I have not personally interviewed the President of the United States.  Therefore, as a psychologist, I am prohibited by professional standards of practice from offering an opinion regarding the psychological characteristics of the President based on his public statements and behavior.

However, there has been discussion in the broader media regarding the psychopathology of the narcissistic personality relative to the public statements and behavior of the President of the United States.

Since I am prohibited from offering an opinion regarding the psychological characteristics of the President as displayed in his public statements and behavior, I will simply report on the professional literature surrounding the narcissistic personality and allow the reader to determine whether or not this information is consistent with the statements and behavior of the President.

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Diagnostic Criteria

The Diagnostic and Statistical Manual, 5th Edition (DSM-5) is the professional catalogue of diagnostic criteria for various forms of psychopathology.  In order to apply the diagnosis of Narcissistic Personality Disorder requires five of the following symptoms:

• Has a grandiose sense of self-importance
  

• Is preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love

• Believes that he or she is “special” and unique and can only be understood by, or should associate with, other special or high-status people (or institutions)

• Requires excessive admiration

• Has a very strong sense of entitlement, e.g., unreasonable expectations of especially favorable treatment or automatic compliance with his or her expectations

• Is exploitative of others, e.g., takes advantage of others to achieve his or her own ends

• Lacks empathy, e.g., is unwilling to recognize or identify with the feelings and needs of others

• Is often envious of others or believes that others are envious of him or her

• Regularly shows arrogant, haughty behaviors or attitudes

Since I am a clinical psychologist, I am prohibited from applying these diagnostic criteria to the public statements and behavior of the President of the United States.  I therefore leave it to the general public discernment to decide if the President exhibits five of these symptoms in his public statements and behavior.

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Associated Psychopathology

However, from a clinical psychology perspective the diagnosis of a narcissistic personality disorder simply serves as the organizing core for a variety of associated features of psychopathology.

For a clinical psychologist, it’s not just about the diagnostic features, its also about the surrounding features of the psychopathology. 

Hypersensitivity to Rejection:  If a person has a narcissistic personality, it is highly likely – extremely likely – that this masks an underlying profound sense of insecurity that will be activated in response to criticism and rejection.

“The failure to be superior or regarded as special activates underlying beliefs of inferiority, unimportance, or powerlessness and compensatory strategies of self-protection and self-defense.” (p. 241)

Criticism and rejection of the narcissistic creates what is called a “narcissistic injury” that punctures the fragile narcissistic defense of grandiose self-inflation.  The narcissistic responds with intense anger directed toward the source of criticism.  The narcissistic personality is also highly vindictive and vengeful, carrying grudges indefinitely and actively seeking revenge for perceived past injustices.

“Rarely physically abusive, anger among narcissists usually takes the form of oral vituperation and argumentativeness.  This may be seen in a flow of irrational and caustic comments in which others are upbraided and denounced as stupid and beneath contempt.  These onslaughts usually have little objective justification, are often colored by delusions, and may be directed in a wild, hit-or-miss fashion in which the narcissist lashes out at those who have failed to acknowledge the exalted status in which he or she demands to be seen.” (Millon, 2011, pp. 408).

• Hyper-sensitivity to criticism and a propensity for vengeful retaliation are exceedingly bad personality traits for a President of the United States.  Hypersensitive to criticism could easily result in poor decision-making, and the tendency toward vengeful retaliation could easily lead to an abuse of power.

Failure to Take Responsibility:  The narcissistic personality ALWAYS externalizes responsibility for failures.  Failures are ALWAYS because of someone else.  Even when the failure is clearly the fault of decisions and actions taken by the narcissistic person, the psychological fragility of the narcissistic personality cannot tolerate any challenge to its faultless superiority so it will actively distort reality in the self-serving effort to make reality conform to the beliefs of the narcissist.

“He or she [the narcissist] remains firmly rooted in the importance of a flawless or powerful image… Without a flawless image, core beliefs of inferiority become activated.” (Beck et al., 2004, p. 246)

“The propensity to blame is an outstanding feature… of narcissistic behavior in general.  It is a way for the narcissist to see himself in a good light and a manifestation of the splitting off of the negative aspects of the self and projecting them onto others that is a major narcissistic defense.” (Cohen, 1998, p. 206)

The narcissistic personality will NEVER admit to being wrong – ever.  When necessary, reality will be twisted and altered in the mind of the narcissist to conform to the psychological need of the narcissistic to be infallible.

• The distortion of reality is not a good quality in the President of the United States.

