Trump’s Mental Health-- What is Narcissistic Personality Disorder? What is a Sociopath?

-by Helen Klein

Much has been said about Trump’s mental health, particularly of late. Indeed, his continuation of astonishing tweets and comments gives cause for alarm. The bells are ringing loudly! Unlike some earlier assurances that were made, Trump has not become “more presidential” as this election season has unfolded. Frighteningly, he has become increasingly and astoundingly less so. Many, including those who know him well (or at least have spent time with him), are very worried and are saying that he is unfit for the Oval Office.

Some on both the right and left are now focusing on exposing Trump’s main shortcoming-- his mental instability. In Tuesday’s Wall Street Journal, Bret Stephens notes:

(Trump’s) problem isn’t a lack of normal propriety but the absence of basic human dignity. He is morally unfit for any office, high or low…As one wag on Twitter put it, the man always finds a new bottom. Conservative die-hards may try to hold fast to the excuse that Hillary Clinton was, is, and always will be “worse,” but the argument can’t be sustained indefinitely. Mrs. Clinton is not the apotheosis of evil. She may be a corner-cutter and a liar, and she’ll almost surely appoint liberals to the Supreme Court. But at least she’s not a sociopath.

Samantha Bee praised the Democratic convention on her show, Full Frontal: “All it took to get their shit together was the looming threat of Armageddon.”

In his speech at the Democratic convention, Michael Bloomberg called Trump a dangerous demagogue. “Truth be told, the richest thing about Donald Trump is his hypocrisy…Trump is a risky, reckless and radical choice and we can’t afford to make that choice… I’m a New Yorker and New Yorkers know a con when we see one…Let’s elect a sane, competent person…”

On ABC News, Senator Lindsey Graham said, “If you are going to be leader of the free world, you have to be able to accept criticism. Mr. Trump can’t.”

On the front page of today’s New York Times, Obama Says Trump Unfit to Serve as President.

In an extraordinary denunciation of Donald J. Trump’s temperament and competence, President Obama urged leaders of the Republican Party on Tuesday to withdraw their endorsements of Mr. Trump’s candidacy, flatly calling him “unfit to serve” as the nation’s 45th president.” Douglas Brinkley, a presidential historian, called Mr. Obama’s comments “a highly unusual and almost unprecedented moment…It’s a reflection of just how radical and dangerous President Obama feels that Trump is.” Mr. Obama suggested that Mr. Trump wound not abide by “norms and rules and common sense.”

Before delving into the nitty gritty of psychopathology, it is illuminating and fascinating to read the recent article in the New Yorker about Tony Schwartz’s experiences with Trump. Schwartz was the ghostwriter of Trump’s breakthrough memoir, Art of the Deal. He spent a great deal of time with Trump and his insights are highly disturbing. Schwartz said that he should have titled the book The Sociopath. These are some excerpts:

The Art of the Deal made America see Trump as a charmer with an unfailing knack for business. Tony Schwartz helped create that myth-- and regrets it.

“I put lipstick on a pig,” he said. “I feel a deep sense of remorse that I contributed to presenting Trump in a way that brought him wider attention and made him more appealing than he is.” He went on, “I genuinely believe that if Trump wins and gets the nuclear codes there is an excellent possibility it will lead to the end of civilization.”

(As) Trump defied predictions by establishing himself as the front-runner for the Republican nomination, Schwartz’s desire to set the record straight grew…The prospect of Trump terrified him. It wasn’t because of Trump’s ideology-- Schwartz doubted that he had one. The problem was Trump’s personality, which he considered pathologically impulsive and self-centered.

After sitting for only a few minutes in his suit and tie, Trump became impatient and irritable. He looked fidgety, Schwartz recalls, “like a kindergartner who can’t sit still in a classroom.” Even when Schwartz pressed him, Trump seemed to remember almost nothing of his youth, and made it clear that he was bored…Week after week, the pattern repeated itself…Trump’s comments remained oddly truncated and superficial...it (was) impossible to keep him focused on any topic, other than his own self-aggrandizement, for more than a few minutes…

He regards Trump’s inability to concentrate as alarming in a Presidential candidate. “If he had to be briefed on a crisis in the Situation Room, it’s impossible to imagine him paying attention over a long period of time.”

…Schwartz believes that Trump’s short attention span has left him with “a stunning level of superficial knowledge and plain ignorance… I seriously doubt that Trump has ever read a book straight through in his adult life.”

(Schwartz) would propose eavesdropping on Trump’s life by following him around on the job…and by listening to his office phone calls. That way, extracting extended reflections from Trump would not be required… “He was playing people...” He would flatter, bully, and occasionally get mad, but always in a calculated way.

…Schwartz has heard some argue that there must be a more thoughtful and nuanced version of Donald Trump that he is keeping in reserve for after the campaign. There isn’t,” Schwartz insists. “There is no private Trump…” He kept a journal in which he expressed amazement at Trump’s personality, writing that Trump seemed driven entirely by a need for attention…”Lying is second nature to him…More than anyone else I have ever met, Trump has the ability to convince himself that whatever he is saying at any given moment is true, or sort of true, or at least ought to be true...He lied strategically. He had a complete lack of conscience about it”... “Truthful hyperbole” is a contradiction in terms. It’s a way of saying, “It’s a lie, but who cares?”

