How to Identify, Causes, and Coping Tips

The standout characteristic of malignant narcissism is a sense of entitlement or extreme sense of self-importance. “They don’t care who they impact or who gets in their way as long as they get what they want,” says Scott Lyons, DO, a licensed psychologist, educator, and author of the bestselling book Addicted to Drama: Healing Dependency on Crisis and Chaos in Yourself and Others. “They have a very inflated sense of self and believe they deserve the best of everything.”

“Being in a relationship with a narcissist is truly a traumatic experience…the relationship is toxic because the narcissist is toxic.” —Nicholette Leanza, LPCC-S

It’s important to note: Malignant narcissism isn’t in the current edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), a guidebook to mental health conditions. (Meaning that malignant narcissism isn’t considered a mental health disorder, more of a personality type.) And while some people may have narcissistic tendencies, those personality traits on their own aren’t the same as having narcissistic personality disorder (NPD)¹, which is in the DSM-5. (Experts add that narcissistic tendencies, including the malignant aspect, can be found in NPD.)

Either way, being in a relationship with someone who has narcissistic qualities of any stripe can be harmful. Below, mental health experts share other signs to look out for, the psychology behind this type of narcissism, and what you can do if you’re in a relationship with a malignant narcissist.

What are the signs of a malignant narcissist?

Any form of narcissism can show up as a need for excessive admiration, a lack of empathy, and arrogance, but malignant narcissism has additional, distinct traits. “There is a cruelty and rudeness that shows up,” says Natalie Jambazian, LMFT, a Los Angeles-based therapist specializing in narcissism and the author of Detoxing From a Narcissist. “They are deceitful, pathological liars, vindictive, exploitive, and sadistic.”

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Further, their often cruel nature and destructive tendencies make “it easy for them to exploit and manipulate others,” says Nicholette Leanza, LPCC-S, a therapist at LifeStance Health.

Other than the descriptors above, here are additional signs to look out for:

• Paranoia
• Acting out after receiving any sort of criticism
• Blaming their partner and projecting their insecurities, like those about cheating
• Using their charm and confidence to manipulate others and create a (false) sense of safety and security
• Manipulating you, like being attentive and wonderful at times then cruelly using your vulnerabilities against you later
• Feeling like you have to walk on eggshells around them or submit to their demands
• Gaslighting, or denying your reality and convincing you that you’re “crazy”
• Being extremely arrogant and self-centered
• Needing power and being highly aggressive towards others
• Demanding preferential treatment because they believe they’re superior
• Harming others to get what they want
• Being angry and hostile, throwing rageful tantrums
• Seeking revenge if they feel wronged

What are the tactics of a malignant narcissist?

Leanza says malignant narcissists use abusive tactics, such as gaslighting, love-bombing, and devaluing to get what they want. All of these tactics are designed to manipulate your emotions and give them control over your life and reality.

Jambazian describes gaslighting as denying and distorting facts, events, and feelings to make you doubt your reality and perceptions.

On the note of love-bombing, Jambazian says a malignant narcissist may come off strong with gifts and over-the-top displays of affection (which just feels like they’re really into you) to reel you in before bringing in the manipulation. That manipulation might look like exaggerating their accomplishments or fabricating stories to gain attention and sympathy from others.

“Future faking” is somewhat similar, in which the narcissist is “mirroring what you like and what you want from your life, only to get you addicted to the relationship so they can take control,” Jambazian says. Further, they maintain that control by isolating you from your support system.

Dr. Lyons says blame-shifting, invalidation of your feelings, threats, and other forms of manipulation are common tactics for a malignant narcissist.

The stages of narcissistic abuse in a relationship

While not all narcissists are necessarily abusive (nor are all abusive people narcissists), narcissistic abuse is very much a thing. Jambazian and Leanza say the four stages of narcissistic abuse are idealization, devaluation, discarding, and hoovering.

