Psychologists say that Trump’s condition is a combination of mental disorders that cause one to distort reality and make violent, impulsive decisions. These disorders form, according to the doctor who coined the term Malignant Narcissism in the 1960s, “the most severe pathology and the root of the most vicious destructiveness.” (Full criteria below.)

This is the first time in history that so many mental health professionals have collectively diagnosed a living individual. Their conclusion, based on the hundreds of hours of Trump’s on-camera dialogue and off-the-cuff public speaking, is alarming because it says that our current president is too mentally disturbed to fulfill his office.

To be clear: Being a standard deviation or two away from the norm when it comes to one’s psychology does not automatically make a person dangerous, bad, or unable to do a job. Millions of people have depression, anxiety, or mild mania and still function well. Abraham Lincoln went through depression, after all.

Unfortunately, unlike many other mental disorders, Malignant Narcissism makes its sufferers actively dangerous to other people. It’s more akin to delusional schizophrenia than it is to anxiousness.

In diagnosing Donald trump, mental health pros are breaking with a decades-old precedent. After Barry Goldwater won a 1969 defamation lawsuit when psychiatrists called him crazy in Fact magazine, the psychiatric community put in place a “Goldwater Rule” in their ethics handbook that forbids diagnosing public figures.

So why are psychologists breaking with tradition now?

A big problem during the Goldwater scenario was that there weren’t objective criteria for diagnosing mental health conditions at the time. Therapists used all sorts of jargon and their best judgment—but they were all over the place. Since then, however, the community has put in place official, objective standards in their bible, the Diagnostic and Statistical Manual of Mental Disorders (DSM for short). This makes it possible to unanimously agree on diagnoses.

The real reason for breaking with the code, however, is principle. Someone in power with Malignant Narcissism is likely to get people killed, and psychologists who know this feel morally obligated to speak up. This has legal precedent in a court case called Tarasoff vs Regents, in which the murder of a woman could have been prevented if the killer’s psychotherapist had warned her or police that the man might kill her. This resulted in The Tarasoff Rule: “When a therapist determines, or pursuant to the standards of his profession, should determine, that his patient presents a serious danger of violence to another, he incurs an obligation to use reasonable care to protect the intended victim against such danger.”

In Judaism, there is a principle called “Pikuach Nefesh” which says that it’s okay to break a rule in order to save a human life. Many in the mental health community believe that Donald Trump’s psychosis is that kind of a life-or-death situation, and that since he sees no mental health doctor, the Tarasoff Rule should supersede the Goldwater Rule. Thousands of psychologists feel morally justified in this. (And some even are saying it is immoral to not speak up.)

In addition to the mental health community, senators and congresspeople from both parties have expressed concern about Trump’s mental health. Whether they are right or not has enormous implications.

“I genuinely do not think this is a mentally healthy president.” — Eliot Cohen, US State Department under George W. Bush

Decoding Donald Trump’s Mental Condition

Malignant Narcissism, according to John D. Gartner, one of the country’s top psychologists, is basically a combination of three mental illnesses — Anti-social Personality Disorder, Paranoid Personality Disorder, and Narcissistic Personality Disorder — plus sadism, or the enjoyment of inflicting pain.

“The concept was developed by a famed psychologist named Erich Fromm, who escaped Nazi Germany, as a way to describe evil,” Gartner says. “He used it to describe Hitler.”

That’s pretty scary. And unfortunately, the assertion that Trump has it is not something that can be chalked up to politics.

“Even though I disagree with everything he stands for, I would be immensely relieved to have a president Pence. He’s conservative; he’s not crazy,” Gartner told me. Paul Ryan? He’d be great, too.

“Martin Luther King famously said the arc of history is long, but it bends towards justice. If we hit a traffic jam on the way to social progress, we’ll still get there,” Gartner said. “But if we’re all dead from a nuclear war, we won’t.”

Which is exactly what someone with Malignant Narcissism might start.

Gartner, who taught personality disorders at Johns Hopkins University for 28 years and explained Bill Clinton’s mental issues in the book In Search of Bill Clinton: A Psychological Biography, says Trump’s illness might be called “Dictator Personality Disorder.” Malignant Narcissism often coincides with mild mania — the ability to consistently stay up all night obsessing on a project — which helps sufferers achieve high career status despite their cruel tendencies. Trump exhibits this, too.

“I’ve been a specialist in personality disorders for 35 years,” Gartner says. “Trump is the most severe case I’ve seen in my career.”

The DSM is clear about what constitutes the three personality disorders that add up to Malignant Narcissism. Here they are broken down:

Now let’s take a look at Donald Trump’s behavior — from the public record — against the criteria:

Antisocial Personality Disorder