Delusions:  The distortion of reality by the narcissist can reach delusional proportions.  A “delusion” is a fixed and false belief that is maintained despite contrary evidence.  When a delusion is circumscribed to only a limited area of functioning, such as a wife’s supposed infidelity (a “jealousy delusion”) or a stalker’s false belief that a movie star will someday love the stalker (an “erotomanic delusion”), the delusion is said to be “encapsulated” – affecting only a limited area of the person’s functioning.

Under conditions of stress and failure, narcissists are prone to collapse into persecutory and paranoid delusions.  One of the leading experts in personality pathology, Theodore Millon, describes the collapse of the narcissistic personality into delusional beliefs in response to stress:

“Narcissists are neither disposed to stick to objective facts or to restrict their actions within the boundaries of social custom or cooperative living… Free to wander in their private world of fiction, narcissists may lose touch with reality, lose their sense of proportion, and begin to think along peculiar and deviant lines.” (Millon, 2011, p. 415)

“Under conditions of unrelieved adversity and failure, narcissists may decompensate into paranoid disorders.  Owing to their excessive use of fantasy mechanisms, they are disposed to misinterpret events and to construct delusional beliefs.  Unwilling to accept constraints on their independence and unable to accept the viewpoints of others, narcissists may isolate themselves from the corrective effects of shared thinking.  Alone, they may ruminate and weave their beliefs into a network of fanciful and totally invalid suspicions.  Among narcissists, delusions often take form after a serious challenge or setback has upset their image of superiority and omnipotence.  They tend to exhibit compensatory grandiosity and jealousy delusions in which they reconstruct reality to match the image they are unable or unwilling to give up.  Delusional systems may also develop as a result of having felt betrayed and humiliated.  Here we may see the rapid unfolding of persecutory delusions and an arrogant grandiosity characterized by verbal attacks and bombast.” (Millon, 2011, pp. 407-408).

“Were narcissists able to respect others, allow themselves to value others’ opinions, or see the world through others’ eyes, their tendency toward illusion and unreality might be checked  or curtailed.  Unfortunately, narcissists have learned to devalue others, not to trust their judgments, and to think of them as naïve and simpleminded.  Thus, rather than question the correctness of their own beliefs they assume that the views of others are at fault.  Hence, the more disagreement they have with others, the more convinced they are of their own superiority and the more isolated and alienated they are likely to become.” (Millon, 2011, p. 415)

“Deficient in social controls and self-discipline, the tendency of narcissists to fantasize and distort may speed up.  The air of grandiosity may become more flagrant.  They may find hidden and deprecatory meanings in the incidental behavior of others, becoming convinced of others malicious motives, claims upon them, and attempts to undo them.  As their behaviors and thoughts transgress the line of reality, their alienation will mount, and they may seek to protect their phantom image of superiority more vigorously and vigilantly than ever… No longer in touch with reality, they begin to accuse others and hold them responsible for their own shame and failures.  They may build a “logic” based on irrelevant and entirely circumstantial evidence and ultimately construct a delusion system to protect themselves from unbearable reality.” (Millon, 2011, p. 415)

Millon. T. (2011). Disorders of personality: Introducing a DSM/ICD spectrum from normal to abnormal. Hoboken: Wiley. 

Losing touch with reality, developing paranoid delusions of “fanciful and totally invalid suspicions,” devaluing the advice and counsel of others and accusing them of being “naïve and simpleminded,”  and finding “hidden and deprecatory meanings in the incidental behavior of others” and “becoming convinced of others malicious motives” to such a degree that the person behaviors and thoughts “transgress the line of reality” to the point where the person is “no longer in touch  with reality” is not a good thing for a President of the United States.

But, as a psychologist, I have not conducted an “examination” of Donald Trump, so I am prohibited from expressing opinions regarding the psychological characteristics of the President because I have not conducted an “examination” of him (and yet if I were to conduct an examination of the President, then I would be prohibited from expressing an opinion because of patient confidentiality issues).

So I am making no statement regarding the psychological characteristics of the President of the United States.  I am simply reporting on the professional literature surrounding the narcissistic personality.  It is up to the general public to decide whether this information is applicable or not to the statements and behavior of the President.

I am not applying the diagnostic criteria of Narcissistic Personality Disorder to the President because I have not conducted an “examination” of the President. 

I am not diagnosing the President with a Narcissistic Personality Disorder because I have not conducted an “examination” of the president. 

I am not applying Theodore Millon’s descriptions of the narcissistic personality’s collapse into paranoid delusions to the President, because I have not conducted an “examination” of the President.

I am simply reporting on the professional literature.  It is up to the reader to decide if this professional literature applies or not to the psychological functioning of the President.

Craig Childress, Psy.D.
Psychologist, PSY 18857