Malignant narcissism is a form of narcissism, where a patient becomes self-obsessed and anxious about how he is perceived by others, that includes tendencies toward antisocial and paranoid disorders, as well as simple narcissism. This is not a formal clinical diagnosis, although mental health professionals have discussed it since the middle of the 20th century. Patients believed to have malignant narcissism can benefit from medications and therapy to address their symptoms.
Narcissism often appears in hand with other psychiatric disorders. The origins are not fully understood, but generally, patients experience a sense of self-importance and grandiosity. Many are very worried about how they are perceived and may have feelings of inadequacy and a need for approval. In malignant narcissism, people can be more aggressive about promoting their own ends. They tend to have less empathy for others around them, although they can and will identify with people they view as role models.
People with malignant narcissism can express fears about how they are perceived in very paranoid ways. They may have delusions about people talking about them when they are not present or believing untrue things about them, and can be aggressive and sometimes violent when confronting the objects of their delusions. The lack of empathy for others can lead people think of malignant narcissists as unfeeling and cold, especially when paired with their aggression, as they may harm others physically or emotionally.
Medications can sometimes be helpful when imbalances in brain chemistry are at least partially responsible for this condition. Drug treatment options vary and a patient needs to be carefully evaluated by a psychiatrist to determine the best course of treatment. These medications can help with delusions and may allow the patient to see the world more clearly. Therapy to explore the origins of the narcissism, as well as how it expresses, is also critical and patients may need to maintain an extended therapeutic relationship.
People with malignant narcissism and other personality disorders can be challenging to treat. They may not recognize that they are having a problem, and suggesting they seek evaluation and treatment can result in hostility and anger. People concerned about friends, family, coworkers, and other people they interact with can consult a mental health professional for advice on appropriate interventions in a specific case. Once patients are in treatment, they have an opportunity to work with a therapist on learning more about their conditions and how to manage them.