Narcissism is a personality trait that has been recognized throughout history, yet narcissistic personality disorder (NPD) and narcissistic personality traits have been in the public eye more often in recent years. As awareness increases, people are wondering if they are dealing with a narcissist rather than someone who is simply selfish, thoughtless, or overly power-seeking in a more general way.
There are different "variants" of narcissism, including malignant narcissism, which many consider the most severe type. Beyond merely wanting to focus primarily on themselves and be held in overly high regard by virtually everyone in their lives, malignant narcissists tend to have a darker side to their self-absorption.
That’s why it helps to know when you have one in your life and what to expect from interactions with them. This knowledge, recognition, and understanding can provide you with some clues as to how to deal with them in the safest way possible.
How to Identify a Malignant Narcissist
What Is Malignant Narcissism?
While there is only one official diagnosis for narcissists, there are different types of narcissists, and narcissism comes in varying degrees of severity, including grandiose narcissists, who require excessive praise and attention, and vulnerable narcissists, who tend to have a lot of anxiety and need a lot of supportive attention.
Among the variants of narcissism, malignant narcissists are by far the most damaging. This subset contains the general traits of NPD, including regular egocentricity, but also some antisocial traits and even a sadistic streak as well as a poor sense of self and lack of empathy. There is often some paranoia involved with malignant narcissism as well.
Some experts see little difference between malignant narcissists and psychopaths in that both have antisocial behavior and low empathy.
Malignant narcissists can be highly manipulative, and they don't care who they hurt as long as they get their own way.
Other symptoms of malignant narcissists include:
- They see the world in black-and-white terms, including seeing others as either friend or foe.
- They seek to win at all costs and generally leave a great amount of pain, frustration, and even heartache in their wake.
- They generally don’t care about the pain they cause others—or may even enjoy it and experience it as empowering.
- They will do what it takes to prevent themselves from loss, inconvenience, or failing to get what they want in any situation.
Signs and Symptoms
While not every person who displays narcissistic traits is a classic “narcissist” in the sense that they have the diagnosable condition of NPD, even those who fail to meet the criteria for diagnosis can create a lot of harm with the traits they do possess.
Signs and symptoms of narcissistic personality disorder and the severity of symptoms vary and include the following that are often characteristic in malignant narcissists:
- Preoccupied with fantasies about beauty, brilliance, success, and power
- Unable to handle criticism
- Tendency to lash out if they feel slighted
- Likely to take advantage of others to get what they want
- Overly concerned about their appearance
- Expectation of being treated as superior
- Lack of empathy for others
- Inflated sense of self and inability to self-regulate
- Having no remorse for hurting others and no interest in apologizing unless it benefits them
- Having an attitude of deserving the best of everything
- Tendency to monopolize conversations and/or mistreat those who they perceive as inferior
- Hidden insecurity and weak sense of self
- Tendency to blame others for their own bad behavior
Diagnosis
While malignant narcissism isn’t recognized as an official diagnosis in the DSM-5, which is the standard for diagnosis of psychiatric conditions, mental health experts often use this term to describe a combination of the following:
- Antisocial personality disorder (APD)
- Narcissistic personality disorder (NPD)
- Aggression and sadism (towards self, others, or both)
- Paranoia
Antisocial Personality Disorder
According to the DSM-5, a person with antisocial personality disorder must be at least 18 years old and have a pattern of disregard for the rights of others including at least three of the following:1
- Disregard for the safety of the self and others
- Failure to obey laws or social norms
- Impulsive behavior
- Irritability and aggression
- Lack of remorse for actions
- Lying or manipulating others for profit or amusement
- Pattern of irresponsibility
Narcissistic Personality Disorder
The following is an abbreviated summary of the diagnostic criteria for NPD according to the DSM-5:1
- A grandiose sense of self-importance
- Persistent fantasies about unlimited success and power
- A belief that they are “special” and unique and can only be understood by or should associate with similar high-status people and organizations
- Constant need for attention, admiration, and praise
- A sense of entitlement and expectation of special treatment
- A tendency to use others for their own needs or wants
- A lack of empathy, or unwillingness/inability to recognize and honor the needs and feelings of others
- Proneness to envy or having a belief that they are envied by others
- A sense of arrogance shown in behaviors and/or attitudes
Narcissism vs. NPD
It's important to note that not all narcissistic traits necessarily indicate a personality disorder, which according to the American Psychiatric Association (APA), involves at least two of the following four areas:2
- Affective (ways of responding emotionally)
- Cognitive (ways of thinking about oneself and others)
- Impulse-control-based (ways of controlling one's behavior)
- Interpersonal (ways of relating to others)
Even if your loved one isn't officially diagnosed with NPD, narcissistic behaviors can still be difficult to deal with and have a negative impact on your relationship.
Treatment
Treating malignant narcissism can be challenging, especially since narcissists themselves rarely seek treatment or diagnosis.
Therapy
If you think someone you care about has a NPD, there are certain therapies that may be helpful. Although there is relatively limited data on empirically supported treatments for NPD, certain therapy approaches are often applied:3
- Psychodynamic psychotherapy
- Cognitive behavioral therapy
- Dialectical behavior therapy
- Couples and family counseling
Narcissists generally resist therapy (which can include diagnosis) because they don't tend to see themselves as having a problem. The distress they cause is often felt by those around them.
Medication
The following medications may also be prescribed to improve symptoms like anger, irritability, and paranoia that may accompany NPD, as well as treat any cooccurring psychiatric disorders:
How to Deal With a Narcissist
How does one deal with NPD in a loved one (or in someone they must deal with, like a boss or co-worker)? Fortunately, they are somewhat predictable, so there are a few guidelines that can help:
- Accept that they will be difficult to deal with. If possible, put some distance between yourself and them. This may be challenging as those with narcissistic traits tend to have poor boundaries and resent when you try to set them, but it is healthier for you.
- Do not try to change them and don't expect them to change, or you will be disappointed.
- Know that if you challenge them directly, they will likely retaliate in any way they can. This may include bringing others into the situation and attempting to turn them against you. This doesn't mean that you agree with whatever the narcissist asks of you, but you may want to find less confrontational ways to communicate your boundaries or disagreements.
- If you do need to confront the person, try not to do so in front of a large audience or they will want to save face and will feel more threatened, sparking more retaliation.
- Surround yourself with supportive people as much as possible to absorb some of the negativity you may experience with this person.
A Word From Verywell
Life with a malignant narcissist will never be easy, so it's simplest if you can put distance between yourself and this person. However, if this person is a family member or co-worker, this can be more difficult. In this case, it helps to know who you are dealing with and how to handle communication in as healthy a way as possible.
If you think your loved one might have malignant narcissism, talk to your doctor. A trained mental health professional can help you learn coping skills and how to set boundaries and practice self-care strategies. Group therapy and support groups may also be helpful resources.
