From the book: The Dangerous Case of Donald Trump by Bandy Lee, MD, MDiv
Personality Disorder #1 – Narcissism
Narcissism is a universal trait on a continuum from 0 to 10. It measures a drive to feel special, to stand out, to feel exceptional. Moderate narcissism (around 4 to 6 – a slightly unrealistically positive self-image) is the healthiest amount. It gives a little boost when we need it to get through challenging times. It helps us feel less anxious and depressed and have better relationships.
People with high levels of narcissism can be extroverted, ambitious, outgoing, charismatic individuals drawn to the spotlight. Most politicians, actors and celebrities are this type. But very high levels, especially combined with high extroversion, increases the odds of abusing power, tolerating unethical behavior in subordinates, stealing, bending or breaking rules, cheating on taxes, and having extramarital affairs. Trump is extremely extroverted. He brags and boasts about himself, and he mocks and insults anyone he doesn’t like.
Pathological narcissism is when someone will do anything to feel special. They will lie, cheat, steal, betray, and even hurt those closest to them. At the highest narcissism levels of 9 and 10, it becomes a narcissistic personality disorder – a strong need in all areas of life to be treated as if special. They see other people as simply mirrors to reflect back their specialness. If that requires making someone look bad by comparison, so be it. They are usually riddled with envy. They have extreme levels of entitlement, exploitation, and low empathy. They show aggression, infidelity, vindictiveness, boasting, name-dropping, and denial of any wrongdoing. They sometimes become psychopaths, without feelings of shame, guilt, or sadness. When psychopathy combines with narcissistic personality disorder, it produces malignant narcissism – seeing other people as pawns in a metaphorical or literal game of kill or be killed (for example, Hitler, Kim Jong-un and Vladimir Putin).
Feeling scared, insecure and unsure are common among pathological narcissists, but they don’t like anyone knowing they are upset. They divide the world into friend and foe, and they attack their enemies, including anyone not willing to confirm their “specialness.” For example, as President Nixon’s paranoia escalated (a growing enemies list, “the press is the enemy”), others had to intervene in many decisions to avoid dangerous consequences. Both Nixon and Trump fired those investigating them.
Dysfunctional people sometimes resort to gaslighting – distorting reality to convince people that others are crazy. That might include denying their own statements that are documented on audio or video recordings and claiming undeniably false facts – “alternative facts.” When Time magazine gave Trump the opportunity to correct his long string of falsehoods, he stated that he says what he wants to be true and is unfazed when proven wrong. He claims that the facts will catch up to his beliefs.
Trump’s incessant tweeting is an example of how easily and instantly he resorts to survival mode at the slightest threat. He reacts emotionally, without reflection or rationality. It is almost impossible to constrain him when he feels threatened by anything he thinks is criticism. He will not tolerate any disagreement.
Trump does not trust anyone. His world view is saturated with a sense of danger and a need to project toughness. He was trained by his father to be a “killer” to avoid being a “loser.” He has alienated many Republican leaders, viciously insulted Democratic leaders both past and present, and been belligerent and disrespectful with many of our closest international allies. He has also discredited our entire seventeen-agency intelligence community, a federal judge, and, of course, the American media (the enemy of the people – a Stalin phrase). He operates on the assumption that everyone is out to get him. He is drawn to conspiracy theorists, such as Stephen Bannon, Gen. Michael Flynn, Roger Stone, and “reporter” Chanel Rion. He demands absolute loyalty while showing none. His subordinates never know where they stand. Trumps need for unquestioning praise, flattery and loyalty help explain his hostility to democracy and to a free press. They both thrive on open dissent
Facts are whatever Trump decides they are. When he is challenged, he instinctively doubles down, even when the issue is trivial. The aim is domination, not accuracy. He has no ideological beliefs or passionate feelings about anything except self-interest. But any reassurance he gets from any self-perceived achievement is always ephemeral. Even being President is experienced as just a bigger stage on which to fail and feel unworthy rather than an opportunity for significance and accomplishment. His need for adulation is like a black hole. Under his impudent exterior is a vulnerable little boy who just wants to be loved.
These behaviors are typical of young children before they develop emotional self-management. Most people develop emotional self-control, empathy, the ability to tell the difference between internal feelings and external reality, and the ability to tell truth from fantasy. People who do not develop beyond primitive stages of emotional development often have abnormalities in the prefrontal cortex (thinking) part of the brain and the amygdala (emotional) part of the brain.