(just fyi, from a review) "Beginning her research, Oakley found an astonishing gap. She writes about exploring the authoritative Medline database for information on the physiology and biochemistry of Machiavellianism. "Antisocial personality disorder" turns up 5494 hits. "Borderline personality disorder" generates 3090 "meaningful hits, including hundreds of imaging studies, genetic studies, drug studies, and so on."
However, she continues, "...if I type in 'malignant narcissist'--a term used by world-class psychiatrists...to describe the kind of malevolent, yet high functioning people I'm researching - I get nothing. Zero hits. No medical studies whatsoever."
That discovery was "unsettling" to her, "like hearing that the oncologist about to operate on your father's cancerous liver actually has a fake degree from a diploma mill." The book is a narrative of how Oakley began trying to fill in the scientific details.
Machiavellian behavior, she writes, is probably closely related to borderline personality disorder, so named because it sits on the borderline between psychosis and neurosis. To illustrate its most extreme manifestations, the book devotes entire chapters to Milosevic, The Butcher of the Balkans, and Chairman Mao, The Perfect 'Borderpath', the coined word indicating a particularly evil constellation of borderline personality traits and psychopathic tendencies."