Remember when the President of the United States got in an extended cyber-bullying Twitter battle with the spouse of one his longest-serving and most senior aides? You should, because it was this week. After the president went intergalactic about Saturday Night Live last weekend, George Conway—husband of Alternative Facts Kellyanne—tweeted a definition from the DSM outlining the behaviors associated with Narcissistic Personality Disorder.

It wasn’t much of a hint: Conway was suggesting the president has the disorder because he, for instance, "requires excessive admiration" or "shows arrogant, haughty behaviors" or "lacks empathy" or "is often envious of others or believes others are envious of him." Trump responded by calling Conway "a stone cold LOSER" who "is VERY jealous of his wife’s success."

For her part, Kellyanne Conway responded to all this in an interview with Politico. “You think [the president] shouldn’t respond when somebody, a non-medical professional, accuses him of having a mental disorder? You think he should just take that sitting down?"

"Don’t play psychiatrist any more than George should be,” she told reporter Daniel Lippman. “You’re not a psychiatrist and he’s not, respectfully.”

So we decided to follow her advice and ask some medical professionals about all this. It is considered unethical to diagnose someone without treating them personally, because you can't compile enough data on the subject to make those calls. But there is actually a huge volume of publicly available data on Donald Trump. There's also the concept of "duty to warn," where a counselor or therapist must tell a third party if they think a patient poses a threat to themselves or others. While Trump isn't their patient, he is the world's most powerful man, and he ain't sitting in a therapist's chair anytime soon.

With that in mind, a group of 27 psychiatrists and mental health experts spoke out publicly in October 2017 with . As circumstance would have it, the group is now embarking on a re-issue featuring 10 more experts, so we took a survey of some of the contributors to see what they made of George Conway's amateur diagnosis.



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Most are not interested in making a diagnosis themselves—at least with regard to any one disorder. But they practice what the leader of the coalition, Bandy Lee, calls "differential diagnosis," where they come up with a list of possible issues to rule in or out. (Lee compiled the answers below from her co-authors.) What they are more interested in is the practical danger they feel Trump poses to the American people and the world when he is vested with as much power as he currently is. The title of the book lays out their obvious opposition to the president, so you can view the following through that lens. But their conclusions are worth your time.

“The point we make in our book is that dangerousness is more important than diagnosis. We refrain from making explicit diagnoses in our book because a lot more information is necessary to finalize on a diagnosis, but until then, we can practice what is called ‘differential diagnosis,’ which is coming up with a list of possible diagnoses to rule in or rule out. My own opinion is that Mr. Trump possibly suffers from more than just one or two conditions, and therefore narrowing down to one or two options would minimize the severity of his impairment—which is why an urgent examination to diagnose him accurately is necessary. That said, narcissistic personality disorder and the more severe version, antisocial personality disorder, would be among the top of my differential.” —Bandy X. Lee, MD, MDiv

“‘What diagnosis?’ reflects a common misunderstanding of mental health and mental illness...President Trump [is] self absorbed, narcissistic, lacking in empathy, capable of great cruelty, extraordinarily short sighted or impulsive, extremely sensitive and vulnerable to slights, combative in response to the smallest slights, and unconcerned for the impacts of his behavior on anyone but himself. As it serves his purposes, he is also exquisitely sensitive to others’ desires and capable of persuading them into believing in him and feeling made whole by participating in or feeling linked with his activities. [For all these reasons, he is] extremely dangerous.” —Edwin Fisher, PhD

Trump speaks to a group of reporters for ChopperTalk. MANDEL NGAN Getty Images

“I have not professionally treated nor evaluated Mr. Trump and as such cannot make a definitive mental health diagnosis. However, we do not need a diagnosis to understand the dangerousness in what we see on a regular basis through the president's tweets, speeches, and other public behavior. His grandiosity, inability to empathize, poor self-reflection, reactivity, and impulsivity is very concerning and we suggest a committee of bipartisan medical and mental health professionals thoroughly assess his psychological, neurological, and cognitive functioning with a full and comprehensive medical and psychiatric evaluation.” —Jennifer Panning, PsyD

"I think the search for a diagnosis is a sort of titillating game that distracts us from what we should be paying the most attention to, i.e., is the President fit to serve? Does he have the capacity for self-control? Can he make decisions based on gathering comprehensive information and can he foresee the consequences of his decisions? Can he react thoughtfully rather than impulsively and emotionally? The answer to all those questions and more about specific necessary traits a leader with great responsibility must have is obviously no. To bring it down to Earth, would you trust him to babysit for your children for 24 hours? If not, why would you trust him to be president?" —Prudence Gourguechon, MD

"I think the search for a diagnosis is a sort of titillating game that distracts us from what we should be paying the most attention to, i.e. is the President fit to serve?"

