Q: Psychiatrists are generally precluded from publicly discussing their opinions or findings concerning individuals' mental illness. But Dr. Vaknin, your expertise comes by over twenty years of focused study of Narcissistic Personality Disorder (NPD) free of such inhibition. You have related grave concerns about one of our Republican presidential candidates, Donald Trump. I think anyone might relate narcissism with Trump as a fairly obvious and perhaps innocuous trait. But you mean something else.

A: I do. I was the first to introduce pathological narcissism into the terms of the political debate with my July 2008 essay where I suggested that Obama may be a narcissist. But Obama is intelligent and prosocial. Trump is neither. I regard him as much more of a menace than Obama ever was to the future of the USA and, by extension, the world. I am shocked that - despite an increasing awareness of the dangers of narcissism in the media and in the public - Trump is still making any headway in this election cycle.

Q. What is Narcissistic Personality Disorder (NPD) as a mental illness and how "malignant," as your book's title states, is it?

A. The latest, fifth, edition (2013) of the Diagnostic and Statistical Manual (DSM) - the classificatory bible of psychology in North America - has done an excellent job of revamping the definition of NPD by introducing a dimensional description of the disorder. But, the diagnostic criteria from the previous, fourth, edition of the DSM are more accessible to laymen. So, here they are, updated with the latest knowledge we have about this pernicious disorder. You can easily see Trump writ large in each and every one of the nine criteria.

The narcissist ...

• Feels grandiose and self-important (e.g., exaggerates accomplishments, talents, skills, contacts, and personality traits to the point of lying, demands to be recognised as superior without commensurate achievements);

• Is obsessed with fantasies of unlimited success, fame, fearsome power or omnipotence, unequalled brilliance (the cerebral narcissist), bodily beauty or sexual performance (the somatic narcissist), or ideal, everlasting, all-conquering love or passion;

• Firmly convinced that he or she is unique and, being special, can only be understood by, should only be treated by, or associate with, other special or unique, or high-status people (or institutions);

• Requires excessive admiration, adulation, attention and affirmation – or, failing that, wishes to be feared and to be notorious (Narcissistic Supply);

• Feels entitled. Demands automatic and full compliance with his or her unreasonable expectations for special and favourable priority treatment;

• Is "interpersonally exploitative", i.e., uses others to achieve his or her own ends;

• Devoid of empathy. Is unable or unwilling to identify with, acknowledge, or accept the feelings, needs, preferences, priorities, and choices of others;

• Constantly envious of others and seeks to hurt or destroy the objects of his or her frustration. Suffers from persecutory (paranoid) delusions as he or she believes that they feel the same about him or her and are likely to act similarly;

• Behaves arrogantly and haughtily. Feels superior, omnipotent, omniscient, invincible, immune, "above the law", and omnipresent (magical thinking). Rages when frustrated, contradicted, or confronted by people he or she considers inferior to him or her and unworthy.

Q. How likely do you believe it is that Donald Trump has NPD? Why do you think so? Can you surmise how far up or down the NPD scale he may be?

A. I have watched 600 hours of video of Trump. Here are my preliminary clinical observations:

Trump confabulates a lot and has grandiose fantasies, which he has come to believe in, thus partially and intermittently losing touch with reality (delusionally "failing the reality test");

Trump is hypervigilant to the point of paranoia, besieged by conjured enemies and imaginary slights to his person, appearance, or accomplishments. He reacts aggressively and vindictively to such perceived narcissistic injuries and humiliations. His is a siege mentality;

Trump is a compulsive attention-seeker and will go to any extreme to obtain it;

Trump is counterdependent: he abhors authority, rules, traditions, and "The Establishment" and rebels against them vociferously and ostentatiously. He is manifestly defiant and abrasive. He is an avowed and ostentatious iconoclast;

Trump talks about himself in the third person ("Trump will do this") and often uses the royal "we" to refer to himself. His first person pronoun density (the number of times he uses "I", "me" and "myself" in a conversation or in interviews) is the highest I have ever heard from any politician, Obama included;

Trump places a premium on appearances rather than on substance;

