Health and Medical History of President

Donald Trump

As a handy reference, various laboratory test results, spanning years, have been charted MORE and consolidated links to his physician notes are available.

Refer to the book by Trump's psychologist niece, Mary L. Trump, for a solid argument that much of Trump's behavior can be explained by the abnormal personalities and dynamics in his family 2. Details of the Trump family's medical history are compiled here → MORE.

• Trump's father died with Alzheimer disease at age 93. His mental status was in decline for at least seven years before then. Mary Trump describes him as "a high-functioning sociopath" 2a.
• Tump's mother died at age 88, having endured a lifetime of medical challenges, including major gynecological hemorrhage, early surgical menopause with consequent severe osteoporosis, and life threatening trauma during a physical assault. She also had marked insomnia.
• Trump's older brother, Fred, died at age 42 from complications of alcohol abuse -- the specific cause is not clear.
• Trump's younger brother by two years, Robert, died in summer 2020 of undisclosed causes.
• Trump has children by at least three different women.
• Trump's son Barron, born in 2006, contracted covid-19 in 2020. His tall stature is obvious.

Appendectomy at age 10 3 or age 11 4. Per Trump in 2016: "I had my appendix out when I was 11, and that was the last time I was in a hospital. That was a one-night deal." 5 (His streak ended in 2020 when covid-19 forced him into the hospital.)

Talking to a TV-doctor in September 2016, Trump said 5:

Sometimes in the spring or in the fall, I'll get a little hay fever. And that comes and goes. Actually I don't know why this would be. It used to be worse when I was young. Maybe it's given up on me. ... But when I was young, it could be pretty rough, the hay fever. But very, very little now.

At the height of the Viet Nam war in 1968, 22-year-old Trump was found medically unfit to be drafted, because of one or more heel spurs. In reality, the heel spurs did not exist. They were fraudlently concocted to evade the draft. Under oath, his personal attorney testified to the ruse in 2019, confirming the previous year's revelations from the daughter of the podiatrist who signed the papers. MORE

A complete chronology of Trump's draft status is available. MORE

A section on Trump's draft card entitled "obvious physical characteristics" notes a "birthmark on both heels" 6. MORE

Comment: None of the released medical examinations have mentioned this.

Trump is obese. His 6 feet 2 inches of height and 244+ pounds of weight, give him a body mass index (BMI) of 31.3, well above the threshold value, 30.0 kg/m², that defines obesity. Trump and his physicians have demeaned themselves with a meager fiction that he is an inch taller. MORE    A tabulation of his hights and weights is available. MORE

Trump has abstained from smoking and drinking throughout his life 3 -- perhaps because of his brother's fate. He also "never had a joint, never had any drugs, never even had a cup of coffee" 7. Comment: His attitude to coffee is fatuous, given his large intake of coffeinated soda.

During an appearance on Howard Stern's radio program in 1997, Stern asked Trump how he handled the risk of contracting a sexually transmitted disease from the women he was dating 8. In response, Trump described women's vaginas as "potential landmines," saying "there's some real danger there" and added:

It's amazing, I can't even believe it. I've been so lucky in terms of that whole world, it is a dangerous world out there. It's like Vietnam, sort of. It is my personal Vietnam. I feel like a great and very brave soldier.

Trump has deeply internalized this point of view. Four years earlier (1993, when age 36 or 37) he had told Stern 8:

You know, if you're young, and in this era, and if you have any guilt about not having gone to Vietnam, we have our own Vietnam -- it's called the dating game ... Dating is like being in Vietnam. You're the equivalent of a soldier going over to Vietnam.

Comment: Juvenile.

Measurements of Trump's hands shows they are small, not only for his height, but for the male population in general. For example, although Trump is taller than 95% of firefighters, 92% of firefighters have larger hands than he does. MORE

The smallness of his hands clearly nettles Trump. It began with a magazine article calling him a "short-fingered vulgarian" in the 1980s -- to which Trump wrote rebuttals for more than 25 years 9. His sensitivity extended into the 2016 presidential campaign, during which Trump felt it necessary to characterize the size of his genitals after an opponent mocked his small hands. He was still sensitive even into 2019. MORE

Trump's skin often has an orange hue. For example, the FBI director noted on Jan. 6, 2017 that "His face appeared slightly orange, with bright white half-moons under his eyes where I assumed he placed small tanning goggles" 10a. Trump himself has complained of looking orange, blaming it on light bulbs though this is incorrect (the bulbs do not make his white teeth look orange) 11. Reports state he has also complained of looking too yellow on television 11. Preposterously, administration officials have ascribed Trump's orangeness to "good genes" 11.

