María E. Deveze-Villarreal, Department of Psychiatry, “Dr. José Eleuterio González” University Hospital and School of Medicine, Universidad Autónoma de Nuevo León, Monterrey, Nuevo Leon, Mexico Carlos A. López-Acevo, Department of Psychiatry, “Dr. José Eleuterio González” University Hospital and School of Medicine, Universidad Autónoma de Nuevo León, Monterrey, Nuevo Leon, Mexico


Malignant narcissism is the most severe form of narcissistic personality disorder, just above antisocial personality. In addition to the particularities of narcissistic disorder, it is characterized by severe ego-syntonic sadistic behavior, important flaws in the internal moral code, and significant paranoid traits. Malignant narcissistic patients often come to the clinic for other psychiatric reasons other than problems related to their characteropathy. The treatment is reserved, although they have a better prognosis than those with an antisocial personality disorder. The case of Damian, a patient with malignant narcissism, is described, along with a detailed analysis of his personality.



Keywords: Malignant narcissism. Narcissist personality disorder. Case report. Sadism. Aggression.