Trump is highly somatic and hypochondriac as he emphasizes the way he dresses and refrains from damaging his shrine-like body by consuming substances like alcohol or nicotine. He is self-worshipping and painfully self-conscious;

Trump is disproportionately aggressive, hypersensitive, and defensive, faking superiority which, in all probability is compensatory: it masks a deep and unsettling sense of inferiority and extreme awareness of and an agonizing dependence upon what other people think of him ("thin skin");

Trump lacks empathy and clearly enjoys embarrassing and hurting other people gratuitously. Such antisocial bullying misconduct makes him feel (and, in his mind, actually renders him) all-powerful and God-like ("omnipotent"). He seems to regard himself as an intellectual and entrepreneurial Gulliver, trapped among contemptuous, pusillanimous, and retarded Lilliputians who he despises;

Trump has an inordinately developed "cold empathy": the kind of an "x-ray vision" that allows him to immediately spot the vulnerabilities, weaknesses, and chinks in the armor of his interlocutors, adversaries, partners, and enemies and to leverage this knowledge to his benefit by penetrating their defenses, taunting, and tormenting them, often with aggressive and cruel “humor”. This capacity for instant penetration allows him to resonate powerfully and intimately with the hidden hopes, dreams, fantasies, delusions, and negative emotions (rage, hatred, fear) of his "constituencies". He is a consummate predator.

To my mind, Trump is the most perfect example I have ever come across of a malignant and, probably, psychopathic narcissist. Of course, he cannot be fully and assuredly diagnosed this way. Only a qualified mental health diagnostician can determine whether someone suffers from Narcissistic Personality Disorder (NPD) and this, following lengthy tests and personal interviews. But the overwhelming preponderance of presenting signs and ymptoms and visual and textual evidence for tentative profiling is definitely there.

Q. Mr. Trump has recently threatened two other wealthy men with reprisals for behvior that he relates as being against him: Tom Ricketts (also, Ricketts' family) allegedly for "secretly" spending money against him and possibly his political ambitions, also Jeff Bezos, whose Washington Post has editorialized against his presidential candidacy. He has also threatened to sue Ted Cruz for his ad about Trump's varying positions on abortion. Is such behavior likely to be a trait of NPD? Also, one doesn't usually associate narcissism with violence, but Trump has apparently come out for ordering our military or intelligence personnel to murder the families of terrorist combatants, also to torture terrorists (or suspected terrorists or collaborators) in ways "much worse than waterboarding." These are war crimes. Does this suggest problems in his make-up beyond NPD?

A. All narcissists lack emotional empathy and are, to some extent, anti-social. Many narcissists are somewhat psychopathic and, therefore, sadistically prone to violence. They get a high and derive an almost sexual gratification from wielding power and inflicting pain and humiliation on others. It sustains their grandiose fantasy of omnipotence (that they are Godlike, all-powerful). That's why many narcissists are litigious, threaten "their enemies" incessantly, seek to embarrass and humiliate them in public, stalk them, and harass them recurrently. Narcissists have a black and white view of the world: if you are not 100% with me, you are 110% the enemy (this is known as "splitting" in the psychological jargon). Trump strikes me as this type of narcissist.

Q. Is it your considered opinion that Donald Trump would represent a significant danger were he to become president of the United States of America and if so, how?

A. You just have to look at Trump's business history to extrapolate America's future under a President Trump. Narcissists are unstable and go through repeated cycles of self-destruction (with other people usually paying the heft of the price). Narcissists tend to be divisive, vindictive, confrontational, aggressive, hate-filled, raging, incoherent, judgement-impaired, and irrational. Narcissists are junkies: they are addicted to attention ("Narcissistic Supply") and will go to any extreme to secure it. Narcissists are liars, confabulators, and miserable failures (although some of them, like Trump, are geniuses at disguising the fact that they are, in fact, losers). Is this the kind of person you want in the White House?

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Author Bio

Sam Vaknin ( http://samvak.tripod.com ) is the author of Malignant Self-love: Narcissism Revisited and After the Rain - How the West Lost the East, as well as many other books and ebooks about topics in psychology, relationships, philosophy, economics, international affairs, and award-winning short fiction.