Malignant narcissism is a syndrome consisting of a combination of aspects of narcissistic personality disorder and antisocial personality disorder as well as paranoid traits or may be a fundamental aspect of human nature. Malignant narcissism should be considered a theoretical or 'experimental' diagnostic category; although narcissistic personality disorder is found in the current version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR), malignant narcissism is not. Individuals with malignant narcissism would be diagnosed under narcissistic personality disorder. Malignant narcissism can be partially treated with medications and therapy helping to reduce aggravating symptoms.
The malignant narcissist differs from narcissistic personality disorder in that the malignant narcissist derives higher levels of psychological gratification from accomplishments over time (thus worsening the disorder). Because the malignant narcissist becomes more involved in this psychological gratification, they are apt to develop the antisocial, the paranoid, and the schizoid personality disorders. The term malignant is added to the term narcissist to indicate that individuals with this disorder tend to worsen in their impulse controls and desires over time.
Malignant narcissism can be comorbid with other psychological disorders not mentioned above.
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."
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 this essay, "malignant narcissism" and psychopathy are employed interchangeably. Kernberg first proposed malignant narcissism as a psychiatric diagnosis in 1984.
Kernberg described malignant narcissism as a syndrome characterized by a narcissistic personality disorder (NPD), antisocial features, paranoid traits, and ego-syntonic 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 claimed that malignant narcissism should be considered part of a spectrum of pathological narcissism, which he saw as ranging from the 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 narcisscist thus represents a less extreme form of pathological narcissism than psychopathy. Individuals with narcissistic personality disorder, malignant narcissism and psychopathy all display similar traits which are outlined in the Hare Psychopathy Checklist. (The traits in the checklist are common amongst individuals with psychological disorders. The psychopath/malignant narcissist must display a strong tendency towards these characteristics.)
Malignant narcissism can be differentiated from psychopathy, according to Kernberg, because of the malignant narcissists' 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 psychopaths' paranoid stance against external influences makes them 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." The malignant narcissist's main differences in impulse control from the psychopath is in the area of psychological gratification. While the psychopath displays more antisocial features, the malignant narcissist desires "unlimited power". It is possible for the malignant narcissist to move above and beyond their contemporaries, and make a positive contribution to society (although rarely is this the case). The malignant narcissist will attempt to make full use of their capabilities. Neither the malignant narcissist nor the psychopath can delay gratification, but malignant narcissism lends itself to gratification in intellectual and other positive pursuits.
The term 'narcissistic supply' was introduced by Psychoanalyst Otto Fenichel in 1938 in describing the way in which a narcissistic individual "requires a 'narcissistic supply' from the environment in the same way as the infant requires an external supply of food". The term was later used by Kernberg in describing one of the features which distinguish pathological from normal narcissism, namely the coldness of a narcissist's relationships in the form of a "tendency to disregard others except in temporary idealization of narcissistic supply".
The malignant narcissist receives psychological gratification from feelings of power that come from the outside world. These positive social cues can be in the form of attention, power, and notoriety. Over time, the malignant narcissist becomes accustomed (even addicted) to this form of psychological gratification (also known as narcissistic supply). Similar to other addictions, the narcissist needs to feed off other people's emotions for narcissistic supply to help stimulate their psychological needs. Without narcissistic supply, the narcissist will undergo withdrawal symptoms similar to a drug addict.
The malignant narcissist is inherently weak because he/she derives their ego functioning ability by constantly feeding off the emotions of other people (to build up their sense of self-worth to higher levels). This is why malignant narcissism is likened to a drug addiction. The drug addict (like the malignant narcissist) needs higher dosages of a drug to get the same after-effect. The narcissist (on the other-hand) needs to build up their sense of self-worth at increasingly higher levels to maintain the same level of ego-functioning. The malignant narcissist will go to extreme levels to build up their esteem, often resorting to antisocial behaviors and isolation of others (which is why antisocial, schizoid and paranoid personality disorders accompany this disease). If the malignant narcissist's grandiose fantasies fail them and they cannot feed their ego enough to function properly, they will undergo periods of dysphoria, emotional lability and anhedonia as well as display other negative symptoms of psychological disorders.
Individuals with malignant narcissism will display a two faced personality. Creation of a "false self" is linked to the narcissist's fear of being inadequate or inferior to others and this mask becomes ingrained into their personality so as to project a sense of superiority to others at all times. The narcissist gains a sense of esteem from the feedback of other people as it is common for the malignant narcissist to suffer from extremely low levels of self-esteem.
The conjured up alter ego (or false self) of the malignant narcissist is created because the real self doesn't meet his or her own expectations. Instead, the narcissist tends to mimic emotional displays of other people and creates a grandiose self to harbor their internalized fantasies of greatness. The alter ego is used by the narcissist to present to the outside world what appears to be a normal, functioning human being and to help maintain his or her own fantasies of an idealized self. The narcissist constantly builds upon this false self, creating a fictional character that is used to show off to the world and to help them feed off the emotions of other people.
