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.

Fairy tales allow parents to help children prepare for the realities of life. Although we imagine leaving fantasy behind as we grow up, we continue to mix fantasy with reality throughout life and often deny reason to hold onto our fantasies (Bettleheim 1981).

Fairy tales arise from folk traditions. Things that are too dangerous to accept consciously are repressed and reappear in dreams and fairy tales. Fairy tales take place in a transitional space between fantasy/magic and reality. The dangerous becomes less frightening in fairy tales where good always triumphs over evil (Bettleheim 1981).
As youth we are inducted into society by finding ourselves reflected in folk images. Initially, we live in a world saturated with elementary folk images, and later,
we encounter the elementary ideas themselves. Jung described these elementary ideas as archetypes. We must struggle over time with life experiences that put us
in touch with good and evil and if development is to be successful, then, metaphorically, the serpent that represents the struggle between life and death has to bite us strongly enough to awaken us to an internal world of transcendence. We need to die in the world of the ego to transcend ourselves. However, not everyone can master this and not every elemental idea is transcended by society (Campbell 1981).
In the fairy tales of Snow White and Cinderella an evil stepmother is presented who humiliates and tries to psychologically and physically kill an innocent stepchild. She is presented as an aloof, arrogant, cold, person with high social status and power who is
preoccupied with external beauty and the need to impress others. She has no remorse for her evil actions. She is loyal to her biological children whom she treats with entitlement and projects all her hatred and anger onto her stepchildren. The world is divided into that which is hers, which is perfect, and that which is not hers, which includes bad objects she believes should be humiliated and destroyed. The father figure is frequently absent or passive in fairy tales. He is ‘handicapped’ in his relationship with the stepmother because he has a child. The cruel woman is not his first choice, but she is beautiful and powerful. He may be attracted to this
image because he feel  inadequate for loosing his first wife and wants to be seen as a success. His primary interest is not in protecting his child. In the end of the
fairy tales, the evil stepmother is banished and disappears into the void. She is never punished or asked to redeem herself. The evil stepmother portrays a classical
malignant narcissist (Moore & Goldner-Vukov 2004).

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