For years, Donald Trump’s most outrageous fabrications have, in a way, served to bolster his reputation as a media savant. Braggadocio and exaggeration were the keys to building his brand as a successful businessman—a role he performed weekly on The Apprentice—despite multiple bankruptcies and allegations of fraud. He rose to political prominence by promoting the racist lie that President Barack Obama was not born in the United States. On the campaign trail, he mixed his talent for self-promotion with an even headier dose of conspiracy theories, all the while instructing his supporters to disbelieve anything they read or saw in the mainstream media. His boldest act of deception—or, perhaps, self-delusion—came on the first week of his presidency, when he ordered Sean Spicer to inform the press that his inaugural crowd had been the largest in history, despite clear photographic evidence to the contrary. Trump’s top adviser, Kellyanne Conway, called it an “alternative fact.”

But a growing body of evidence suggests that Trump’s alternative view of the world is more than just dirty politics: it may be pathological. On Tuesday night, The New York Times and The Washington Post published dueling accounts of what can only be described as the president suffering some kind of break with reality. In private, Trump has reportedly told people that the infamous Access Hollywood video, in which he is heard on tape boasting about sexually assaulting women, must have been doctored. “We don’t think that was my voice,” Trump reportedly told one senator in January, suggesting that the voice in the video isn’t his, despite already having publicly acknowledged the comments and apologized for them. Since then, according to the Times, he has repeatedly suggested that the tape is fake. His comments in recent days have stunned advisers. He continues to believe that Obama’s birth certificate is not real, according to multiple sources, despite prominently declaring during the campaign that he had been convinced otherwise. And he continues to claim, behind closed doors and without any evidence, that he only lost the popular vote because millions of illegal votes were cast against him.

The Post, which confirmed the earlier Times report about Trump’s skepticism of the Access Hollywood tape, adds other concerning details: “Trump has dismissed his historically low approval ratings as ’fake’ and boasted about what he calls the unprecedented achievements of his presidency, even while chatting behind the scenes, saying no president since Harry Truman has accomplished as much at this point.” Perhaps most significant, the president is said to believe that Robert Mueller’s probe into his campaign’s ties with the Russian government will conclude by the end of this year, and that he will be fully exonerated. (Experts believe that Mueller’s team, which appears to be negotiating the cooperation of Michael Flynn, is just getting started.)

The Times and Post both describe this behavior as characteristic, and strategic. Trump “has a long history of stretching facts, predating his presidency,” the Times notes. “He has claimed his signature building, Trump Tower in Manhattan, was several stories taller than it actually is. In his first book, The Art of the Deal, he conceded to employing what he called ‘truthful hyperbole.’” The Post writes that Trump “has sought to paint the rosiest possible picture of his presidency and his character—and has tried to will others to see it his way, like the big-promises salesman he once was.” And there is surely some method to the madness. Publicly denying inconvenient truths, while attacking the media as “fake news,” is a key element of Trump’s continued support among his voters. But his private misstatements, within the White House, about easily verifiable facts, are harder to explain.

One possibility is that Trump’s original statements—his apology for the Access Hollywood comments and his renunciation of birtherism, for example—were delivered in bad faith, and that he has always believed the tape, and birth certificate, were fake. Other possibilities point to a much more serious break from reality.