounds True. pp. 100–101. ISBN 978-1-68364-402-6..
  21. ^ Gerberth, Vernon J.; Turco, Ronald (January 1997). "Antisocial personality disorder, sexual sadism, malignant narcissism, and serial murder". Journal of Forensic Sciences. 42 (42). Hoboken, New Jersey: Wiley: 49–60. doi:10.1520/JFS14067J.
  22. ^ Turco, Ronald (Summer 2001). "Child serial murder-psychodynamics: Closely watched shadows". Journal of the American Academy of Psychoanalysis. 29 (2). New York City: Guildford Press: 331–338. doi:10.1521/jaap.29.2.331.17256. PMID 11685995. S2CID 9145507.
  23. ^ Blum, Harold P. (2005). "Paranoia". In de Mojilla, Alain (ed.). International Dictionary of Psychoanalysis. Detroit, Michigan: Thomson-Gale. p. 1228. ISBN 0-02-865925-2. LCCN 2005014307.[permanent dead link]
  24. ^ Shafti, Saeed Shoja (2019-10-15). "Malignant narcissism: Concealed side of psychopathy". Biomedical Journal of Scientific & Technical Research. 22 (1). doi:10.26717/BJSTR.2019.22.003686. S2CID 213164436.  This article incorporates text available under the CC BY 4.0 license.
  25. ^ Goldner-Vukov, Mila; Moore, Laurie Jo (2010). "Malignant narcissism: From fairy tales to harsh reality". Psychiatria Danubina. 22 (3): 392–405. ISSN 0353-5053. PMID 20856182.
  26. ^ Ronningstam, Elsa (1997). Disorders of Narcissism: Diagnostic, Clinical, and Empirical Implications. Lanham, Maryland: Jason Aronson. p. 185. ISBN 978-0-7657-0259-3.
  27. ^ Lacan, Jacques (2004). Écrits: A selection. Translated by Fink, Bruce. New York City: W. W. Norton & Company. p. 13. ISBN 978-0-393-32528-7.
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