There is no shame in talking about Trump’s symptoms of Narcissistic Personality Disorder

This past week an article has been making the rounds in which Allen Frances, chair of the department of psychiatry at Duke University School of Medicine, issued a metaphorical wrist slap to professionals and gen-pop alike for suggesting that our president displays symptoms of Narcissistic Personality Disorder. Because I’m a facts nerd, and also a former therapist and pysch professor who totally believes Trump has Narcissistic Personality Disorder, I wanted to address this article with some clarifications from my professional experience.

1. This title is click-bait. Allen Frances did not define the diagnosis. It was first described by Otto Kernberg and Heinz Kohut in the 60’s. It was added to the DSM-III in the 80’s. Allen Frances was a part of the team that revised the DSM-III resulting in the DSM-IV but he is not, and was not, someone who defined this disorder. He was part of a team that edited the phrasing of a massive psychiatric manual.

2. Allen Frances suggests that a mental disorder requires that a person have a subjective experience of distress in order for a personality to be mental illness, but in fact this is NOT the case with cluster B personality disorders. Specifically, in the cases of Borderline and Narcissistic Personality Disorders, individuals often have very little insight and empathy, and the distress is experienced by the people around them. Their relationships may be impaired but it is usually because the people in relationships with them are being victimized by their manipulation.

3. Allen Frances creates a false binary between mental illness and evil. It’s possible to be both, and often mental illness causes people to act in ways that we would deem “evil.” That is certainly the case with NPD, where grandiosity, entitlement and a lack of empathy are hallmarks of the disorder.

4. Allen Frances suggests that Trump does not have NPD because he benefits from the traits of NPD. “He has been richly rewarded, rather than punished, for his grandiosity, self-absorption and lack of empathy.” In my experience, both personally and professionally, people with NPD often reap rewards and avoid punishment for these traits. The diagnostic criteria does not stipulate that a person be devoid of personal gain due to their NPD behaviors. In fact, one criterion is “taking advantage of others to get what you want.” Most people with NPD are skilled manipulators and they are resistant to treatment and to change because their selfish behavior works for them.

4. I personally think it’s disingenuous for him to suggest that it’s an insult to people who really have NPD, because people with NPD very rarely believe that they have it, and are unlikely to be sitting in a corner crying over being compared to Trump. Someone in recovery from NPD likely recognizes the tendencies in our president.

5. We can see that Trump is fixated on power, and on proving that he is more important, beloved, and popular than he really is. He is obsessed with disproving unflattering press.

6. The DSM-IV diagnostic criteria and Trump’s behavior speaks for itself. It doesn’t require a graduate degree to make the connections here.

Exaggerated sense of self-importance.
Expecting to be recognized as superior 
even without achievements that warrant it.
Exaggerating your achievements and talents.
Being preoccupied with fantasies about success, power, brilliance, beauty or the perfect mate.
Believing that you are superior and can only be understood by or associate with equally special people.
Requiring constant admiration.
Having a sense of entitlement.
Expecting special favours and unquestioning compliance with your expectations.
Taking advantage of others to get what you want.
Having an inability or unwillingness to recognize the needs and feelings of others.
Being envious of others and believing others envy you.
Behaving in an arrogant or haughty manner.
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