Malignant narcissism refers to a specific, less common manifestation of narcissistic personality disorder. Some experts consider this symptom of narcissism to be the most severe subtype.

It is not recognized as an official diagnosis in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). However, many psychologists and mental health professionals have used the term to describe a specific set of personality traits.

According to the Campbell Psychiatric Dictionary, malignant narcissism combines the characteristics of:

Narcissistic personality disorder (NPD)
Antisocial personality disorder (APD)
Aggression and sadism, either toward others or oneself or both
Megalophobia

Read on to learn more about malignant narcissism, including common characteristics, how it compares to sociopathy, and whether it is treatable.

What Are the Traits of Malignant Narcissism?

Malignant narcissism can manifest in a number of ways — there is no definitive list of traits. It can also be very difficult, especially for someone who is not a mental health professional, to distinguish between malignant narcissism and severe narcissistic personality disorder.

Again, there is no consensus among experts on the criteria for malignant narcissism. However, many mental health experts support its existence as part of the narcissism spectrum. There is also some general agreement on the likely presentation of symptoms.

However, this type of narcissism may present with any combination of symptoms from the following categories.

Narcissistic Personality Disorder

Like other personality disorders, narcissistic personality disorder occurs on a spectrum and involves a range of symptoms. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) lists nine traits that help define narcissistic personality disorder, but only five are required for diagnosis.

Common symptoms of narcissistic personality disorder include:

Exaggerated delusions and behaviors, such as preoccupation with ideas of personal success, power, attractiveness, or sex appeal

Lack of empathy for or lack of empathy for the feelings or emotions of others

A great need for attention, admiration, and appreciation

An exaggerated sense of self-importance, such as a tendency to exaggerate personal talents or accomplishments

A belief in personal excellence and superiority

A sense of entitlement

A tendency to take advantage of others or exploit people for personal gain

Arrogant or conceited behaviors and attitudes

A tendency to be envious of others and to believe that others are envious of them

People with narcissistic personality disorder often have difficulty dealing with change. They may feel depressed or humiliated when they feel slighted, have difficulty dealing with insecurities and weaknesses, and react with anger when others do not seem to view them with the admiration they need and feel they deserve.

This condition also tends to involve difficulty managing emotions and behavioral responses to stress.
Auditory Processing Disorder

The core features of this condition are a persistent disregard for the feelings of others. This can include manipulation and deception as well as physical or emotional abuse. Another key component is a lack of remorse for wrongdoing.

Violent or aggressive behavior can be a sign of this condition, but some people with auditory processing disorder never act violently.

People with auditory processing disorder typically show symptoms of conduct disorder in childhood. This can include violence toward other people and animals, vandalism, or stealing. They generally do not think about or care about the consequences of their actions.

Auditory processing disorder is only diagnosed in adults. Diagnosis requires at least three of the following symptoms:

Disdain for authority and social norms, demonstrated by persistent illegal or law-breaking behavior

A pattern of deception, including taking advantage of and manipulating others

Reckless, impulsive, or risky behavior that shows a lack of concern for personal safety or the safety of others

Lack of remorse for harmful or illegal actions or distress or no remorse

A hostile, irritable, aggressive, agitated, or generally restless mood

A pattern of irresponsible, arrogant, or disrespectful behavior

Difficulty planning for the future

Aggression

Aggression describes a type of behavior, not a mental health condition. People cannot be diagnosed with aggression, but a mental health professional or other expert may note acts of aggression as part of a diagnostic profile.

Aggressive behavior can occur in response to anger or other emotions and generally involves the intent to harm or destroy. There are three main types of aggression:

Hostile aggression. This is behavior that is specifically intended to harm or destroy someone or something.

Instrumental aggression. This is an aggressive act related to a specific goal, such as smashing a car window to steal a wallet.

Emotional aggression. This refers to behavior that is usually directed at someone or something that has aroused emotion. It can also be redirected if the actual source cannot be targeted. Punching a wall instead of punching another person is an example of emotional aggression, especially when the act involves a desire to cause harm.

Sadism

Sadism is the enjoyment of humiliating or causing someone pain.

The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) lists sexual sadism disorder as a condition that involves sexual arousal associated with the idea of ​​causing unwanted pain to a non-consenting person. Sadism itself is not a mental health diagnosis, and it is not always sexual.

People with sadistic tendencies may enjoy:

Harming others

Enjoy watching others suffer

Get sexual arousal from seeing others suffer

Spend a lot of time fantasizing about hurting others, even if they don’t do it

Want to hurt others when they’re upset or angry

Enjoy humiliating others, especially in public situations

Tend to act or behave aggressively

Act in controlling or domineering ways

Some experts suggest that sadistic behavior helps distinguish narcissistic personality disorder from malignant narcissism. Narcissistic personality disorder often involves the selfish pursuit of desires and goals, but people with narcissistic personality disorder may still show some remorse or regret for hurting others in the process.

Is it the same as psychopathy?

Many people use the term psychopathy in casual conversation. You may hear it used to describe people who don’t seem to care about others or who take advantage of and manipulate their loved ones.

Psychopathy usually refers to the characteristics and behaviors common to auditory processing disorder. But like malignant narcissism, psychopathy is only used as an informal term, not a specific diagnosis.

Malignant narcissism is not the same as psychopathy, as the traits of auditory processing disorder are only part of this subtype of narcissism.

Is it treatable?

In general, therapy can help anyone who seeks treatment to make an effort to improve their feelings, behaviors, or emotional responses.

It is certainly possible for people living with malignant narcissism, or any other type of narcissism, to go to therapy and work on changing behaviors that are negatively impacting their quality of life or that of their family members, partners, and friends.