Key Points

Malignant narcissism is a combination of narcissistic personality and antisocial personality.
Malignant narcissists will attack or humiliate others for even minor infractions.
Those who deal with malignant narcissists often find them to be jealous, petty, thin-skinned, punitive, spiteful, scheming, and angry.

Narcissistic personality disorder is often equated with a self-centered, superficial, boastful personality that drains your patience. However, there is much more to this condition than that. Their behavior and mood are often driven by and driven by feedback from their environment; they typically need a positive message from others. The impression they want to make and the intense guarding of their fragile self-esteem is a powerful factor that shapes their actions and thoughts.

Some narcissists may become angry, anxious, depressed, ashamed, etc. if the information they receive does not match their inflated, protected inner self. From a neuropsychological perspective, narcissistic personality disorder reflects problems with self-regulation and emotion.

People who meet the diagnostic criteria may have extremely fragile and fluctuating self-esteem. There is a disconnection from the true self. The condition often has a negative impact on the lives of people they love or interact with.

Symptoms

Narcissistic personality disorder includes symptoms such as poor self-identity, inability to value others, entitlement, lack of authenticity, need for control, intolerance of others’ opinions/perspectives, emotional detachment, grandiosity, lack of awareness or concern about the impact of their behavior, poor emotional reciprocity, and a desperate need for approval and positive attention from others.

Not everyone with pathological narcissism or narcissistic personality disorder will experience the same symptoms. There is variation, of course, because people are complex. There are different levels of severity and dimensions. For example, some people with pathological narcissism are shy and avoidant (vulnerable), while others are outgoing and overtly ostentatious (arrogant).

Cluster B Personality Disorders

Narcissistic personality disorder falls under the category of Cluster B personality disorders in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Conditions in this cluster include borderline personality, narcissistic personality, histrionic personality, and antisocial personality. Psychopathy, a condition characterized by a lack of conscience, inability to relate, aggression, and interpersonal abuse, is a subset of antisocial personality disorder.

Related : Why Do Narcissists Make Such Poor Leaders?

Although the disorders are distinct and reflect different categories of symptoms, it is not unusual for someone to have symptoms of more than one Cluster B condition. As many psychologists and psychiatrists will attest, our patients’ personality profile does not always fit into a nice little box. There can be features of other personality disorders that accompany the primary condition. Take, for example, the combination of narcissistic and antisocial personality in the description of malignant narcissism.

Self-enhancement

“I’m so smart! My IQ is over 140.”

Self-enhancement is a prominent feature of narcissistic personality disorder, regardless of dimension. They view themselves in an overly positive light and believe they are unique and superior to others. In a meta-analytic review, researchers Grijalva and Chang explored the outlook of individuals with narcissistic personality disorder. Studies have shown that people high in narcissism tend to overestimate their abilities, status (e.g., intelligence), and appearance, more than the reality can support.

They believe they are better than others, and the variables that enhance their self-esteem are often related to “power and status” (agency). Even when presented with evidence to the contrary, such as intelligence test results. This reality is often challenged, rather than accepted. They may become extremely defensive and verbally attack or belittle the examiner who administered the test or the test itself (“What a stupid test!”). Indisputable evidence of their inaccurate and exaggerated self-assessment does not change the self-perception of someone high in narcissism.

weakness

“Make them think I’m smart and handsome. I won’t settle for anything else!”

In Section III of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (“The DSM-5 Alternative Model for Personality Disorders”), personality-related conditions are conceptualized differently from current diagnostic criteria. Both the individual’s “functioning” as well as the personality “traits” are considered and viewed along a dimensional continuum. As a clinician, I find this approach more in tune with the complexity of human behavior.

With regard to Narcissistic Personality Disorder, Section III highlights that people with this condition have “poor self-esteem.” This is regardless of whether the person is extroverted or introverted, or of the “vulnerable” or “grandiose” variants. They need regulation from the outside world to maintain many aspects of the self. Therefore, they often use people to stabilize their emotions and the feelings they have about who they are and what they want to do or be.
The Brain, Pathological Narcissism, and Empathy

Research suggests that individuals diagnosed with narcissistic personality disorder have some of the neurobiological abnormalities of psychopathy. This makes sense, since narcissistic personality disorder is thought to fall along a spectrum that includes psychopathy. One neuroimaging study found that people with narcissistic personality disorder had problems with the right anterior insular cortex—an area of ​​the brain thought to be associated with empathy.

In a 2013 publication, using neuroimaging, researchers from a German university examined the brain patterns of individuals with narcissistic personality disorder. They found similar results to the study above. The group that met criteria for the condition showed smaller gray matter volume within brain regions associated with “emotional empathy” (the anterior insula and the perifrontal areas).