Trump is known to use "bronzer" -- "a powder or cream designed to give a tanned look" -- sometimes in a thick layer. A line of oxidized bronzer has been seen around his hairline. Trump prefers to apply his make-up himself, in private, but the line is evidence of poor technique. 11

Whether Trump undergoes artificial tanning is unknown. Some accounts say yes, but sources say the White House has no tanning booth nor tanning bed. However, some Trump-owned properties offer spray-on tans. 11

Photographers have noticed that the white balance in Trump's 2017 official photograph is "too cold" but cannot be corrected without making him look orange-ish 12.

Not disclosed before the 2016 election, this usually-minor skin condition was disclosed in a post-inaugural interview with Trump's physician, Dr. Bornstein 13.

Before 2017 Trump was on a long-acting tetracycline for the condition 13, e.g. doxycycline or minocycline. By February 2018 he was on ivermectin cream 14. No reason for the change has been disclosed. Comment: Two possible reasons for the switch would be: (a) a desire to limit the number of systemic medications any president takes, and/or (b) tetracyclines (not so much minocycline) cause sensitivity to the sun in some people, which would be a factor if Trump does do artificial tanning.

Trump harbors many fears about his personal safety.

• Germs -- Trump has called himself a "germaphobe," as discussed below. Even before the covid-19 pandemic this fear affected his routine behavior. Whether his germaphobia contributed to his catastrophic bungling of a real-world germ crisis -- the covid-19 pandemic -- is a worthy topic of discussion
• Poisoning -- It has been widely reported that Trump is afraid of being poisoned, and that this is one of the reasons he likes to get food from McDonald's, where he can be reasonably sure no one in the kitchen is plotting to do him in 15. Comment: This may be a perfectly valid fear for a highly unpopular person, but if it is the main reason he consumes a high fat diet, then he is merely trading the possibility of acute poisoning for the certain slow poisoning of his arteries.
• Toothbrush tampering -- Moving into the White House "he imposed a set of new rules: Nobody touch anything, especially not his toothbrush" 15. (Unclear if this is a true fear, perhaps related to poisoning, or just a pet peeve.)
• Senility -- "Trump, a man whose many neuroses included a horror of senility" 15. This unsourced report is plausible given the Alzheimer disease Trump would have witnessed in his father.
• Substances [?] -- Trump speaks with a mixture of pride and vehemence about his avoidance of substances, including coffee. (And yet his daily caffeine intake is substantial.) Nevertheless, as a wealthy young man in New York City during the cocaine-fueled 1980s, his avoidance remains notable. Certainly, watching the decline of his older brother has formed his attitudes, which may border on fear.
• Sexually transmitted disease -- Trump has likened the risks of sexually transmitted disease to the risks of combat, as noted elsewhere. The frequency with which he refers to this suggests it is an idée fixe for him. Yet, it appears not to affect his personal decisions about safer sex.
• Sharks -- He is reported as being obsessed and terrified of sharks, and of saying: "I donate to all these charities and I would never donate to any charity that helps sharks. I hope all the sharks die." 16 (Comment: It's hard to know how much truth is in that quote.)
• Military service -- Trump's fear of military service during the Viet Nam war led him to take cowardly and illegal steps.

Perhaps related, Trump also finds "health care and medical treatments of all kinds a distasteful subject" 17 -- a prejudice with potentially major ramifications, i.e. the covid-19 failure and his administration's failure to produce a healthcare plan. A disinclination toward healthcare matters could also explain his otherwise "unfathomable" confusion between HIV and HPV 18.

Despite Trump's claimed freedom from colds, it "appeared that he was under the weather" during the first televised 2016 presidential campaign debate (September 26, 2016). "Weary-eyed and gulping water, he looked as though he might fall asleep were it not for the lectern's support." 19

"Exhaustion" is the opposite of stamina. It can be physical or mental. Trump's mental stamina is compromised by his sleep habits and, most probably, by his sleep physiology, as discussed in a separate entry.

