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What Is A Malignant Narcissist? Definition, Signs & Traits To Know

7 min.

Narcissism is a term that’s used casually to describe people who are self-absorbed, but malignant narcissism is a more serious condition that can harm others. Learn how to spot a malignant narcissist here.

By: Charlie Health Editorial Team

Clinically Reviewed By: Don Gasparini Ph.D., M.A., CASAC

Updated: September 11, 2023


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Table of Contents

What is malignant narcissism?

While not an official diagnostic term in the fields of psychology or psychiatry, “malignant narcissism” or “malignant narcissistic personality disorder” describes a severe and potentially dangerous form of narcissistic personality disorder (NPD). 

People with malignant narcissism tend to exhibit not only the self-absorption and excessive self-confidence associated with NPD but are also manipulative, empathy-deficient, and willing to do harmful and destructive things to achieve their goals. This combination of traits can make malignant narcissists exceptionally challenging to interact with and, in some cases, even pose a threat to the well-being of people around them. 

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The primary goal of a person with malignant narcissism is to gain power and control over others.  They may use manipulation, exploitation, and aggression to achieve their goals and maintain their sense of superiority. They often need admiration and validation from others, which is often rooted in deep-seated insecurity, low self-esteem, and a fear of being seen as weak or vulnerable.

Signs and symptoms of malignant narcissism

Identifying a malignant narcissist can be difficult, as they are often skilled at manipulating others and hiding their true nature. Also, people with malignant narcissism may not exhibit all of these traits, and the severity of these symptoms can vary. However, here are some common signs and symptoms of malignant narcissism to look out for:


Malignant narcissists often have an exaggerated and unrealistic sense of their own importance, which stems from low self-esteem. They may believe they are exceptionally talented, intelligent, or unique, and they expect others to admire and validate their self-perceived superiority.

Lack of empathy

People with malignant narcissism struggle to empathize with others, making it difficult for them to understand or care about the feelings, needs, or suffering of others. They may appear indifferent to the emotional experiences of those around them.

Manipulative behavior

Malignant narcissists are adept at manipulating others to serve their own interests. They may use charm, flattery, or deceit to gain the trust and compliance of others. This manipulation can be subtle or overt, depending on the individual.


When challenged or threatened, malignant narcissists can respond with aggression. This may manifest as emotional abuse, verbal abuse, intimidation, or even physical violence. They are prone to outbursts of anger and may become vindictive when they feel their ego is bruised.


Some people with malignant narcissism exhibit paranoid tendencies, constantly suspecting others of having ulterior motives or conspiring against them. They may be hypersensitive to perceived slights or criticisms.


In extreme cases, malignant narcissists can derive pleasure from causing emotional or physical pain to others. They may enjoy manipulating situations to watch others suffer and feel a sense of power and control over them through physical abuse, emotional abuse, or other tactics. 


Malignant narcissists often act impulsively without considering the consequences of their actions. They may make rash decisions, engage in reckless behaviors, and disregard the impact on themselves and others.

Lack of accountability

People with malignant narcissism frequently avoid taking responsibility for their actions and deflect blame onto others. They may engage in rationalization and denial to justify their behavior, making it challenging to hold them accountable.

Unstable relationships

Due to their manipulative and exploitative behaviors, malignant narcissists often struggle to maintain stable and healthy relationships. They may use people for their own gain and discard them when they are no longer useful or when conflicts arise.


Despite their less-than-desirable traits outlined above, malignant narcissists can be charming and charismatic, especially when it serves their interests. They may use their charm to win people over, gain trust, and manipulate situations to their advantage.

Is malignant narcissism a personality disorder?

Malignant narcissism is not a recognized diagnosis in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5)—the manual used by mental health clinicians to classify and diagnose mental health conditions. Rather, malignant narcissism is a descriptive term used to highlight the most severe and harmful aspects of narcissistic personality traits. Malignant narcissism is often considered to be a subtype of NPD and is characterized by a combination of narcissistic and psychopathic traits. 

As mentioned, people with NPD often have a grandiose sense of self-importance, a lack of empathy for others, and a need for admiration. Malignant narcissists take these traits to an extreme level and often engage in manipulative and aggressive behavior towards others.

Why is the behavior of malignant narcissism often considered dangerous?