“A President or anyone else having a mental health disorder does not, in and of itself, rise to a level of concern that would cause me to make a public statement on that topic as a mental health professional. It is the combination of a disorder and the propensity for dangerousness that causes me to speak out in the public interest. In answer to your question, while a provisional diagnosis of Narcissistic Personality Disorder is so likely that most laypersons offer that description, I believe Antisocial Personality Disorder is much more important as a rule out…Additionally, I believe a neurocognitive disorder, such as the onset of dementia, is very important to rule out, especially as it is in his immediate family history.” —Diane Jhueck, LMHC

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“Video of him as a young man show him articulate and fairly reasonable. Recent deterioration of his memory and loosening of his impulse control suggests that in addition to his pathological personality he may have a dementing neurological condition. I would urgently recommend a neurological examination with MRI and PET imaging to determine if he should be removed from office for impairment. The evaluations he has had are either inadequate or kept secret.” —James Merikangas, MD

“I have no doubt that he is a potentially serious danger to millions of people the longer he remains in office and the conditions become more serious."

“A diagnosis is a term we utilize in order to describe what it is we are trying to influence about someone under our care, and not a description of a whole person; in any case, we have no interest in diagnosing the elected president and are solely concerned with the question of whether he—with the extraordinary powers he wields—likely poses a danger. He, indeed, demonstrates in his overt behaviors two signs of dangerousness typical of the severely personality-disturbed person: the inability to see others as subjects in their own right, and the sharpest of splitting of the World into those with him and those who are against him. We predicted correctly that these characteristics would precipitate, as they typically do: impulsive behaviors; disinterest in extant organizations, government structures, conventional practices and laws; a lack of both skepticism and nuance in thinking; and, finally, disinterest in any truth except his own.” –Howard Covitz, PhD



“Because we have far more evidence on Trump’s behaviors and mental functioning than any patient who self-reports their behaviors to us, and his behaviors are so extreme, I believe this permits mental health professionals to offer [that Trump possibly] meets criteria for Narcissistic Personality Disorder, Antisocial Personality Disorder, and Paranoid Personality Disorder. These three disorders are actually caused by a common character flaw: low self-worth, which leads to poor shame tolerance. To deal with feelings of inadequacy, people like Trump attempt to manage relationships to forestall or avoid shaming experiences and being held accountable. This leads to maladaptive coping mechanisms, such as extreme fear of judgment, failure or blame; vindictive anger when criticized or held accountable, demands for loyalty to avoid criticism, controlling, abusive or domineering behavior to intimidate others into not criticizing; blatant lying to shift blame to others; and a belief one is above the law and should not be held responsible for one’s actions.” —Harper West, MA, LLP

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“I would certainly prefer to have personal access to him, as would any clinician, to offer a complete differential diagnosis, as it appears that there are several conditions that would have to be considered, Narcissistic Personality Disorder certainly at the top of the list. I would also want to consider issues related to cognitive abilities at this point. The specificity of those diagnoses would require access to more information than we have right now. I have no doubt that he is a potentially serious danger to millions of people the longer he remains in office and the conditions continue to become more serious.” —Ellyn Kaschak, PhD

"I believe this permits mental health professionals to offer [that Trump possibly] meets criteria for Narcissistic Personality Disorder, Antisocial Personality Disorder, and Paranoid Personality Disorder."

"[He may have] manic traits as part of his personality…Mania is a state of being sped up in one’s thoughts, feelings, and behavior, and it’s often associated with creativity and productivity. But the flipside is it can predispose a person to impulsivity, as well, and reckless behavior, especially if the symptoms become severe…[P]ublicly known and confirmed knowledge about Trump is consistent with manic symptoms: distractibility, decreased need for sleep, high physical and sexual energy, talkativeness, and elevated self-esteem. These symptoms are constant, and part of his personality, as with hyperthymic temperament. As with…other leaders [like Franklin Roosevelt, John Kennedy, Winston Churchill], there are some benefits to these manic traits, such as his creativity in his business life as well as presidential campaign. And there are some drawbacks, such as his [alleged] sexual impulsivity in his personal life and the possibility of impulsively dangerous decision-making in his political life.” —Nassir Ghaemi, MD

German Chancellor Angela Merkel deliberates with Trump at the 2018 G7 summit. Handout Getty Images

“The data available about Trump—far greater than what we'd ever collect on any patient in a clinical practice—strongly suggest he suffers from malignant narcissism, a character defect that goes beyond a personality disorder and is not a diagnostic category in DSM. Malignant narcissism is comprised of psychopathy, sadism, Machiavellianism, and paranoid tendencies, in addition to narcissism. Unlike most personality disorders, malignant narcissism (a.k.a narcissistic psychopathy) is not treatable.” —Elizabeth Mika, MA, LCPC



“There is so much information available to the public regarding Trump’s behaviors and interpersonal interactions, from the last few years and going back decades, that it is very reasonable to say that it falls well ‘within reasonable medical certainty’ that the data are fully consistent with the presence of severe narcissistic pathology, with sadistic and probably anti-social features.” —David Reiss, MD



Jack Holmes Politics Editor Jack Holmes is the Politics Editor at Esquire, where he writes daily and edits the Politics Blog with Charles P Pierce.

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