As predicted by leading mental health professionals several years ago, Donald Trump’s emotional and psychological collapse continues unabated. In his third year in office, the president has demonstrated through his public and private behavior that he is mentally unwell. The pressures of the impeachment process have only worsened Trump's condition. There will be no bottom. Trump’s mental decompensation and associated downward spiral will only get worse. This is both a national and global crisis.

The newest low point in Donald Trump’s behavior arrived last Friday when he ordered the assassination of Iranian Maj. Gen. Qassem Soleimani. The Trump administration claims that Soleimani was planning imminent attacks against the United States and therefore that killing him was an urgent necessity. Trump's followers, most notably Vice President Mike Pence, have falsely tried to claim that Iran poses a dire threat to the U.S. and was somehow involved in the 9/11 attacks.

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These pretexts are either verifiably untrue or implausible. Donald Trump apparently ordered the assassination of Soleimani — and the escalation to a de facto state of war between Iran and the U.S. — because he was afraid of looking “weak”.

The assassination of Soleimani is also a distraction from Trump’s impeachment and the ongoing torrent of incriminating information about the Ukraine scandal.

Trump continues to behave in a manner that would previously have been considered impossible for an American president. Over the course of several days, he has publicly threatened to commit war crimes by destroying Iranian cultural sites. Trump has also — via Twitter, as usual — threatened to attack Iran with “disproportionate force.” As a practical matter, he is threatening to order intentional large-scale attacks on civilian populations. That too would be a war crime.

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Iran has retaliated for the killing of Soleimani by launching ballistic missiles at two airbases in Iraq where U.S. troops are stationed. At this writing, the number of American and Iraqi casualties, if any, is not known. The Iranians also issued a series of statements on Tuesday evening including one suggesting that they are willing to de-escalate and the missile attacks were a one-off response.

After Iran's attack, Trump made the following announcement on Twitter:

All is well! Missiles launched from Iran at two military bases located in Iraq. Assessment of casualties & damages taking place now. So far, so good! We have the most powerful and well equipped military anywhere in the world, by far! I will be making a statement tomorrow morning.

Trump has again shown that he lacks the maturity, temperament and intelligence, as well as the emotional and mental stability to lead the United States in a time of crisis.

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In an effort to gain more insight into the Iran crisis, I asked a panel of the country’s leading mental health experts for their thoughts about what Trump’s recent behavior reveals about his psychological and emotional health. Their responses have been edited for clarity and length.

Dr. John Gartner, co-founder of the Duty to Warn PAC and co-editor of "Rocket Man: Nuclear Madness and the Mind of Donald Trump"

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So this is where we are. America, once the good guy, may drag the world into war, maybe even world war, to quell the anxiety and rage of our mad king.

In February 2018, at a conference chaired by Tom Steyer at the National Press Club about President Trump’s psychological fitness to serve as commander in chief, a panel of mental health professionals (including myself) warned that under the stress of investigations into his misconduct, it was probable that Trump would make an impulsive catastrophic error on the world stage that could lead to war. That moment has arrived with the assassination of Gen. Qassem Soleimani.

Why did we see it as almost inevitable?

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As a malignant narcissist, when threatened, Trump must reassert his dominance over the world at all costs. And to a sadistic psychopath (one component of malignant narcissism), the collateral damage is not a cost but a bonus. As I said in 2018:

He has no empathy or concern for anybody but himself and so he will not care about the destruction that it will cause other people. In fact, because of his sadism, there's a part of him that perversely seems to revel in causing chaos and destruction and making us all frightened all the time, but even more importantly, it will be irresistible for him because it will transform him from feeling like a hunted victim of this witch hunt to feeling like an omnipotently destructive victor.

It’s not just a political “wag the dog” scenario but a psychological one, meant to reverse his narcissistic panic in response to a fear of looking weak, exposed, damaged and disgraced by turning the tables, so he now seems newly powerful and frightening. In Donald Trump’s paranoia, he believes he is being persecuted by bad people, so killing some other bad people makes him feel better. And really isn't that all that counts? Instead of being the defendant in the dock, now he is a toxic avenger — a hero!

Dr. David Reiss, psychiatrist, expert in mental fitness evaluations and contributor to “The Dangerous Case of Donald Trump”

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I and a significant number of other experienced mental health professionals have written at length (for over two years) addressing the fact that Trump’s public behaviors are fully consistent with the presence of a severe personality disorder (malignant narcissism). Others have speculated regarding Trump’s cognitive state and possible deterioration, which requires formal neurological and neuro-psychological testing to determine if there is an applicable diagnosis.

However, at the current time, psychiatric and neurological diagnoses are irrelevant. The urgent issue is that we have a POTUS whose impaired decision-making, judgment and ethics have put our nation in grave danger — including, most recently, tweeting public threats to commit war crimes.