Trump and his team have exaggerated his physical stamina MORE, not acknowledging the multiple occasions on which he had exceeded his energy reserves, most notably his May 2017 trip to Europe MORE.

Several anomalies afflict Trump's hair: its sparsity, its color, its styling, and an unexplainable acceptance of these facts by its owner. These are discussed on a separate page. MORE

Trump's first wife, Ivana, testified in a sworn deposition that Trump had scalp reduction surgery 20.

During his 2016 campaign and during his presidency, Tump had a peculiar and unhealthy dietary focus on fast food, snacks, and Diet Coke. MORE

His 2016 campaign manager wrote that the "orchestrating and timing of Mr. Trump's meals was as important as any other aspect of his march to the presidency," requiring great attention from top aides to ensure the delivery of hot fast food after rallies 21.

In the White House, Trump consumed approximately a dozen Diet Cokes per day 22. Pressing a button on his Oval Office desk would summon a White House butler to bring him one 23. In speculating on possible reasons for Trump's Coke gluttony MORE, Dr. Zebra bets on either (a)  he needs the caffeine to counteract pathological somnolence, or (b) given his fear of being poisoned, he finds security in drinking from an unopened can.

President Trump, like every human past middle age, has presbyopia -- difficulty focusing visually on a nearby objects, as when reading. While George Washington's presbyopia arguably prevented a mililtary coup in 1783, Donald Trump's was a fiasco that not only threatened national security but also epitomized the unsophisticated recklessness of a "norm-breaking" approach to the presidency. MORE

As of January 2018, "The President has no partial or any dentures of any kind" 24. This became a question because Trump occasionally slurs words, with some commentators opining that dentures could be a cause.

However, there is no question that Trump has other artificial oral structures. MORE

For physical exams while he was a private citizen, Trump said, "Well, I try and do it every year" 5. His long-time personal physician has written: "He has had an annual physical exam in the spring of every year" 4.

As a candidate, Trump issued three statements about his medical health:

• 2015: (December)   MORE 3 (Physician statement #1)
• 2016: (September)  MORE 4 (Physician statement #2)
• 2016: (September)  MORE 5 (Interviews: Dr. Oz, Fox)

Since taking office, Trump has had more-or-less yearly physical examinations at Walter Reed National Military Medical Center:

• 2017: (January)  Takes office.
• 2018: (January)  MORE 14 Press briefing: MORE 24
• 2019: (February) MORE 25
• 2019: (November) MORE 26 sham exam part 1
• 2020: (June)     MORE 27 sham exam part 2

The main medical results from these evaluations are tabulated elsewhere MORE, and are discussed in various pages.

Comment: Incredibly, these physical examinations, which one would expect to be routine, staid affairs, took on circus-like characteristics:

• The 2015 report had ridiculous, unprofessional hyperbole that made Trump's physician a national laughingstock. It later emerged that Trump wrote this report himself.
• The 2018 report was delivered during a press conference in which the President's physician made good-humored and properly caveated remarks that commentators unfairly inflated to ridiculousness.
• The first 2019 report, though more subdued (and, sadly, far less complete), still contained unsupportable prognostications from the new presidential physician.
• The second 2019 report, for Trump's "interim checkup" if that's what it really was, is a shambles. Subtexts of the nonsensical statements from the White House and the President's physician strongly suggest it was not a routine examination at all, but a hurried, abrupt consultation at Walter Reed for undisclosed medical reasons.
• The 2020 report was no report at all, except for confirming with painful clarity the degree to which this White House physician is a patsy of his President. Worse, with a presidential election occurring less than five months later, the results of this physical examination will be the only recent medical data available to the electorate when they vote.

Hence, four times in three years confidence in the office of the President's physician was undermined -- a low ebb in its history. Even if one credulously believes that the President's medical team has been completely and honestly forthcoming, all this sturm und drang is itself dangerous, as it can easily detract from substantive medical issues -- as it already seems to have done with Trump's sleep.

