The medical diagnoses usually applied to Trump's mind are illnesses known as
"personality disorders." These diseases, of which there are 10 types,
are the bread and butter of psychiatric practice in contemporary America
All have several characteristics in common:
[Personality disorders are]
pervasive, maladaptive, and chronic patterns of behavior, thinking, and
feeling, ultimately leading to distress and dysfunction.
Patients with personality disorders suffer from distorted perceptions of
reality and abnormal affective behavior, manifesting in maladaptive coping
mechanisms and distress.
The psychiatric profession groups personality disorders
into three clusters, unimaginatively called A, B, and C.
Cluster-B, which is particularly relevant to Trump, is sometimes labeled
the "dramatic/emotional/erratic" cluster
and includes antisocial, narcissistic, histrionic, and "borderline"
Commonly, patients will have more than one diagnosed disorder from within
Assessment of Dr. Mary Trump
Trump's niece, Dr. Mary L. Trump
is a well-trained and experienced Ph.D. psychologist
Although she certainly harbors biases against her uncle, she also knows him
far better than any other mental health professional ever will.
She assesses possible diagnoses for her uncle as follows:
Narcissistic personality disorder:
I have no problem calling Donald a narcissist -- he meets all nine
criteria [listed in the DSM-5 book]
[But] this is far beyond garden-variety narcissism; Donald is not simply
weak; his ego is a fragile thing that must be bolstered every moment
because he knows deep down that he is nothing of what he claims to be.
Antisocial personality disorder:
A case could be made that he also meets the criteria for
antisocial personality disorder, which in its most severe form is generally
considered a sociopathy but can also refer to chronic criminality, arrogance,
and disregard for the rights of others.
Dependent personality disorder: [from Cluster-C]
Donald may also meet some of the criteria for dependent personality disorder,
the hallmarks of which include an inability to make decisions or take
resposibility, discomfort with being alone, and going to excessive lengths
to obtain support from others.
Dr. Trump entertains the possibility of "a long undiagnosed learning
disability that for decades has interfered with his ability to process
as well as a co-morbid sleep disorder
Donald's pathologies are so complex and his behaviors so often inexplicable
that coming up with an accurate and comprehensive diagnosis would require a
full battery of psychological and neuropsychological tests that he'll never sit for.
Testifying to the accuracy of this statement is the large number of relatively
minor, but still unfathomable,
behaviors noted elsewhere on this page:
his caffeine hyper-consumption
his multiple personal fears
his sexual bravado
as expiation for
the cowardice of his illegal draft evasion
his sensitivity about his hand size
his laughable hair style
his overabundant skin make-up
and so on.
Despite Mary Trump's warning about the difficulty in diagnosing her uncle,
Dr. Zebra offers the following, which has been leavened by
long discussions with an astute psychiatrist.
Mr. Trump's psychiatric illness is best identified as "a mixed,
severe personality disorder with sociopathic and borderline features."
Specifically, it is a mixture of antisocial personality disorder and
borderline personality disorder.
- "Sociopathic" refers to a severe degree of antisocial personality disorder
-- a disease that psychiatrists
formally diagnose in adults who have a "pervasive pattern of
disregard for and violation of the rights of others," as described by
the standard textbook of mental disorders, "The DSM-5."
- "Borderline" does not refer to features that are on the verge of being
abnormal. It refers instead to a defined list of clearly abnormal features that are not always
present. It forms part of Trump's diagnosis because antisocial personality disorder does
not alone account for all of the abnormal behaviors he displays.
- Although it is tempting to apply narcissistic personality disorder to Mr. Trump, his illness, as
Mary Trump observes, is larger than that. His antisocial
features swallow (and exceed) his narcissism.
To diagnose antisocial personality disorder
the DSM-5 requires that three or more of the following behaviors must be present:
(Use the checkbox squares to tally your assessment of Trump.)
For pointers to the full DSM-5 criteria of all personality disorders, see →
It is relevant to Mr. Trump's recent history, and typical of personality disorders,
that a challenging environment will accentuate the disorder's symptoms, in
particular, delusional thinking. Psychiatrists define a delusion as "a fixed
idea at variance with reality, unamenable to change, with the exception of religion."
Mr. Trump's supremely challenging 2020 --
impeachment, epidemic, economic collapse, riots, defeat in the election, defeats
in the courts -- likely hardened his self-interested deluded beliefs, so much so
that he became mentally incapable of taking any
action contravening them. This equates to a gross impairment of judgment,
which was nowhere more apparent than in his videotaped message during the
heinous riot at the Capitol on Jan. 6, 2021, in which he expressed
sympathy and support for the rioters seeking to keep him in office.
President Woodrow Wilson
suffered a stroke in 1919
that left him partially paralyzed and mentally damaged.
Mr. Trump is no less paralyzed than Wilson, but instead of being medically
unable to move a limb, he is medically unable to move his mind to the common
good, or, indeed, to move it to any good other than his own.
No pill can cure this paralysis.
The framers of the
may not have had in mind a psychiatric illness specifically like Mr. Trump's,
but they certainly had in mind debilitating neuro-psychiatric disease -- which
his became. Thus, the Vice President and the Cabinet had a Constitutional duty
to remove Mr. Trump from office. They also had a moral duty to make sure
this unfortunate man gained access to medical treatment.
Personality disorders disqualify a person for service in the US Air Force