WASHINGTON (NYTIMES) - President Donald Trump directly attacked the husband of one of his most senior advisers on Tuesday (March 19), calling George Conway, who is married to Kellyanne Conway, a "total loser" after George Conway questioned his mental fitness.
While "loser" is one of Trump's favourite slights, it was the first time the president had publicly aimed it at the spouse of one of his closest advisers, and marked an escalation of a feud with George Conway, who has long been an outspoken opponent of the president.
It followed a Twitter post a day earlier from Trump's re-election campaign manager, Brad Parscale, assailing George Conway.
George Conway, a lawyer, said on Tuesday that the loser label was "a badge of honour."
And he quickly returned fire on Twitter, posting a citation on narcissistic personality disorder from a mental health handbook and asking, "Tell us, @realDonaldTrump - which of these diagnostic criteria do you not satisfy?"
Conway's post continued a string of assertions he has made about the president's mental state in recent days, including the contention on Sunday that Trump's "condition is getting worse."
Kellyanne Conway, the counsellor to the president, said on Monday that she did not share her husband's view of her boss' mental health.
The question of Trump's mental fitness to be president is not new, and he addressed it last year when he declared himself a "very stable genius." But it happens to be newly timely, as a group of doctors and academics who oppose Trump gather in Washington on Tuesday to discuss the very issue.
The conference is hosted by the World Mental Health Coalition, an organisation that formed in response to what it says was worldwide concern about dangers posed by Trump's behaviour as president.
A 46-year industry rule states that it is unethical to diagnose the mental state of a public figure, unless the public figure is a patient and the psychiatrist has permission to disclose it. The leaders of the organisation say they are not diagnosing Trump's condition, but rather warning about his dangerousness.
Kellyanne Conway has previously said her husband's criticism of the president is disrespectful towards her.
"I think it's disrespectful," she said in a Washington Post article about the couple last year, delivering her comments in the third person. "I think it disrespects his wife."
Trump has engaged with George Conway's criticisms before, referring to him late last year as "Mr Kellyanne Conway" and accusing him of "just trying to get publicity for himself."
One of Trump's sons, Eric, suggested in December that George Conway's attacks on the president were in fact attacks on his wife.
"Of all the ugliness in politics, the utter disrespect George Conway shows towards his wife, her career, place of work, and everything she has fought SO hard to achieve, might top them all," he wrote in a Twitter post.
The Conway marriage is one of great interest in Washington circles, where it is not uncommon for couples to have opposing political views. But comments from George Conway resonate more broadly because of who he is married to.
Kellyanne Conway, who did not immediately respond to questions about Trump's attack on her husband on Tuesday, has said that their four children get upset when they see their parents being pitted against each other because of their different allegiances.