Trump has calcium deposits in his coronary arteries. They are extensive enough to exceed a common threshold for the diagnosis of coronary artery disease 28 MORE. The calcium was detected on CT scans over a number of years, with the amount of calcium increasing each time. (Results tabulated here: MORE) Trump's risk of arterial disease progression seems to be driven mainly by his age, cholesterol, and obesity MORE.

Trump's secretiveness around his health makes it impossible to say whether he has had direct complications of the disease in his coronary (and other) arteries. Indirect complications may have attended his covid-19 illness.

The issue first attained prominence in March 2016, when Trump enlightened a national television audience that was not expecting to hear about this topic MORE. After his election, Stormy Daniels, a sex worker who claims to have had one episode of unprotected vaginal intercourse with Trump in 2006 16, publicly described the size and shape of his penis 29 30. Her claim is, of course, disputed. However, sworn testimony 31 and evidence collected by the FBI 32 lend it support. Dr. Zebra has not seen challenges to her detailed description of Trump's anatomy (as the description of William Clinton's anatomy was challenged), but freely admits tempering his sleuthish nature in the case of this particular topic, and also in the matter of his admitted dislike for anal sex 33.

Comment: Unprotected intercourse outside of a monogamous relationship is not evidence of good judgment. See also 18.

Comment: The House of Representatives impeached Trump on December 18, 2019, thereby solidifying "Dr. Zebra's Law" which states: "Any president whose genital morphology becomes a topic of public discussion will be impeached." See the page for William Clinton.

Because deranged sleep can contribute to any psychiatric illness, the quantity and quality of Trump's sleep should have occupied a central role in his medical care. This seems not to have been the case.

As described and discussed in detail MORE, he experienced overt daytime somnolence while in office that included sleeping during a G7 meeting in 2018 34. This is not surprising, given the numerous factors that threatened his sleep health:

1. his high risk of having obstructive sleep apnea (stemming from central obesity and a thick neck);
2. his inadequate time in bed;
3. his high level of caffeine intake; and
4. his physician's ignorance or disregard of basic sleep medicine.

Dr. Ronny Jackson saw the president most days, "certainly several times a week," usually for a 30-second check-in, perhaps for something like a nasal spray. Jackson several times called on John Kelly (chief of staff) to lobby for easing up Trump's work schedule at times when Trump seemed under stress. Kelly would try to accommodate by increasing the amount of "executive time" on the calendar, e.g. by 2 hours a day 10b.

Frequent contact between doctor and patient has also been described by members of the White House Medical Unit 24.

Trump has called himself a "germaphobe" 35 36, stating: "I happen to be a clean-hands freak. I feel much better after I thoroughly wash my hands, which I do as much as possible" 37. This is not something new.

During a radio interview in 1993 38 Trump admitted "It could be a psychological problem" and host Howard Stern diagnosed: "He's very wealthy and yet he's a prisoner of obsessive-compulsive disorder."

[Trump] also said he liked to drink through a straw rather than straight out of a glass. "I'd prefer drinking through a straw if I'm going to a restroom," he said. Stern asked: "Because you are afraid that the glasses can be contaminated?" "They certainly can be," Trump replied. ...

"I like it. I like cleanliness. Cleanliness is a nice thing. Not only hands, body, everything," Trump added, telling Stern he had never sought professional help for his compulsive behavior.

A magazine interview in 2011 reported:

He's got a big thing about germs, so he's a frequent hand-washer and goes everywhere with packets of hand sanitizer stuffed into his suit jacket. He pulls one out now, dangling it in the air. It's a Super Sani-Cloth Germicidal Disposable Wipe ("The two-minute germicidal wipe") -- which isn't exactly the kind of market-share leader you might expect Trump to favor. He rubs his palms together. "I don't use Purell, Purell is too sticky, but this other stuff is great. I always carry a couple of them." 7

This led him to write of handshaking in one of his books: "It's a medical fact that this is how germs are spread ... I wish we could follow the Japanese custom of bowing instead" 20. At one time Trump called shaking hands "barbaric" and in his 1997 book The Art of the Comeback said that pressing the flesh "is one of the curses of American society" 37.

Medically, handwashing is a good thing. It may explain Trump's observation in 2016 that "People are amazed because I don't get much with the colds. ... I haven't had a cold in a long time. Years." 5 Trump's presidential physician has, however, disclosed that "he suffers from the same viral upper respiratory stuff that you and I do" 14 and has covered for him on the hand-washing habit 24.

