The particular illness he has s called Malignant Narcissism. Although it is not in the DSM and has never even been proposed, it has a theoretical long history in psychiatry. Karen Horney did some of the best early descriptive work on it, and Otto Kernberg added to that with a superb monograph in 1984. Unfortunately, most of the writing about this disorder is coming out of the psychoanalytic community, where dubious theory is common.
Think of narcissism as self-esteem. They are the same thing, and don’t let anyone tell you otherwise. Almost all human beings are narcissistic, and narcissism is an essential part of the makeup of any healthy human. However, as with most things, even water, you can have too much of a good thing.
Narcissism, like most things in abnormal psychology (or for that matter, on Earth), exists on a continuum.
At the far left, we have low narcissism, which could be seen as low self-esteem. This is not a good condition, but it is very hard to fix once it gets set in.
Healthy narcissism is the sort of thing that most people have.
High narcissism is better seen as high self-esteem and it is generally regarded as a sign of good mental health. Some people might find these people a bit too much, and some people refer to them as vain, conceited, or self-impressed. At worst, they can be arrogant, condescending, and cocky and they can wear out their welcome after a bit. However, if the downside of the feeling (arrogance, condescension and cockiness) are played down, high self-esteem does not generally get too much in the way of functioning well as a human being. In addition, many of these people retain a lot of empathy for others, but as they tend towards arrogance and cockiness, they can start to seem unempathetic.
Beyond that, we move into the toxic zone of Narcissistic Personality Disorder, which may also exist on a continuum of mild NPD, moderate NPD and serious NPD. If you told the first two that they had NPD, they would laugh in your face and turn it into an attack on you. The latter may well recognize that they have this condition, but they don’t care that they do, or else they like it.
Beyond NPD, we move into the area of Malignant Narcissism. This is a poorly understood construct, but I believe that it does exist and should be in the DSM. This could be seen as narcissism heading off into psychopathy. They are sometimes called Narcissistic Sociopaths.
A lot of people think that narcissism and psychopathy are on the same spectrum , as the sociopath is the ultimate narcissist. In a way he is, but it is in an odd way. To the narcissist, other humans exist, but he just doesn’t care about them.
For the sociopath, in a sense, the sociopath is the only person in the whole world. Not only does the world revolve around them but even worse, the world is them and they are the world. Other humans don’t exist as such. They exist in a way, but they are not really human. Instead, other humans are like the hammers and screwdrivers in your tool chest. Sure, they come in handy sometimes, but they’re not exactly alive. And I can take that hammer or screwdriver and do whatever I want to with it. I can throw it away, set it on fire, throw it in a river, or smash it to pieces. Which is about how a sociopath sees you – as a handy tool that is about as alive as a rock which can be destroyed or tossed aside if he desires to without any more of a thought as you would give to tossing away any nonliving thing.
Here is a good schematic on the Narcissistic continuum:
Low Narcissism (Low Self Esteem) -> Healthy Narcissism -> High Narcissism (High Self Esteem) -> Mild Narcissistic Personality Disorder (NPD) – Moderate NPD – Serious NPD -> Malignant Narcissism -> Various degrees of sociopathy and psychopathy ranging from 20-40 on Hare’s Psychopathy Scale
They kept saying Trump had NPD, but I always wondered about that. I have met a few NPD’s in my life, and I have known at least one quite well. Sure, they are insufferable, and they can be serious jerks, but they didn’t seem to have the same level of crazy as Trump. I kept thinking, “Well, severe NPD is a pretty nasty illness,and they can seem pretty nuts,” but I was unsure about that statement.
And now it all makes sense. The reason he seemed so extreme for an NPD is because he is not an NPD at all.
Instead, he is something considerably worse, a Malignant Narcissist. It is separate disorder from NPD, past NPD on the road to sociopathy. But I do not understand this illness well, and it has never been in the DSM, though it ought to be.
NPD’s can definitely be dangerous, but in general they are too obsessed with their wonderful greatness and their superb lives to commit serious violence and risk imprisonment. They also might not want to hurt their glorious public image.
The one thing you need to know about Malignant Narcissists is that they are dangerous. Now that doesn’t mean that they are ever going to do anything truly bad, and they may go through their whole lives without spending an hour in jail. But the potential for some serious bad behavior all the way up to serial murder is there.
To give you an example of how dangerous a Malignant Narcissist can be, Ted Bundy was a malignant narcissist.