We have seen a consistent pattern of Trump beginning with a statement (or tweet) regarding his perception of a situation (a perception often inconsistent with verifiable facts) after which he proceeds to proposing and/or implementing a “necessary” course of action — yet there is no explication of any fact-based, logical analysis or thought processes that led from point A to point B. Trump does not appear to seek advice from “advisers” but only information regarding available reactive options, then unilaterally (ignoring the advice of experts) choosing a response without any indication of understanding, consideration or care regarding legality, ethics or consequences.

The irrationality of Trump’s immature, ego-driven and severely sadistic manner of impulsively choosing courses of action is an existential threat to our democracy, our Constitution, our country and our national security.

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Dr. Lance Dodes, assistant clinical professor of psychiatry (retired), Harvard Medical School, currently training and supervising analyst emeritus at the Boston Psychoanalytic Society and Institute. He is also a contributor to “The Dangerous Case of Donald Trump”

Assassinating the Iranian general is the Reichstag incident many of us have predicted Trump would create when under pressure. Like Hitler and other dictators, he needs to create the conditions for a war — in this case via a reprisal attack on the country — to rally his base and try to use support for an attacked America as a reason to support him personally.

Psychologically, the important point is that this act demonstrates, once again, that Donald Trump’s single goal is to benefit himself and his hold on power, regardless of the disastrous risks to follow for many Americans and other. Trump has no conscience about those other people. Indeed, if Trump does not succeed in causing a war this time, in the case of Iran, it is highly likely that he will try again before the 2020 election.

Those Republicans who have supported him up to this point are now faced with the moral imperative to remove him from office because of the fatal risks to America and the world that Donald Trump now presents because of his predicted incapacity to function safely under stress.

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Dr. Steven Buser, former U.S. Air Force psychiatrist who was tasked with conducting fitness for duty evaluations for airmen, especially those responsible for nuclear weapons.

For four years now, my colleagues and I have been warning anyone who will listen that Donald Trump is a clear and present danger to the United States and indeed the world. His bizarre and reckless behaviors have been so numerous it is difficult to know where to begin anymore. He has shown unmistakable evidence of severe narcissism, sociopathy, hypomania and possibly even early cognitive decline. His decision to assassinate Iranian Gen. Qassem Soleimani is an even more egregious example of recklessness and a bizarre thought process.

There appears to be little to no thoughtful consideration of consequences, planning or reasonable consultation with Congress or world leaders. Unfortunately, most of us have become habituated to Trump’s constant barrage of impulsive and aggressive attacks towards others. They happen so frequently that we barely notice them anymore. While his bullying on Twitter can appear comical at times, an impulsive assassination of an Iranian leader has escalated his impulsivity to an entirely new level.

What is deeply unsettling about this impulsive attack against Iran is how serious the implications could be. There is a real chance that Trump is unleashing a massive attack/revenge/counterattack sequence that could end in a catastrophic conventional or nuclear exchange. I understand that many Americans would rather keep their heads in the sand rather than acknowledge the grave situation in which President Trump has again put us, yet it is now more crucial than ever that we stand up to this bully before he inflicts catastrophic damage.

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Dr. Justin Frank, former clinical professor of psychiatry at the George Washington University Medical Center, and author of “Trump on the Couch: Inside the Mind of the President.”

At this point in our impending crisis with Iran, it’s again essential to illuminate the president’s character structure. Donald Trump has never left his either/or mentality, which has been how he functioned his entire life. You are bad or good, period. He was told since childhood by his father, a domestic tyrant in his own right, to be a “killer." And Trump is a tortured sadist — a tortured torturer. A breaker of things.

Trump is dominated by fear. He is also dominated by paranoid anxiety about being convicted in the U.S. Senate for the high crimes and misdemeanors that led to his impeachment. Fear, more than anything, is “the thrust behind the knife, the fist, the blow to the head.” Fear of being found out to be lacking or small also plays a part in Trump's lying. Thus he is driven by a need to recreate the feeling of infantile omnipotence. He tries desperately to get others to believe him, so they can share his feeling of being all-powerful. But with impeachment, Trump no longer lies to impress others or even to assert himself. His lies about the reasons behind the assassination to distract us from his impending Senate trial: Trump lies now to survive.

My second point is that Trump the builder is at heart Trump the destroyer. His loyalty to America is limited. Just ask Putin! His loyalty to the Constitution doesn’t exist; he has already been impeached. He has tweeted that he was giving notice to Congress that if Iran retaliates, the U.S. will strike back “perhaps in a disproportionate manner.” He doesn’t ask Congress; he gives notice to a weak handmaiden. With one tweet, Trump swept away any remnant of the separation of powers.

Since he has no loyalty to America, he feels he has nothing to lose by starting a war. Tragically, he answers the question I raised in my chapter on his malignant narcissism when I wrote, “Which prospect is likely more frightening to Donald Trump — revealing his tax returns or starting a nuclear war?"