How reliable are narcissistic threats

How dangerous are narcissism and personality of President Trump?

Narcissism, as I said, falls into several sub-categories, and what you see in abundance on the internet are in fact basically histrionic qualities: exaggerated expression of feelings, theatrical behavior, incessant desire for approval and so on. That's exactly the point: If someone just wants to be the center of attention as often as possible, that alone is not narcissism. Narcissism means, above all, poverty of empathy. Narcissists are not interested in others - they are just material, just water carriers.

Does a person have to suffer himself to be considered sick?

No. I once had a patient who was absolutely convinced that Paul McCartney was in love with her. Except for depressive break-ins, she got along quite well in life - and did not feel that she was sick at all. Still, I had to tell her that she was sick. She suffered from madness because her ideas differed too much from general experiences and behavior.

And what about narcissistic personality disorder?

According to the DSM-5 diagnosis system, the person concerned must suffer from his or her personality, only then can one speak of a personality disorder. But that certainly does not apply to Trump. He does not suffer from himself.

"Narcissism means above all empathy poverty. Narcissists are not interested in others - they are only material, only water carriers"

How do you treat a narcissistic personality disorder in everyday clinical practice?

There are two typical ways that narcissistically disturbed patients get into therapy. One is: The person affected has a massive suicidal crisis, for example after losing a job or because the partner has separated from him. Then, as part of subversive psychotherapy, we try to bring him back to his normal narcissistically stable level. In other words, one does not initially confront the patient with his or her personality traits at all. Only when it is possible to get the person back into their everyday life does the question arise whether they can be motivated for further therapy. However, narcissists usually do not see themselves as the problem, but rather their environment. And then of course you have a very bad chance that someone will work on yourself with motivation.

And the second way?

The second way is more common in my everyday life. For example, someone calls up who says that his wife has already scolded him as a narcissist and that he now googled a little and thinks that he was actually affected. If someone like this is motivated, a usually longer therapy begins, in the course of which the patient learns to take other people into their own eyes. Basically, it is about a change of perspective: How do you think the other person is doing when I am like that? What do I trigger with my wife when I come home in the evening, hardly say hello and only tell about the great things I did again today?

Is that cognitive behavior therapy then?

There are different approaches, such as psychoanalytic, depth psychological, behavioral therapy and other approaches. Basically, they have very similar elements, the overlap is extremely large. For example, they all emphasize the importance of being able to develop a relationship with the patient as a therapist and how to do that.

And nothing is being done pharmacologically?

No.

Let's come back to Trump again. Usually psychiatrists and psychologists shy away from diagnosing people they have not examined themselves, a principle known as the "Goldwater Rule". In the case of the US President, however, you and other experts have decided to make an exception. Why?

For two reasons. For one thing, we have enough information in the Trump case. A colleague of mine once said that Thomas Gottschalk is a typical narcissist. I don't think that's okay, because we don't know what Thomas Gottschalk is like in private. The fact that someone appears in TV shows like Thomas Gottschalk does is a zero statement, because a TV show has special requirements and circumstances. As I said, the context shapes behavior. As TV viewers, we have no idea whether Thomas Gottschalk isn't a loving father, a good husband, an easy-going friend - qualities that have nothing to do with narcissism. It's different with Trump because he expresses himself spontaneously on anything and seeks the public so much that we have enough information to clearly establish that he has very strong narcissistic personality traits.

And the second reason?

Of course, we don't want to examine every politician, every actor, every musician against the background of psychopathological terms. That would be a psychiatization of society, which I reject. But if you look at history - think of Josef Stalin, Adolf Hitler - to say "I do not express myself" is also a kind of cowardice at some point. It's always easier to stay out of it. I did that up to a point with Donald Trump, until I realized it got worse after his election and inauguration. And the population has to form an opinion in his case. Therefore I now express myself.

Carsten K├Ânneker asked the questions.