In this in-depth article, two high profile mental health experts delve further into the inconsistencies and untruths that underlie much of what this President says and does.

By Seth Davin Norrholm, Ph.D. & David M. Reiss, M.D.

AAP At a recent NATO summit, President Trump, in classic narcissistic fashion, shoved his way to the front of the gathering of international representatives and assumed a dominant posture.

During his ascent from the business world and reality television to the Presidency of the United States of America, Donald Trump has consistently displayed many of the qualities and behaviors associated with narcissism including:

· grandiose sense of self-importance;

· preoccupation with unlimited fantasies of success, power, and brilliance;

· belief that one is special;

· consistent requirement for excessive admiration;

· sense of entitlement;

· taking advantage of others for one’s own gain;

· lack of empathy for others, and

· hyper-sensitivity to criticism

These behaviors and their potential consequences have been well documented in the mainstream media and individuals representing different schools of thought and areas of expertise within the mental health community, including the two of us, have provided comment and insight to the relationship between extreme narcissism and Presidential fitness for duty.

One aspect of the narcissistic personality that has been increasingly apparent to outside observers during the first 120 days of Trump’s term is his noted penchant for controlling the narrative about him and his performance through misleading statements, exaggerations, or flat out lying…and he has let out some real doozies (492 in his first 100 days by some counts) including:

- he had the biggest Electoral College win since Ronald Reagan

- his Inauguration crowd was the largest in history

- 3 to 5 million “illegals” voted in the general election and cost him the popular vote

- the rollout of his travel ban from predominantly Muslim nations was “going well with very few problems” and that any of those protesting the action were “paid” “professional anarchists”

- Former President Obama wiretapped his phones at Trump Tower during the campaign

- FBI Director James Comey told him that he was not under investigation three times prior to Comey’s firing

GETTY IMAGES Shortly after his Inauguration in January, President Trump and then FBI Director James Comey greet one another. Trump would later fire Comey in what has been debated as a self-preservation move and/or obstruction of justice.

The narcissist is self-serving and will go to great lengths to protect himself from ego injury, including changing facts to fit his worldview rather than changing his worldview to fit objective facts. The nexus of repeated lies, creating an “alternative reality” even in the face of conflicting evidence, is so deeply rooted and so intricately woven that severe narcissists can display a quasi-delusional state (separation from reality) similar to that seen in psychotic disorders. While there is a subtly different quality of the false beliefs than occurs in primary psychotic disorders (e.g., schizophrenia, bipolar disorder, delusional disorder, etc.) the distortion of reality by the narcissist can be equally as irrational.

For the past several weeks, the President has been embroiled in controversy regarding the apparent interference by Russia in our 2016 election, the ties of several members of Team Trump with Russia, and accusations levied toward him suggesting that he is actively obstructing the ongoing Trump-Russia investigation. For example, Trump’s rationale for firing FBI Director James Comey has changed numerous times with the most recent explanations seeming to be more closely related to self-preservation rather than dereliction of duty on Comey’s part.

All of these observations beg the questions: Why does the President lie to the extent that he does and why does he appear unconcerned about the consequences of such substantial “twisting of the facts?”

Based on our combined 50 plus years of experience examining human behavior and studying psychopathology, we suggest the following cognitive framework may help explain the contradictory, deceptive, and sometimes bizarre, statements and actions of this President:

1. The extreme Narcissist will distort reality and tenaciously maintain the existence of their distorted reality. This type of defense is not unique to narcissism and is present almost ubiquitously in both psychiatrically healthy individuals and those who suffer from some form of psychopathology.

Distorting reality serves to protect an individual from distressing, fearful, painful, or overwhelming emotion. What is unique to those with personality disorders, including narcissistic subtypes, is the degree to which an individual will go to maintain and rationalize this defense.

The extreme Narcissist will provide any plausible defense for his behavior in order to maintain the ego-protecting reality he has created. In other words, consider that within legal proceedings there exists the concept of demonstrating that something did or did not happen by meeting the criteria of being “beyond a reasonable doubt.” The severe narcissist will seek out and employ a defense, tenaciously, even if it could be characterized as well within the realm of “unreasonable doubt,” and having only the slightest chance of plausibility.

It is not distressing to the severe narcissist if a belief is improbable (e.g., the reported ties between my team and Russia are a hoax created by the opposition) as long as the belief is even barely theoretically possible. In fact, being directly challenged that a belief is improbable (for example, by the press) may actually embolden the extreme narcissist by confirming a sense of “specialness” – the conviction that one is so smart or so important that he sees what others do not. He might respond to such a challenge “That just proves how special I am, how unique my situation is, and that my abilities are so superior!”

TWITTER Two representative tweets in response to President Trump’s recent claims that his recent overseas trip to the Middle East and Europe has been “very successful” despite conflicting evidence and controversy along the way.

