The Malkavians are a clan of Kindred cursed with insanity. Every Malkavian is in some fashion insane; in game terms, they have at least one derangement they can never remove. They are one of the original seven clans of the Camarilla and a pillar of the organization. Throughout history, the Malkavians have been the seers and oracles of the Kindred, bound by strange compulsions and insight.

Due to their inherent clan weakness, every last vampire of Malkav's blood is irredeemably insane in some form or another. Some attribute this to a curse of the blood, while other Lunatics actually call it a special blessing, a gift of insight. When a Malkavian character is created, the player must choose at least one derangement for that character at the time of the Embrace; this derangement can be temporarily fought with Willpower, but can never be permanently overcome. They are also pranksters, with their "jokes" ranging from benign to sadistic.

As with all the major clans, the Malkavians originated in the pre-Deluge city Enoch. Little is known about the clan's early composition, only that their Antediluvian, Malkav, was a seer Embraced by one of the Second Generation. Malkav was particularly close to two other Kindred: Saulot, the founder of the Salubri, and Set, self-appointed god to his followers. Some accounts suggest the three shared the same sire, possibly Enoch.

Sometime after the Flood, Malkav was ambushed and murdered by his fellow Antediluvians. Most Malkavians believe that he is still undead, only now he exists entirely within the Madness Network (or "Cobweb"), the group mind that all Malkavians share. Some Malkavians speculate that Malkav literally is Clan Malkavian and that when Gehenna arises, he will devour the clan whole and reconstitute himself.

Many of the early Malkavians posed as city-gods, using their oracular powers to convince the population that they spoke and listened to the gods. In Greece and the lands of the Fertil Crescent, many of the early Malkavians prospered as oracles and soothsayers and later, their foresight placed them into the role of viziers and advisors to the ruling Ventrue of Rome. It was on behest of the Malkavian prophetessTryphosa that Camilla called for the war against Carthage and it was with the aid of Alchias, the Malkavian ruler of Syracuse, that the Romans proved to be successful in the end. Later, however, the Malkavians were blamed for the more instabile emperors and when Rome finally fell apart, the Malkavians drifted away, shattered and lost. Several Malkavians, however, became attracted to early Christianity (a running gag within some elements of the Clan are the consequences of a graverobbery in 33), seeing Jesus as the reborn Malkav who would end their curse. Some even claimed that Andreas, one of the disciples of Jesus, was secretly a Malkavian, and tasked by him to find Caine to persuade him to finally ask for forgiveness from God.