Some election day psychology: A primer on narcissistic and antisocial personality disorders

By Hal Brown, MSW, Retired psychotherapist

I have written numerous articles about mental health especially as related to Donald Trump. Many were published on Daily Kos. I was one of the first members of Dr. John Gartner's Duty to Warn group.

If you do this Google search for Trump Hal Brown this is what you come up with:

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I'd forgotten that a letter I wrotewas published on Medium.

Donald Trump is not the only politician to have manifest deeply concerning signs he or she had psychiatric disorders which could endanger democracy. 

On Election Day I thought it was a good to time to put together a simple primer for those who are interested in assessing which other politicians seem to have personality disorders which may make them a danger to democracy.

This is how The Mayo Clinic describes personality disorders:

A personality disorder is a type of mental disorder in which you have a rigid and unhealthy pattern of thinking, functioning and behaving. A person with a personality disorder has trouble perceiving and relating to situations and people. This causes significant problems and limitations in relationships, social activities, work and school.

In some cases, you may not realize that you have a personality disorder because your way of thinking and behaving seems natural to you. And you may blame others for the challenges you face.

Personality disorders usually begin in the teenage years or early adulthood. There are many types of personality disorders. Some types may become less obvious throughout middle age.

Not all people with personality disorders actually are distressed by having them or even have an inkling that they do. They are broken down into three groupings called clusters as follows:

Cluster A: characterized by odd, eccentric thinking or behavior. They include paranoid personality disorder, schizoid personality disorder and schizotypal personality disorder.

Cluster B: characterized by dramatic, overly emotional or unpredictable thinking or behavior. They include antisocial personality disorder, borderline personality disorder, histrionic personality disorder and narcissistic personality disorder.

Cluster C personality disorders: characterized by anxious, fearful thinking or behavior. They include avoidant personality disorder, dependent personality disorder and obsessive-compulsive personality disorder.

All of these disorders with the exception of two are treatable. The people who have them seek treatment because they are suffering. The two that are not considered by the majority of mental health professionals to be treatable are narcissistic personality disorder antisocial  personality disorder. Rather than suffering themselves they causes other people to suffer. Some of them even revel in making others suffer and would be considered sadists or bullies. They often build up themselves at the expense of others.

How many politicians meet the criteria for one or both narcissistic personality disorder and/or antisocial  personality disorder (which used to be called sociopathic disorder)?

Let's review the characteristics of each disorder.:

Narcissistic personality disorder (NPD) includes:

A pervasive pattern of grandiosity (fantasy or behavior), need for admiration, and with lack of empathy, beginning by early adulthood, as indicated by at least five of the following:

• Has a grandiose sense of self-importance (e.g., exaggerates achievements, expects to be recognized as superior without actually completing the achievements)
• Is preoccupied with fantasies of success, power, brilliance, beauty, or perfect love.
• Believes that they are "special" and can only be understood by or should only associate with other special people (or institutions).
• Requires excessive admiration.
• Has a sense of entitlement, such as an unreasonable expectation of favorable treatment or compliance with his or her expectations).
• Is exploitative and takes advantage of others to achieve their own ends.
• Lacks empathy and is unwilling to identify with the needs of others.
• Is often envious of others or believes that others are envious of them.
• Shows arrogant, haughty behaviors and attitudes

Antisocial personality disorder:

 Disregard for and violation of others rights since age 15, as indicated by one of the seven sub features: 

1. Failure to obey laws and norms by engaging in behavior which results in criminal arrest, or would warrant criminal arrest 
2. Lying, deception, and manipulation, for profit or self-amusement,
3. Impulsive behavior
4. Irritability and aggression, manifested as frequently assaults others, or engages in fighting
5. Blatantly disregards safety of self and others, 
6. A pattern of irresponsibility and 
7. Lack of remorse for actions 

It is possible for one person to have both narcissistic personality and antisocial personality. While not a formally recognized diagnosis this has been called malignant narcissism.

(Malignant narcissism is) a psychological syndrome comprising an extreme mix of narcissism, antisocial behavior, aggression, and sadism.  Grandiose, and always ready to raise hostility levels, the malignant narcissist undermines families and organizations in which they are involved, and dehumanizes the people with whom they associate.

Malignant narcissism is not a diagnostic category, but a subcategory of narcissism. Narcissistic personality disorder (NPD) is found in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR), while malignant narcissism is not. Malignant narcissism could include aspects of narcissistic personality disorder (NPD) alongside a mix of antisocial, paranoid and sadistic personality disorder traits. The importance of malignant narcissism and of projection as a defense mechanism has been confirmed in paranoia, as well as "the patient's vulnerability to malignant narcissistic regression".  

A person with malignant narcissism exhibits paranoia in addition to the symptoms of a Narcissistic Personality Disorder. Because a malignant narcissist's personality cannot tolerate any criticism, being mocked typically causes paranoia. Wikipedia

I do not believe we can dismiss the way some Republican politicians fit into one or both categories. History should warn us what happens when people like this end up in power.