2. The extreme Narcissist lives in the moment with little regard for linear time, cause and effect, or behavioral consequences. Our clinical observations suggest that the severe narcissist lives in a protective (and expanding) bubble within which life events all occur “in the present.” There is no emotional conception of time in the narcissist as perceived by most individuals. In general, people are able to conceptualize their life history as a linear, logically flowing, autobiographical narrative. While the narcissist may be able to tell you factually that events occurred on a certain date at a specific time, their perception is that it is all encompassed in terms of an immediate “now.”

This phenomenon can be described as a “collapse of time” or an ever-enlarging array of interconnected events as opposed to a directional, sequential passage of time and experiences. Dr. Reiss has used Kurt Vonnegut’s metaphor from Slaughterhouse 5 to explain this type of life perception. Normal perception of time can be thought of as riding in a train traveling in a linear direction with “events” coming up to you and then passing behind you. You have the sense of where you are, you can try to peek at what is coming up, and you can recall what has passed by – yet you are fixed in that position traveling in that direction and you can report how far you have travelled (by using a clock or calendar, for example).

The “collapse of time” is perceived as more of being within an expanding balloon in which neither the events that you experience nor the sense of self that you develop are fixed or anchored. Events that occurred in the past are recalled and re-experienced without a definitive emotional sense of how long ago they occurred.

The relationship between events is dynamic and changeable. In addition, all of the events that an individual experienced are all “there” at the same time and accessible to recall. Events that occurred years ago carry the same emotional power (and impact upon decision making and behavior) as events of perhaps the current month.

The extreme Narcissist lives in the “now” such that:

· gratification (e.g., praise, reward, accolades, adoration) is sought within the moment,

· explanations for misdeeds are presented in present tense terms,

· boastful statements are made because they feel good right now –

TWITTER In posting boastful tweets like this, which also includes a false statement, Trump is able to “lean on” his Electoral College victory to feel good “in the now.”

In other words, the severe narcissist does not stop to consider future challenges to his statements or actions, the relevance or consistency of present behaviors with previous events, or the potential negative consequences that “now” actions could have later. The extreme narcissist’s perception of time impairs the ability to function effectively in a society that is based on an implied linear progression of time.

For the narcissist, the sense of the “future” may have a similar “immediate” quality. While narcissists may “plan” for the future, at times even for a legacy after death, when closely exploring the accompanying emotional sense, there is often a hidden child-like belief that even if deceased, one will still be present to experience the “glory” of their own legacy – and in fact, one is already reveling in that anticipated adulation at the present moment. Emotionally, a magical immortality is embraced.

It is our belief that until a Narcissist is directly confronted “head on” with irrefutable evidence of his misdeeds or the clear impossibility of the scenario that has been created, he will devise a narrative to fit the gratification of his ego within the present “now.”

This may, at least in part, explain why there have been so many examples of this President contradicting his previous statements, speaking extemporaneously without substance to back his claims, or “flip-flopping” between positions, all without any indication that he is aware of or experiencing a sense of conflict or inconsistency, or any need to offer an explanation for the objectively illogical presentation.

In our proposed schema, he doesn’t conceive of time in the sense that most people do and, as such, there is no linear relationship between events. That is not to say he cannot engage in more cognitive types planning and thought (i.e., Today I will attend several meetings and tomorrow I will play golf) but that this lack of linearity exists at an emotional level.

WH.gov Living in the now, the severe narcissist does not weigh the long term impact of his actions - such as removing environmental restrictions by Executive Order - which may have devastating effects.

It is also worth noting that the “collapse of time” phenomenon previously described coupled with the lack of empathy associated with extreme narcissism may also help to explain the apparent lack of concern by this President for those who would be harmed (including even his own younger wife, children, and grandchildren) by the long-term detrimental effects of his actions, legislation, and positions on such issues as climate change, nuclear arms proliferation, healthcare cutbacks, the defunding of biomedical research, and an overall isolationist approach to global politics.

3. How does the extreme Narcissist develop a fantastical reality within “collapsed time?”

While there may be complex neuro-psychological factors that contribute to the perception of time, from a psychological point of view, there are two inter-related factors related to early-life experience that appear to contribute to the “collapse of time.”

During childhood, it is universally important for a child to learn how to cope with frustration and discomfort. Frustrations and discomforts may range from normal, inescapable circumstances (e.g., experiencing hunger, hot or cold, physical pain, normal anxiety, fear or worry) to situations that are overtly traumatic or abusive. It is well known that sufficient fear or discomfort triggers a “fight or flight” response involves emotional, physical and cognitive reactions. One of the reactions that commonly occurs during the “flight or fight response” is the sensation of time “elongating” or “standing still.” Thus, for a child who experiences an environment that is perceived as particularly stressful, there may be a significant number of episodes (or in severe cases, an almost constant state) during which there is an experience of time distortion or “timeless”, which likely interferes with development of a healthy and normal perception of the passage of time.