Neuroscience studies of this type provide significant evidence that people with pathological narcissism have limited ability to socially interact with society. The dysfunctional brain functions are a major impediment.

Dimensions of Narcissistic Personality Disorder

There’s more to narcissism than levels of severity. Studies have identified dimensions. Some researchers refer to them as variants or subtypes, however, Kenneth Levy’s 2012 review of the literature suggests that it is more accurate to view the variants of this condition as dimensions and “dynamics.” This reflects the fact that in narcissistic personality disorder, an individual can exhibit patterns of more than one variant. The two most common dimensions or variants described in research are grandiosity and vulnerability:

Grandiosity. This type of narcissism is often described as extroversion, attention seeking, and grandiosity.

Vulnerability. This reflects a neurotic style where the individual displays a quieter/introverted presentation, anxiety, mood issues, avoidance, and modesty.

MalignantNarcissism

I want to explore with you the darker side of Narcissistic Personality Disorder, where aggression, antisocial behaviors, and doubt are as prominent as their weak sense of self, fragility, and selfishness. (Below is a video exploring the symptoms of malignant narcissism.)

Related : All About Narcissistic People

A person with malignant narcissism has the ability to destroy families, communities, countries, and work environments. This condition reflects a combination or blend of narcissistic and antisocial personality disorders. Psychologist Erich Fromm coined the term “narcissistic personality disorder” in 1964. Psychoanalyst Otto Kernberg later identified the symptoms of this condition and described it as an intermediate between narcissistic and antisocial personality disorders.

Why is malignant narcissistic behavior often so dangerous?

Individuals with this disorder can form relationships with others. However, they process information in ways that can harm society in general, but also the people they love or depend on. Family, coworkers, employees, and others in their lives often have to tread carefully to satisfy their fragile ego and limit the occurrence of their unstable, impulsive, or aggressive behaviors.

They attack or humiliate others for even the most trivial transgressions (e.g., you expressed an opinion that differed from theirs; you showed confidence, making them look bad; or you told a joke that involved making fun of them).

For some people, their ego and protection of their fragile “true self” can reach such extreme levels that they lie and give the impression that simply saying what they say makes it true. Many will become angry if their lies are challenged with the truth or facts. Of course, this can lead to problems for people close to them, as this pattern of behavior can easily turn into manipulation.

Malignant narcissism is a combination of two disorders that pose interpersonal problems for their victims—narcissistic and antisocial personality disorders. It is not uncommon for others to feel anxious, intimidated, and fearful of people with this condition. The combination of poor empathy, aggression, hypersensitivity, and suspicion can cause pain to others.

Those who deal with malignant narcissists often see them as jealous, petty, sensitive, punitive, hateful, scheming, and angry. Because of their shallowness, they are emotionally dysregulated and have beliefs that swing from one extreme to the other.

Their decisions can hurt others because they categorize relationships and people based on superficial criteria and categories. They want to come out on top, even when they are pretending to be altruistic or engaging in an activity that should not be “all about them.” They often view the world through a primitive binary lens (e.g., winner/loser; smart/dumb; rich/poor; pretty/ugly; black/white)—while maintaining the belief that they are superior. This is likely related to problems processing emotional information, reflecting faulty neuroscience.

Narcissistic and Antisocial Personality Disorder (Inclusion of a Subcategory of Psychopathy)

Researchers Gunderson and Runningstam reviewed the work of Robert Hare, creator of the Psychopathy Checklist, and Otto Kernberg, MD (i.e., malignant narcissism). They noted that both individuals found narcissistic personality disorder to be a component of or a subset of other related conditions, such as antisocial personality disorder and psychopathy.

Both Hare and Kernberg argue for including narcissistic personality disorder within more destructive and evil personality types. Given the close association between antisocial personality disorders and narcissism, Gunderson and Runningstam decided to explore whether narcissistic personality disorder was truly a distinct condition from antisocial personality.

They found that grandiosity was an important differentiator between antisocial personality and narcissism. Specifically, individuals with narcissistic personality tend to be “boasty,” arrogant, and conceited about their abilities and accomplishments. Although they determined that both clusters (ASPD and narcissistic personality disorder) exploit others, exploitation was more likely to be the goal of those with antisocial personality.

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Although I have presented a spectrum view of narcissism, some researchers take the ASPD angle, while others consider both cluster B disorders to be overlapping.

I agree with research that conceptualizes personality disorders, such as narcissistic personality and antisocial personality, as falling along a continuum. Along the continuum, or spectrum, we will find a variety of disorders that are distinct but comprised of symptoms of each other. I believe that the overlap is often considerable, and that current typological classifications of personality often miss the mix of personalities that we see in our patients—for example, malignant narcissism, psychopathy with borderline features, and avoidant narcissism.