Malignant narcissism

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Narcissus (mythology), after whom narcissism is named. Painting by Jan Cossiers. Jan Cossiers - NarcisoFXD.jpg
Narcissus (mythology), after whom narcissism is named. Painting by Jan Cossiers.

Malignant narcissism is a theoretical personality disorder construct comprising a combination of narcissism, antisocial behavior, sadism, and a paranoid outlook on life. [1]

Contents

Malignant narcissism is not recognized as a diagnostic category in any major classification system for mental disorders, namely [2] DSM-5-TR, [3] or ICD-11, the latter of which diagnoses personality disorders dimensionally rather than categorically. [4] Rather, it is conceptualized as a subcategory of narcissistic personality disorder (NPD). [5] [6] 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 [7] may be specified for NPD. [8] [9]

Malignant narcissism is conceptually distinguished from typical NPD by the presence of antisocial behavior, egosyntonic sadism, and a paranoid orientation, while still retaining some capacity for guilt and loyalty. [10]

History

Early uses of the term

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

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.

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] 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 framework 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]

As of March 2025, malignant narcissism has not been included as a diagnostic category in any of the medical manuals, such as the International Classification of Diseases (ICD) or the Diagnostic and Statistical Manual of Mental Disorders (DSM).

Relation to other concepts and diagnoses

Sadism and cruelty

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] Since sadism is often[ how often? ] considered[ by whom? ] a feature of malignant narcissism, an individual with the syndrome may not only lack feelings of guilt or remorse for hurting others but may even derive pleasure from the[ which? ] 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.

Narcissism

The primary[ according to whom? ] difference between narcissism and malignant narcissism is that malignant narcissism includes comorbid features of other personality disorders and thus consists of a broader range of symptoms than pathological narcissism (NPD).[ citation needed ] In the term "malignant narcissism", the word "malignant" is used in the sense described by the Merriam-Webster Dictionary as "passionately and relentlessly malevolent, aggressively malicious". [23] In malignant narcissism, NPD is accompanied by additional symptoms of antisocial, paranoid and sadistic personality disorders. While a person with NPD will deliberately damage other people in pursuit of their desires,[ citation needed ] they may regret, and will in some cases show remorse, for doing so. On the other hand, because traits of antisocial personality disorder are present in malignant narcissism, the "malignant narcissist" has a more pervasive lack of empathy than someone with NPD alone and will lack feelings of guilt or remorse for the damage they cause.[ citation needed ]

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". [24] Because a malignant narcissist's personality cannot tolerate any criticism, being mocked typically causes paranoia. [25]

Therapy

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. [26]

Typically, in the analysis of a malignant narcissist, "the patient attempts to triumph over the analyst by destroying the analysis and himself or herself"; [27] 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'". [28]

See also

References

  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.
  2. ↑ 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)."
  3. ↑ 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.
  4. ↑ 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.
  5. ↑ 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.
  6. ↑ 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.
  7. ↑ 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.
  8. ↑ 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.
  9. ↑ 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.
  10. ↑ 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.
  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.
  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. 1 2 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. ↑ "Merriam-Webster Dictionary definition of Malignant". January 2024.
  24. ↑ 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 ]
  25. ↑ 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. Creative Commons by small.svg  This article incorporates text available under the CC BY 4.0 license.
  26. ↑ 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.
  27. ↑ Ronningstam, Elsa (1997). Disorders of Narcissism: Diagnostic, Clinical, and Empirical Implications. Lanham, Maryland: Jason Aronson. p. 185. ISBN   978-0-7657-0259-3.
  28. ↑ 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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