• Idealization: Love-bombing—aka all of the excessive attention, charm, compliments, attention, and admiration directed toward you—comes first.
• Devaluation: Once you’re sucked in, they may criticize or belittle you; they may withhold affection or ignore your needs. These behaviors can become more and more obvious and cruel over time. All of a sudden, you aren’t so special anymore, in their eyes, and they aren’t so sweet.
• Discarding: Signs of this phase include giving the silent treatment, acting cold, cheating, and even ending the relationship.
• Hoovering: This is where the cycle of abuse essentially restarts. After all of that horrible treatment, they try to win you back so they can continue to manipulate you for their benefit. But remember, you won’t see the results they promise. Their “promises” and “asks for forgiveness” may come in the form of flattery, false apologies or “fauxpologies,” re-starting the love-bombing phase, and future faking.

What causes malignant narcissism?

Adverse childhood experiences (ACEs)

Leanza says that severe trauma can contribute to the development of NPD for some individuals. For children, these traumas are often referred to as adverse childhood experiences, or ACEs.

While lots of ACEs exist, the ones Jambazian focuses on for narcissism are sexual, physical, emotional, and mental abuse. She says it “can lead to the development of maladaptive coping mechanisms as a way to protect their fragile self.” For example, they may always fight for control because they used to feel unsafe when they were out of control (like when they experienced abuse) as a kid.

Growing up with certain parenting styles

Dr. Lyons believes while there’s no singular cause, particular parenting styles mixed with a biological predisposition are largely to blame. “Parenting styles might include abusive, controlling, lack of support and warmth, boundaryless, or unrealistic expectations that cause high performance [or] perfectionism to be the currency of love,” he says.

Jambazian adds how a narcissistic parent may model unhelpful ways of treating others, such as overindulgent or neglectful parenting, excessive praise, and inconsistent boundaries. This can be emotionally difficult for that child and may be behaviors they believe are “okay” in future relationships.

Brain abnormalities

While Jambazian hasn’t seen much research that suggests genetics play a role, she has read about how an individual’s brain structure can affect their behavior². “There is evidence that suggests there are abnormalities in brain structure or function, particularly in the areas of emotional regulation and empathy, that can contribute to the development of narcissistic traits,” she says. “Research has found that narcissistic brains have both lower cortical volume and thickness³.”

The latter basically means they have less gray and white matter in the center of the brain, which means lower functioning cognitive abilities. She says this could explain why narcissists lack emotional and cognitive responses to empathy, although more research needs to be done to understand why and how these brain differences can happen.

Increased oxidative stress

Jambazian refers to a 2020 study in the Journal of Personality Disorders⁴, which found that people with narcissistic and borderline personality disorders had an increased risk of oxidative stress—an imbalance of harmful free radicals, which over time is associated with health conditions like heart disease, cancer, and neurological diseases.

How does malignant narcissism affect a relationship?

There’s no doubt that someone who’s on the other end of such malicious behavior has been through the wringer. “Being in a relationship with a narcissist is truly a traumatic experience in and of itself,” Leanza says. “The relationship is toxic because the narcissist is toxic.”

As a result, malignant narcissism can have a host of consequences on anyone in its vicinity. A study in Psychiatria Danubina⁵ concluded that malignant narcissism “has devastating consequences for the family and society.” What might that look like, though?

For starters, the person in a relationship with a malignant narcissist may face anxiety, depression, low self-esteem, and a loss of identity, Leanza says. Others may also struggle with codependency, which keeps them stuck in that abusive cycle. And it’s no wonder these effects are present when their narcissistic partner is constantly blaming them, attacking their character, and making them question their sanity.

“The manipulative and contradictory behavior of the narcissist can leave survivors unsure about what is real and what is unreal,” Jambazian says. “The constant criticism, gaslighting, and manipulation can wear away at the survivor’s self-esteem, making them doubt their worth. Walking on eggshells around the narcissist—whose moods are unpredictable—can cause depression and anxiety for the victim.”

They may also feel trauma-bonded to the narcissist, she continues, wanting to leave the relationship but feeling like they can’t. (Side note: Trauma bonding might not be what you think: It’s an attachment created by a cycle of physical or emotional trauma and intermittent positive reinforcement.)

All of this can lead to the person living in fear of retaliation, rage, and threats, too. “Over time, survivors are left feeling hopeless, helpless, and resentful toward their relationship,” Jambazian says.

Can malignant narcissists love?