Under poor conditions, the narcissist may take off their mask and display a weaker or even hideous personality.
Common to malignant narcissism is narcissistic rage. Narcissistic rage is a reaction to narcissistic injury (when the narcissist feels degraded by another person, typically in the form of criticism). When the narcissist's grandiose sense of self-worth is perceivably being attacked by another person, the narcissist's natural reaction is to rage and pull-down the self-worth of others (to make the narcissist feel superior to others). It is an attempt by the narcissist to soothe their internal pain and hostility, while at the same time rebuilding their self worth. Narcissistic rage should not be confused with anger (although the two are similar), and is not necessarily caused by a situation that would typically provoke anger in an individual. Narcissistic rage can be explosive or passive aggressive.
Narcissistic rage also occurs when the narcissist perceives that he/she is being prevented from accomplishing their grandiose fantasies. Because the narcissist derives pleasure from the fulfillment of their grandiose dreams (akin to an addiction), anyone standing between the narcissist and their fulfillment of such accomplishments may be subject to narcissistic rage. Narcissistic rage will frequently include yelling and berating of the person that has slighted the narcissist, but if strong enough could provoke more hostile feelings. Narcissistic rage is frequently short lasting, and passes when the narcissist rationalizes the shame that they felt.
Malignant narcissism is an incurable disease, although medical treatment and talk therapy are beneficial. Antipsychotic drugs (such as abilify) have the tendency to reduce paranoid features of the malignant narcissist. Individuals with this disorder that show signs of drug-like withdrawals may benefit from SSRI anti-depressants or possibly even stimulant medication. No exact diagnostic criteria has been set for the disorder of malignant narcissism, and it is an understudied problem compared to similar psychological disorders (narcissistic personality disorder, psychopathy, schizoid personality disorder).
Common characteristics of those with malignant narcissism include:
Malignant narcissism is related to narcissistic regression in infancy, in which the infant sees her/him-self as the "center of the world." Whereas most infants grow out of this stage, the malignant narcissist is thought to be trapped in this period throughout their lifetime. If this disorder is left untreated in childhood, symptoms may worsen over time. Other personality disorders are likely to branch out from malignant narcissism.
Factors that may cause malignant narcissism include:
These factors are based on the theory that malignant narcissism is 'similar' to narcissistic personality disorder, but include progressively worsening symptoms of NPD over time.
Pathological narcissism is related to improper (external) ego functioning, where the narcissist derives their ability to function properly from external sources. Malignant narcissism is also related to an underdeveloped "or a lack of a" superego (conscience).
Using Freud's analogy of the man (ego) on a horse (Id) and a whip (superego) punishing the horse when it gets out of line in context of the "malignant narcissist" is as follows:
A simple illustration of the pathological narcissist's needs structure can be depicted using Maslow's Hierarchy of Needs:
Maslow's Hierarchy of Needs displays the normal distribution of motivational needs for a healthy functioning person- Physiological<Safety<Love/Belonging<Esteem<Self-Actualization:
The pathological narcissist varies in their motivational needs, frequently placing esteem needs (and self-actualization needs) above love and belonging needs as well as being on par with safety needs. These esteem needs are put in a higher priority to the narcissist because their ego functioning abilities depend on the outside world, whereas normal functioning individuals derive ego functioning internally. Without fulfilling the esteem needs of the narcissist, the ego cannot properly regulate between the id and the superego. The narcissist's structure of motivational needs would look more like the following: Physiological<Safety=Esteem<Love/Belonging=Self-Actualization.
Victimology is the study of the relationship between victims and their offenders. It is related to malignant narcissism in that the narcissist frequently uses/abuses others for personal gain, leaving others to feel victimized at the end of a relationship with the narcissist. Author Sam Vaknin, a self-proclaimed malignant narcissist, has written extensively about victims of malignant narcissists. He claims that victims are often overwhelmed with the emotional demands of a malignant narcissist, and they may develop similar narcissistic traits; as if a person can "catch" narcissism like a cold. Personality disorders are not contagious. While such claims have been implied by Vaknin and a few celebrity doctors to perhaps broaden the appeal of their books, these claims are unfounded and irresponsible. The reality is that anyone who is in close contact with a malignant narcissist is in an unhealthy, and very likely, dangerous situation. Little is understood about the disorder because of its very nature. It is impossible for a narcissist to hold himself responsible for any mistakes or transgressions. In his eyes, he is the most moral, upstanding person on the planet. Thus a narcissist almost never seeks psychological assistance on his own. Charming, glib, and a master at upholding a carefully crafted image of himself, the malignant narcissist can manipulate and convince the most well respected, experienced medical professionals in the industry to sympathize with him, to be on his side. The fact that the best trained professionals have trouble identifying the disorder is an indication that victims are not merely "more apt to be impressed with superficiality and grandiosity" as one writer implied. Instead, malignant narcissists can con the smartest, most down-to-earth and loving people in society. The following statement attributed to Vaknin is patently false (after all, consider the source!): Hence, pathological narcissism (or the gratification gained from using others) can be partially "contagious".