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.”