If you think a person who is often cruel, vindictive, and sadistic seems unlikely to be able to love someone, you’d be right. “Malignant narcissists do not know how to love; their relationships are merely a supply—a supply of attention, admiration, and services that they require,” Jambazian says.

The main symptom Dr. Lyons sees as a contributor to their inability to love is their lack of empathy. They can’t feel the pain that someone is going through and have compassion for that person, which are core parts of love.

Leanza agrees it’s unlikely. She says the symptoms “make it almost impossible for them to genuinely care about anyone else besides themselves.”

What happens when you ignore a malignant narcissist?

Ignoring a malignant narcissist can be an effective way to disentangle yourself from them (we’ll get more into that later), but be prepared for a strong, negative reaction from them. Dr. Lyons says this is largely because they want attention and will do what it takes to get it, including acts of violence.

Another reason behind their explosion, according to Jambazian, is their narcissistic ego. They can’t tolerate being ignored. “When you ignore a narcissist, they will throw a tantrum and use shame and guilt to shift the blame onto you,” she says.

Their tantrums may look like aggressive responses, threats of punishment, manipulation, fabricating stories about you to isolate you from friends and family, and playing the victim to regain power and control over you, she continues.

How do you end a relationship with a malignant narcissist?

Take time to understand what’s really happening

Dr. Lyons encourages you to put your needs first and give yourself time to think everything through. Learn more about what gaslighting looks like, understand when it happened to you, and note what occurred (especially any instances of abuse). This may take time as the gaslighting and blame-shifting work to make you think you’re the problem when you’re not.

Grey rocking

Acknowledging how hard ending a relationship with a narcissist can be and knowing they don’t respect boundaries, Jambazian mentions “grey rocking.” The grey rock method suggests you hardly engage with the narcissist so they’ll eventually get bored.

“Grey rocking can be helpful, where you avoid engaging in arguments with them and [do] not respond to their attempts to get an emotional reaction from you,” she says.

Ultimately, though, she thinks the best idea is to seek support from loved ones and a therapist who specializes in dealing with narcissists. (More info on that below!)

Go no contact

Besides grey rocking, Jambazian says completely going no contact can be extremely beneficial. This usually means not only avoiding talking to that person, but also blocking their phone number, social media accounts, and any other mediums in which contact could occur.

She acknowledges this can be especially hard for people who have a child with the narcissist. “Sharing kids with a narcissist makes it more tricky, and these methods may not be the best option, especially if you are going through a challenging divorce,” she validates.

If you do have kids or have to stay connected for another reason, don’t lose hope—consider the other options listed.

Build a support system of loved ones

Narcissists may isolate you from your friends and family. To whatever extent you can, try to keep some sort of connection with those people you trust.

Jambazian emphasizes the importance of a support system. “Let friends know of your situation and have a code to text them when you’re in danger,” she says. Ideally, the code will be a word or some indication that only you and this person would understand, and wouldn’t use in conversation otherwise.

Create a safety plan, ideally with a professional

Jambazian says that creating a “safety plan”—a way to help people stay safer while living with abusers and/or helping them exit the relationship—usually entails documenting interactions with the narcissist, including the dates, times, and details. It can also mean having a secret bag with extra car keys, a cell phone only you have access to, and some cash.

She encourages finding a therapist to co-create this plan with you. They can help you consider all aspects that are pertinent to your particular situation. If that’s not doable, another option is connecting with an advocate from National Domestic Violence Hotline who is experienced in formulating these plans.

When to seek professional help

Professional help is vital for both the narcissistic person and the person who’s in a relationship with them. However, Jambazian and Leanza agree that narcissists won’t seek help because they don’t see themselves as the problem.

While you can’t control their behavior, you can control your own by finding support in whatever way(s) is doable for you. When it comes to finding a therapist, Jambazian recommends one who’s highly knowledgeable and educated in narcissistic abuse, and Leanza suggests one who specializes in trauma. To find these practitioners, check out Psychology Today’s database. It allows you to filter through providers by specialization and other factors that can help you find the right fit.

While healing from any type of narcissist will require lots of time and support, keep in mind that malignant narcissists are the most harmful kind. Give yourself as much compassion and care as possible, and know you aren’t alone in this process.