At the same time, a second factor derives from the fact that in a “normal” situation of “stress” or discomfort, a child perceives that within a reasonable period of time, their caretaker (parents, parental figures, etc.) will take action to restore a state of comfort. When that occurs regularly, the uncomfortable child learns to “look forward” to the arrival of comforting – and the act of learning to “look forward” supports the perception that events proceed in a linear, progressive passage of time. However, if a child does not experience an expectation of comfort (whether due to comfort not being available or due to an impairment of perception), there then does not exist a motivation to “look forward” for relief. Rather, there develops an attempt to do the best possible to find some manner of “defense” to at least relieve the sense of the distress in the immediate moment . Thus, time is not a factor and there is no “looking forward” or linearization of time – there is only a need to seek immediate relief/gratification in the “ever-present now.” In fact, in unfortunate situations of abuse or overt neglect, the child may learn to fear that the passage of time will only lead to increased distress, leading to a disruptive motivation to avoid “looking forward” and to remain fixed in the present.

Facebook: Donald J. Trump During his upbringing with a “stern, demanding, and ultimately rejecting father (left)” and as a military school cadet (right), Trump developed “a life is war” mentality.

Without attempting to analyze or evaluate Trump’s developmental years in depth, it is notable that his father has been described as, “stern, demanding, and ultimately rejecting", leaving young Trump with “a life is war mentality.” That experience could well repetitively trigger a subtle “fight or flight” state that then engenders a “collapse of the perception of time.”

4. What happens when the extreme Narcissist is confronted with “irrefutable evidence” against the fantasy life he has created?

At times, and for many, inevitably, the narcissistic individual will be inescapably confronted with the fact that the fantastical world they have invented and in which they “live emotionally” is not reality-based. This may occur when practical circumstances (e.g., arrest, conviction, incarceration, or financial ruin) prevent even a modicum of the desired fantasy state)

Typically, the first response to this type of confrontation is the emergence of anxiety and an attempt to restructure the narcissistic defenses/fantasies to rationalize the new situation, often at the cost of creating even more of an irrational distance from reality. If those attempts fail, anxiety leads into having to face inner emptiness and despair, with emergence of significant and at times malignantly severe depression.

Depending upon the practical circumstances and environment as well as other personality traits (and possibly, biochemical vulnerabilities), depression may slowly or precipitously lead to a suicidal level of despair or a total “escape” from realty into a “full-blown” paranoid state. The latter statement underscores the need for experts to highlight these behaviors in the current President due to the danger it presents to the millions upon whom his actions have consequences.

5. Concluding Remarks

This phenomenon is, in fact, an aspect of the entrancing power of the severe narcissist. Even while cognitively aware that he is spinning a false tale – i.e., lying – emotionally, in the moment, the story being told is both experienced as reality and conveyed with a tone of conviction and “sincerity” (albeit often bombastically so) such that the listener is forced into the position of taking the significant risk of questioning the sanity a powerful, apparently self-assured person; or adopting the safer, more passive role of relinquishing their own cognitively analytic processes and deferring to the intoxicating, intense and grandiose thought processes of the narcissistic. Thus, the interpersonal interaction commonly referred to as “gaslighting” in fact represents the projection onto the public of the powerful, illogical, and timeless fantastical world of lies in which narcissist (emotionally) lives.

About the Authors:

Seth Davin Norrholm, PhD is an Associate Professor of Psychiatry and Behavioral Sciences at Emory University School of Medicine, a full-time faculty member in the Emory Neuroscience Graduate Program, and a member of the Emory Clinical Psychology Graduate Program. Dr. Norrholm has spent 20 years studying trauma-, stressor-, anxiety-, depressive-, and substance use-related disorders and have published over 80 peer-reviewed research articles and book chapters. The primary objective of his work is to develop "bench-to-bedside" clinical research methods to inform therapeutic interventions for fear and anxiety-related disorders and how they relate to human factors such as personality, genetics, and environmental influences. Dr. Norrholm has been featured on NBC, ABC, CNN.com, USA Today, WebMD, Scientific American, and is a regular Contributor to The Huffington Post.

David M. Reiss, M.D. has been a practicing psychiatrist for more than 30 years, specializing in “front-line” adult and adolescent psychiatry. He has evaluated and treated over 12,000 persons of diverse social and cultural backgrounds, from every occupational field. Dr. Reiss has been recognized internationally for expertise in character and personality dynamics. He is often interviewed and quoted in the print, Internet and radio/TV media, nationally and internationally, to help the public understand the psychological aspects of current events. He is an authority on issues regarding social and political phenomena, medical and mental health treatment, PTSD, violence in society, and the functioning of the current mental health system.