Narcissism comes in many forms, including what's often termed malignant narcissism. Signs of malignant narcissism include a mix of narcissism, antisocial personality disorder, aggression, and sadism. It's worth noting that malignant narcissism doesn't have its own entry in the latest Diagnostic and Statistical Manual of Mental Disorders (DSM-V) — basically the Grey's Anatomy of psychology — which makes it a hypothetical and experimental diagnostic category (so, proceed with caution). If you want to see it in action, though, the Journal of Psychoanalytic Psychology described the 2000 movie American Psycho as a depiction of malignant narcissism. This isn't to say that all narcissists are Patrick Bateman, of course — but there's a reason the word "malignant" is in there.
While malignant narcissism isn't in the DSM-V, narcissistic personality disorder is. In beginning, the positive traits of a narcissist may win you over; narcissists are very good at what they do. As Peg Streep explained at Psychology Today, "Nothing the narcissist says or does is what it seems, and he or she is very, very skilled at manipulation — and, at least at the start of things, very attractive and engaging."
Meanwhile, Carrie Barron, M.D. described malignant narcissists on Psychology Today as, "Intelligent, high functioning, soft-spoken, charming, tearful/seemingly emotional, gracious, well mannered, kind and have the ability to form relationships."
It's easy to see why, at first glance, this type of person would be appealing. However, Barron also wrote, "The combination of subtle paranoia, lack of conscience and sadism in malignant narcissists renders these individuals scary, dangerous, and ruthless."
How do you know if you're dealing with malignant narcissism? These eight signs might tip you off. Again, it doesn't necessarily mean that the person who's displaying these qualities are a malignant narcissist — only a mental health professional can diagnose narcissistic personality disorder, and it's worth remembering once more that malignant narcissism is not an official diagnosis according to the DSM-V — but it might help you understand how to handle them.
1. A Sense Of Entitlement
Everyone can feel a little entitled every now and then. If it's your birthday, you might feel like you deserve the last piece of cake, but a malignant narcissist feels entitled all of the time.
According to BPD Central, "Narcissistic entitlement is not the same as self-worth; for example, that is, the belief that one is worthy of accomplishments earned through hard work. Instead, the narcissist is like a toddler who never learned he is not the center of the world and becomes enraged when others don't meet his [or her] immediate demands."
So the difference here is that perhaps it is your birthday, but the malignant narcissist believes he or she is entitled to the last piece of your birthday cake.
2. A Lack Of Conscience And Empathy
According to Psychology Today, empathy is the experience of understanding another person's condition from their perspective. When you feel empathy for someone else, you place yourself in their metaphorical shoes, and you try to feel what they are feeling.
Barron explained that for the malignant narcissist, "Their desire can be so consuming that there is little comprehension of, respect for or ability to empathize with the other. ... They lack guilt or remorse and tend to feel or pronounce that it is they who have been mistreated."
If you've ever confronted someone who has hurt you, and by the end of the conversation you've accepted all of the blame even though you are the one who was hurt, you're probably dealing with someone who lacks empathy.
3. A Sadistic Streak
A vicarious sadist might enjoy killing his or her opponent in video games, or watching others be hurt, humiliated, or killed in violent movies. However, the person does not actually participate in the harm of another person in their real life.
An everyday sadist is willing to inflict actual emotional and/or physical harm, or humiliation to another living creature, and even gains enjoyment from it.
Everyone knows someone with an out-of-control ego. They may talk about themselves incessantly, seek compliments nonstop, and basically behave as if the Earth orbits around them instead of around the Sun.
Krauss explained on Psychology Today that, "Egocentrism can cause us to make incorrect assumptions about what other people are thinking or feeling."
However, a person can be egocentric without being a narcissist. Someone who is just egocentric is able to see other people's points of views, but a narcissist becomes "annoyed or even enraged when others fail to see things their way. "
While most people can have an inflated ego at one time or another, a non-egocentric person usually reflects on their behavior and understands how it may have negatively affected others. The same can't necessarily be said for malignant narcissists.
A person who is grandiose has an unrealistic sense of superiority; they may see themselves as better than everyone else, thus viewing others with disdain or inferiority.
Grandiose people also have a strong feeling of uniqueness, believe that others have little in common with them, and that they can only be understood by a special few.
In Psychology Today, Shahram Heshmat Ph.D. described paranoia as referring to "someone who feels excessively suspicious without justification, and/or that others are plotting against him [or her]. They read far too much into everything people say and are quick to criticize, but they are not open to criticism themselves."
While we're all a little paranoid sometimes ( 15 to 30 percent of people regularly experience suspicious thoughts, according to Heshmat), most people are not paranoid all of the time, and do not actually believe that everyone is out to get them.
While I might say that the person who writes me a traffic ticket is "out to get me," I don't actually believe this to be true. Someone who is truly paranoid might believe that a random person is trying to cause them harm.
7. A Manipulative Nature
Let's be honest, most of us have tried to use a situation to our advantage at some point in our lives, but that doesn't automatically make someone a narcissist. Someone of a true manipulative nature operates from this position all of the time.
Abigail Brenner M.D. wrote on Psychology Today, "Manipulative people are really not interested in you except as a vehicle to allow them to gain control so that you become an unwilling participant in their plans."
In the beginning of a friendship or relationship with a manipulator, the person may seem charismatic, sincere, and complimentary, but they may eventually resort to gaslighting.
"They will often take what you say and do and twist it around so that what you said and did becomes barely recognizable to you," Brenner wrote. "They will attempt to confuse you, maybe even making you feel as if you’re crazy. They distort the truth, and may resort to lying if it serves their end."
8. They Project Their Bad Behavior Onto Others
Psychological projection is when someone projects what they are doing onto someone else. For example, if I stole something (which I never would, but let's just work with it for now), then I called you a thief, that would be projection.
"In projection people become unwilling to see their own shortcomings but rather attribute them to someone else," wrote Susan J Elliott JD, M.Ed. on Psychology Today. "They know of these shortcomings because they have them, but they won't admit them. Instead, they deflect and insist the rest of the world is actually guilty of doing what they're doing."
With a list like this, it seems like it would be easy to spot someone with malignant narcissism, right? But it might not be as simple as it seems. Barron advised that if the malignant narcissist is an effective storyteller, well meaning others will unwittingly support his or her destructive actions, thus contributing to a terrible mess.
The good news? Now you know what to look for.