The behavior of malignant narcissism is considered dangerous because it often involves manipulation, exploitation, and aggression towards others. Malignant narcissists have a need for power and control and will do whatever it takes to achieve their goals, even if it means harming others in the process. They are often prone to fits of rage and can be physically violent towards those who cross them.

How to deal with a malignant narcissist

Dealing with a malignant narcissist can be extremely challenging, as their behaviors are often manipulative, exploitative, and potentially harmful to those around them. Here are some strategies to consider if you find yourself in a situation where you have to deal with a malignant narcissist or if you have a loved one who is a malignant narcissist: 

Set boundaries

It is important to set clear boundaries and limit contact with the malignant narcissist if their behavior becomes too toxic or harmful.

Don’t engage in their manipulations

Avoid getting caught up in the malignant narcissist’s manipulations or attempts to blame or gaslight you. Stay calm, be assertive, and stick to the facts.

Focus on your own goals

Maintain a focus on your own goals and priorities, and don’t allow the person with malignant narcissism to distract you from what is important to you.

Practice self-care

Engage in activities that promote self-care and reduce stress, such as exercise, meditation, or spending time with a supportive friend or family member.

Seek support

Consider seeking support from a therapist or counselor who can help you cope with the impact of the malignant narcissist’s behavior.

What to do if you are in a relationship with a malignant narcissist?

If you’re in a relationship with someone dealing with malignant narcissism, it’s essential to prioritize your well-being and safety. Start by educating yourself about narcissistic behavior to better understand what you’re dealing with. It’s important to keep in mind, though, that you cannot change their malignant narcissism.

Next, set clear boundaries and seek support from friends, family, or a therapist who can provide emotional guidance. When those boundaries aren’t respected, limit your contact with the malignant narcissist as much as possible, and consider professional help to navigate these challenges. 

In some cases, ending the relationship may be the best option for your long-term happiness and safety, especially if the relationship is abusive or severely detrimental to your mental and emotional health. Your well-being should always come first, and everyone deserves to be in a healthy relationship.

Treatment for narcissistic personality disorder

Since malignant narcissism usually describes a type of NPD, treatment for the condition would mirror treatment for NPD. That being said, treatment for NPD (and, in turn, malignant narcissism) can be challenging because individuals with this disorder often lack insight into their behavior and may resist seeking help from a mental health professional. However, therapy and interventions can be beneficial in certain cases. Here are some treatment approaches for NPD that may benefit people with malignant narcissism. 


Also known as talk therapy, this form of treatment, particularly cognitive-behavioral therapy (CBT) and psychodynamic therapy, can help people with NPD gain insight into their behavior, thoughts, and emotions. A mental health professional can work with clients to identify and modify unhealthy thought patterns and behaviors, such as unrealistic self-appraisals and a lack of empathy.

Dialectical behavior therapy (DBT)

DBT, which was originally developed for people with borderline personality disorder (BPD), can be adapted to treat narcissism. It focuses on emotional regulation, interpersonal effectiveness, and distress tolerance.

Group therapy

Group therapy can allow people with NPD and malignant narcissism to practice interpersonal skills and gain peer feedback. It can also help them understand how their behavior affects others.

Family therapy

In some cases, family therapy may be beneficial to address interpersonal conflicts and improve communication within the family system when one family member has NPD or malignant narcissism. 


There are no specific medications approved to treat narcissism itself, but medication may be prescribed to address co-occurring conditions, such as depression or anxiety, which are common in individuals with NPD or malignant narcissism.

Treatment for narcissistic personality disorder and malignant narcissism at Charlie Health

If you think a loved one in your life is a malignant narcissist or struggles with narcissistic behaviors, Charlie Health is here to help. 

Our personalized virtual Intensive Outpatient Program (IOP) provides mental health treatment for teens, young adults, and families dealing with various mental health struggles, including NPD, malignant narcissism, and other co-occurring conditions. To promote holistic healing, Charlie Health’s IOP combines peer groups—where clients are matched with people facing similar struggles—individual therapy, family therapy, and medication management as needed—all components of recommended treatment for NPD or malignant narcissism. 

Coping with narcissism can be very difficult, but it is certainly possible for people with NPD or narcissistic tendencies to experience a healthier, higher quality of life and improved mental health. Fill out this short form to get started

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