Trump has many times chased from his presence aides who seem to have a cold 36.

And then the covid-19 pandemic struck. Comment: One wonders if his irrationally unshakable and counterproductive need to appear "strong" during the pandemic was born from a great and secret fear of the virus, plus a misplaced sense that the rest of the nation was as frightened about it as his germaphobia made him frightened of it.

MSNBC's program Deadline: White House telecast this image on June 5, 2020, at about 1:23 PT. Although reproduced below from an LED display and so not of the highest quality, the photo clearly shows (1) a red line at the tooth-gum border, underlying all four lower incisors and (2) on both his left and right sides, a red mass in the gum between Trump's lower canine tooth and its neighboring incisor.

Without disclosing the identity of the patient, Dr. Zebra showed the image to a dentist, who felt the most likely diagnosis is gingivitis, i.e. inflammation of the gums. If, however, there is also bone loss under the teeth or weakened attachment of the teeth, then the condition would be a more serious condition: periodontitis. The dentist suspected the patient does not floss.

Less likely, the red markings could be blood. But given that gums do not normally bleed, some additional abnormality would have to be present. This could be gingivitis, or a bleeding disorder, or anti-coagulant medication, or some anti-seizure medications. If a deep cleaning of the teeth recently occurred, that would exacerbate any bleeding tendency. The date of the photograph is not known.

Dr. Zebra is not the first to notice Trump's gingivitis 39. Interestingly, gum disease has been cited as a metaphor for Trump's presidential administration 40.

With no prior announcement, Trump was driven to Walter Reed Hospital during the afternoon of Saturday, November 16, 2019, supposedly for a routine "interim" physical examination 41. Despite reassuring statements from the White House press office and, later, from the President's physician that all was well with the President MORE, the undeniably unusual logistics of the event raised medical questions (that have yet to be answered) and prompted much speculation (including from Dr. Zebra MORE).

Eight months later, questions about Tump's health arose after he visited West Point. In response, the White House released a summary of his physical, including a statement that the physical had been completed at the White House. Trump, however, later stated that the November visit to Walter Reed was the conclusion of his physical. 42 Specific refutations of much of the earlier medical speculation were also released 43 44.

On the heels of this, a Pulitzer Prize-winning reporter from the New York Times reported in a book 45a that

In reporting for this book, I learned that in the hours leading up to Trump’s trip to the hospital, word went out in the West Wing for the vice president to be on standby to take over the powers of the presidency temporarily if Trump had to undergo a procedure that would have required him to be anesthetized. Pence never assumed the powers of the presidency, and the reason for Trump's trip to the doctor remains a mystery.

Asked about this, Pence said he didn't recall being told to be on standby 46 -- a rather incredible statement 47.

During the height of the covid-19 pandemic's first American peak, in spring 2020, Trump took a two-week course of hydroxychloroquine (HCQ) and zinc. His personal physician tersely stated: "After numerous discussions he and I had regarding the evidence for and against the use of hydroxychloroquine, we concluded the potential benefit from treatment outweighed the relative risks" MORE. Medical professionals widely criticized the action, owing to the absence of good quality evidence that the benefit of HCQ outweighed its non-zero risks.

Comment: The decision of Trump and his physician smells of panic. Apparently they judged the risk of the disease to be so high that they felt justified in exposing Trump to a medication that has well-documented significant side effects and (as known then) had only weakly suggestive benefit against the disease. Furthermore, time has shown that their judgment was wrong: subsequent studies demonstrate that HCQ offers no benefit against covid-19 48 49 50 51 52 53 54. Trump's admitted germaphobia would no doubt have contributed to any panic.

Conspicuously, Dr. Conley's note did not say that he or any other physician prescribed these agents. Comment: This is no defense. Conley could just as easily have written that Trump took the medications against his advice or that he (Conley) had no opinion and left it to Trump's decision. But he didn't. Moreover, if Conley believed at the time that the benefits outweighed the risk for his obese 73-year-old male patient with subclinical coronary artery disease, then why didn't he (and the administration) press for the rest of the obese men age 73+ with coronary disease in the United States to begin taking the medication? Conclusion: the White House physicians were either patsies or unethical or both -- there is no other possibility.

