Malignant narcissism


 * For the Rush instrumental, see Malignant Narcissism (instrumental).

Malignant narcissism is a syndrome consisting of a combination of aspects of narcissistic personality disorder and antisocial personality disorder as well as paranoid traits. Malignant narcissism is a theoretical or 'experimental' diagnostic category; although narcissistic personality disorder is found in the current version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR), malignant narcissism is not. Individuals with malignant narcissism would be diagnosed under narcissistic personality disorder. Malignant narcissism can be partially treated with medications and therapy helping to reduce aggravating symptoms.

The malignant narcissist differs from narcissistic personality disorder in that the malignant narcissist derives higher levels of psychological gratification from accomplishments over time (thus worsening the disorder). Because the malignant narcissist becomes more involved in this psychological gratification, they are apt to develop the antisocial, the paranoid, and the schizoid personality disorders. The term malignant is added to the term narcissist to indicate that individuals with this disorder tend to worsen in their impulse controls and desires over time.

Malignant narcissism can be comorbid with other psychological disorders not mentioned above.

History
Social psychologist Erich Fromm first coined the term malignant narcissism in 1964, describing it as a "severe mental sickness" representing "the quintessence of evil." He characterized the condition as "the most severe pathology and the root of the most vicious destructiveness and inhumanity."

Psychoanalyst Otto Kernberg pointed out that the antisocial personality was fundamentally narcissistic and without morality. Malignant narcissism includes a sadistic element, creating, in essence, a sadistic psychopath. In this essay, "malignant narcissism" and psychopathy are employed interchangeably. Kernberg first proposed malignant narcissism as a psychiatric diagnosis in 1984.

Kernberg described malignant narcissism as a syndrome characterized by a narcissistic personality disorder (NPD), antisocial features, paranoid traits, and egosyntonic aggression. Other symptoms may include an absence of conscience, a psychological need for power, and a sense of importance (grandiosity). Pollock wrote: "The malignant narcissist is presented as pathologically grandiose, lacking in conscience and behavioral regulation with characteristic demonstrations of joyful cruelty and sadism."

Spectrum of pathological narcissism and psychopathy
Kernberg claimed that malignant narcissism should be considered part of a spectrum of pathological narcissism, which he saw as ranging from the Cleckley's antisocial character (today's psychopath or antisocial personality) at the high end of severity, through malignant narcissism, and then to narcissistic personality disorder at the low end. The malignant narcisscist thus represents a less extreme form of pathological narcissism than psychopathy. Individuals with narcissistic personality disorder, malignant narcissism and psychopathy all display similar traits which are outlined in the Hare Psychopathy Checklist. (The traits in the checklist are common amongst individuals with psychological disorders. The psychopath/malignant narcissist must display a strong tendency towards these characteristics.)

Malignant narcissism can be differentiated from psychopathy, according to Kernberg, because of the malignant narcissists' capacity to internalize "both aggressive and idealized superego precursors, leading to the idealization of the aggressive, sadistic features of the pathological grandiose self of these patients." According to Kernberg, the psychopaths' paranoid stance against external influences makes them unwilling to internalize even the values of the "aggressor," while malignant narcissists "have the capacity to admire powerful people, and can depend on sadistic and powerful but reliable parental images." Malignant narcissists, in contrast to psychopaths, are also said to be capable of developing "some identification with other powerful idealized figures as part of a cohesive 'gang'...which permits at least some loyalty and good object relations to be internalized." The malignant narcissist's main differences in impulse control from the psychopath is in the area of psychological gratification. While the psychopath displays more antisocial features, the malignant narcissist desires "unlimited power". It is possible for the malignant narcissist to move above and beyond their contemporaries, and make a positive contribution to society (although rarely is this the case). The malignant narcissist will attempt to make full use of their capabilities. Neither the malignant narcissist nor the psychopath can delay gratification, but malignant narcissism lends itself to gratification in intellectual and other positive pursuits.

Malignant narcissism is highlighted as a key area when it comes to the study of mass, sexual, and serial murder.