Malignant Narcissism: from fairy tales to harsh reality

Psychiatr Danub. 2010 Sep;22(3):392-405.


Introduction: Malignant Narcissism has been recognized as a serious condition but it has been largely ignored in psychiatric literature and research. In order to bring this subject to the attention of mental health professionals, this paper presents a contemporary synthesis of the biopsychosocial dynamics and recommendations for treatment of Malignant Narcissism.

Methods: We reviewed the literature on Malignant Narcissism which was sparse. It was first described in psychiatry by Otto Kernberg in 1984. There have been few contributions to the literature since that time. We discovered that the syndrome of Malignant Narcissism was expressed in fairy tales as a part of the collective unconscious long before it was recognized by psychiatry. We searched for prominent malignant narcissists in recent history. We reviewed the literature on treatment and developed categories for family assessment.

Results: Malignant Narcissism is described as a core Narcissistic personality disorder, antisocial behavior, ego-syntonic sadism, and a paranoid orientation. There is no structured interview or self-report measure that identifies Malignant Narcissism and this interferes with research, clinical diagnosis and treatment. This paper presents a synthesis of current knowledge about Malignant Narcissism and proposes a foundation for treatment.

Conclusions: Malignant Narcissism is a severe personality disorder that has devastating consequences for the family and society. It requires attention within the discipline of psychiatry and the social science community. We recommend treatment in a therapeutic community and a program of prevention that is focused on psychoeducation, not only in mental health professionals, but in the wider social community.

Publication types

  • Case Reports
  • Review

MeSH terms

  • Adult
  • Aggression / psychology
  • Antisocial Personality Disorder / diagnosis
  • Antisocial Personality Disorder / psychology
  • Antisocial Personality Disorder / therapy
  • Child
  • Child Abuse / psychology
  • Child of Impaired Parents / psychology
  • Family Conflict / psychology
  • Family Relations
  • Fantasy*
  • Female
  • Folklore*
  • Humans
  • Literature, Modern*
  • Male
  • Medicine in Literature*
  • Mental Disorders / diagnosis
  • Mental Disorders / psychology
  • Mental Disorders / therapy
  • Paranoid Disorders / diagnosis
  • Paranoid Disorders / psychology
  • Paranoid Disorders / therapy
  • Parenting / psychology
  • Personality Disorders / diagnosis*
  • Personality Disorders / psychology
  • Personality Disorders / therapy
  • Sadism / diagnosis
  • Sadism / psychology
  • Sadism / therapy
  • Suicide / psychology
  • Syndrome
  • Therapeutic Community
  • Unconscious, Psychology