Vice President Pence did not follow suit 55.

Trump's mental status has generated analyses and opinions from co-workers MORE, mental health professionals MORE including his niece (Dr. Mary L. Trump), and Dr. Zebra, who was driven by the events of 2020 to significantly revise his diagnosis MORE. The current assessments (January 2021) from Dr. Trump and Dr. Zebra are below.

Personality Disorders

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 56. 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. 57

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" personality disorders 58. Commonly, patients will have more than one diagnosed disorder from within a cluster.

Assessment of Dr. Mary Trump

Trump's niece, Dr. Mary L. Trump 2b, is a well-trained and experienced Ph.D. psychologist 2c. 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] 2c... [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. 2d

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. 2e

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. 2f

Other:
Dr. Trump entertains the possibility of "a long undiagnosed learning disability that for decades has interfered with his ability to process information" 2f, as well as a co-morbid sleep disorder 2f.

She summarizes:

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. 2e

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 germaphobia, 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.

The Diagnosis

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.)

• Failure to conform to social norms concerning lawful behaviors;
• Deceitfulness, repeated lying, or conning others for pleasure or personal profit;
• Impulsivity or failure to plan;
• Irritability and aggressiveness;
• Reckless disregard for the safety of self or others;
• Consistent irresponsibility, failure to sustain consistent work behavior, or honor monetary obligations; or
• Lack of remorse, being indifferent to or rationalizing having hurt, mistreated, or stolen from another person.

For pointers to the full DSM-5 criteria of all personality disorders, see → MORE.

Delusion or Not

Challenging environments will typically worsen the symptoms of a personality disorder. Because Mr. Trump's 2020 was supremely challenging -- impeachment, epidemic, economic collapse, riots, defeat in the election, defeats in the courts -- it is no surprise that his conduct deteriorated at the beginning of 2021, leading to his second impeachment.

If he has a genuine belief that he won the 2020 election, that is a delusion, defined by psychiatrists as "a fixed idea at variance with reality, unamenable to change, with the exception of religion" MORE. Delusions may occur as a symptom of severe personality disorders.

But if his belief about winning the election is not genuine, and is instead part of a cynical ploy to manipulate the public and retain power, then that, too, is compatible with his antisocial personality disorder -- in fact, it is the essence of his disease.

Trump's diagnosis, therefore, does not depend on whether he believes what he is saying. It depends only on his observable, indisputable actions.

Impact

Persons with antisocial personality disorder are inherently biased to take only those actions in their immediate self-interest. For a leader, this equates to a gross impairment of judgment. In Trump's case, this 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.

Thus, compared to President Woodrow Wilson, who suffered a shattering stroke in 1919 that left him partially paralyzed, Mr. Trump is no less paralyzed. But instead of being medically unable to move a limb, Trump 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 25th Amendment may not have had in mind a psychiatric illness specifically like Mr. Trump's, but they certainly had in mind a debilitating neuro-psychiatric disease -- which his became. Thus, the Vice President and the Cabinet had a Constitutional duty to remove Mr. Trump from office using that Amendment. They also had a moral duty to make sure this unfortunate man gained access to medical treatment.

Comment: Dr. Zebra learned something from the case of Donald Trump. For too long I believed that Trump could not possibly be genuine in his shabby attempts at peddling falsehoods and cons. I thought he was simply wrapping cynical artifice around a hidden core of rationality. But, as the diagnosis illuminates, his perpetual self-serving hucksterism is genuine. His disease has placed it at the core of his being, making it difficult for psychologically normal people to understand him and his actions. So, just as every historian writing about the last 18 months of Wilson's presidency must start with Wilson's stroke, every historian who writes about the Trump presidency must start with Trump's psychiatric illness. Dr. Zebra apologizes to his psychiatrist friends with whom he disagreed for years. You were right.

Personality disorders disqualify a person for service in the US Air Force 59a.

The covid-19 virus infected Trump in late September 2020. He tested positive on October 1, and, after news stories broke 60, announced his infection on October 2 42. Hours later -- after the stock market closed 61 -- national television showed Trump's helicopter evacuation from the White House to Walter Reed Hospital. There he was treated with experimental therapy before being released some days afterwards.

Dr. Zebra will have further details at a later time.