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Late last year, Dr. Lance Dodes – a retired assistant clinical professor of psychiatry at Harvard Medical School, a training and supervising analyst emeritus at the Boston Psychoanalytic Society and Institute, and one of 27 mental health professionals who penned an open letter to the New York Times warning of the newly elected president’s mental health status – doubled down on his concern regarding Trump’s unfitness for office.

In an interview with Salon, Dodes detailed the behavioral signs he believes would lead any competent psychiatrist or psychologist to a diagnosis of malignant narcissism for the President of the United States.

Donald Trump is, according to Dodes, a “very sick individual”.

The best diagnosis for Trump is that he is a malignant narcissist. It contains the narcissistic part, which is no big deal alone -- lots of people are narcissistic -- but the malignant part is the sociopathy dimension. These terms suggest that Trump is a very primitive man. He is also a man who has a fundamental, deep psychological defect. It is expressed in his inability to empathize with others and his lack of genuine loyalty to anyone. You will notice that Trump wants everyone to be loyal to him, but he is loyal to nobody.

Dodes also said Trump’s sense of reality is “fluid” – bordering on delusional at times. Why? Because the president can only be okay with himself when “reality” portrays him as the winner and the best.

When he says, “I had the largest crowd at an inauguration in history,” it does not matter that you can tell him that it is not true, he still insists on it. Well, that is very troublesome because what it means is that he needs to believe it. He is able to give up reality in exchange for his wished-for belief. Sometimes we call that a delusion. We have not used that word much with Donald Trump because that does get confused with people who think that they are Napoleon. But Trump has a fluid sense of reality, which is a sign of a very sick individual.

Sociopathy itself is a sign of a very sick individual, someone with a lying, cheating and emotional disorder. The intersection of those two occurs in sociopathy. It is not just bad behavior that people have to lie and cheat the way he does, it is an incapacity to treat other people as full human beings. That is why his focus is on humiliating others to aggrandize himself, as he did in the Republican primaries when he was debating and calling people names. The same thing applies to Hispanic immigrants and separating the children from their parents. That is a very, very serious mental and emotional problem. Normal people have normal empathy. It is part of being a human being. Lying and cheating and humiliating others and grinding them into dust in order to triumph is not just bad behavior. It is a serious mental illness.

Where does this leave America?

Dodes said Trump will likely continue on as he has unless Congress reaches a point where enough Republicans are no longer willing to stick up for the president -- or Trump will manufacture a major conflict, such as war with North Korea, to bolster his support and power.

So far it has been more of the same from Trump -- lies, exaggerations, bluster -- but as the special counsel investigations continues on a path toward the president, it is difficult to predict exactly how Trump might respond.

Read more here.