“Trump stands for many of the things I abhor: his willingness to run over people, the gaudy, tacky, gigantic obsessions, the absolute lack of interest in anything beyond power and money.”

“If Trump is elected President,“ he warned, “the millions of people who voted for him and believe that he represents their interests will learn what anyone who deals closely with him already knows-- that he couldn’t care less about them.”

ASSESSMENT OF TRUMP’S MENTAL HEALTH

With the assistance of a professional psychologist, Keith Olbermann took on an amateur’s analysis of Trump’s mental health. The above video for Vanity Fair, entitled, “Could Donald Trump Pass a Sanity Test?” is quite revealing and even amusing, if only this scenario were actually funny.

Olbermann utilized The Psychopathy Checklist, an assessment tool developed in the 1970’s by Canadian psychologist, Robert D. Hare. It is a 20-point inventory of perceived personality traits used to assess the presence of psychopathy. Each item is scored 0-2, with the highest possible total of 40. A score of 30 or above is considered indicative of pathology. For each item, Olbermann describes examples to justify his scoring. His assessment of Trump yields a score of 32. Yes, according to this scale, Trump reaches the heights of bona fide mental disturbance. Olbermann concludes, “Donald Trump could not pass a sanity test.”

Here are the items and scores:

1. Glibness/superficial charm 2
2. Grandiose sense of self-worth 2
3. Need for stimulation/proneness to boredom 2
4. Pathological lying 2
5. Conning/manipulation 2
6. Lack or remorse or guilt 2
7. Shallow affect 2
8. Callous/lack of empathy 2
9. Parasitic lifestyle (taking credit from others) 2
10. Poor behavior controls 2
11. Promiscuous sexual behavior 2
12. Early behavior problems 2
13. Lack of realistic long term goals 1
14. Impulsivity 2
15. Irresponsibility 1
16. Failure to accept responsibility 2
17. Many short term marital relationships 0
18. Juvenile delinquency 2
19. Revocation of conditional release (from parole) 0
20. Criminal versatility* 0
*Olbermann notes that he was generous to Trump by taking the word “criminal” literally. The psychologist assisting him debated this and would have given Trump a 1 or 2 for this item.

The Real Deal

Now let’s take a look at the Diagnostic and Statistical Manual of Mental Disorders-- Fifth Edition (DSM-5). This is the “bible” used by practicing psychiatrists and psychologists to diagnose individuals.

What is a personality disorder?

A personality disorder is an enduring pattern of inner experience and behavior that deviates markedly from the expectations of the individual’s culture, is pervasive and inflexible, has an onset in early adolescence or early adulthood, is stable over time, and leads to distress and impairment.

The personality disorders (twelve are listed) are grouped into three clusters… Moreover, individuals frequently present with co-occurring personality disorders from different clusters.

First, let’s take a look at Narcissistic Personality Disorder, since narcissism is a trait frequently mentioned in relation to Trump. Here is the description and diagnostic features.

Narcissistic Personality Disorder:

A pervasive pattern of grandiosity (in fantasy or behavior), need for admiration, and lack of empathy, beginning by early adulthood and presented in a variety of contexts, as indicated by five (or more) of the following:

• Has a grandiose sense of self-importance (e.g., exaggerates achievements and talents, expects to be recognized as superior without commensurate achievements).
• Is preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love.
• Believes that he or she is “special” and unique and can only be understood by, or associate with, other special or high-status people (or institutions).
• Requires excessive admiration.
• Has a sense of entitlement (i.e., unreasonable expectations of especially favorable treatment or automatic compliance with his or her expectations).
• Is interpersonally exploitative (i.e., takes advantage of others to achieve his or her own ends).
• Lacks empathy: is unwilling to recognize or identify with the feelings or needs of others.
• Shows arrogant or haughty behaviors.

Impressions anyone? Slam dunk?

Another term that has been thrown about for Trump is sociopath. This term is not a diagnostic category per se in the DSM-V; however, the diagnostic category of Anti-Social Personality Disorder has also been referred to as sociopathy.

Anti-Social Personality Disorder:

The essential feature of Anti-Social Personality Disorder is a pattern of disregard for and violation of the rights of others, occurring since age 15 years, as indicated by three (or more) of the following:

• Failure to conform to social norms with respect to lawful behaviors, as indicated by repeatedly performing acts that are grounds for arrest.
• Deceitfulness, as indicated by repeated lying, use of aliases, or conning others for personal profit or pleasure. • Impulsivity or failure to plan ahead.
• Irritability and aggressiveness, as indicated by repeated physical fights or assaults.
• Reckless disregard for safety of self or others.
• Consistent irresponsibility, as indicated by repeated failure to sustain consistent work behavior or honor financial obligations.
• Lack of remorse, as indicated by being indifferent or rationalizing having hurt, mistreated or stolen from another.

Deceit and manipulation are central features of anti-social personality disorder…The individual…must have a history of some symptoms of conduct disorder…The specific characteristics of conduct disorder fall into one of four categories: aggression to people and animals, destruction of property, deceitfulness or theft, or serious violation of rules.

Impressions anyone? Pretty good?

Attention Deficit Hyperactivity Disorder:

Another diagnostic category is also a possibility: Attention Deficit Hyperactivity Disorder. While the implications of this disorder may not be as serious as the personality disorders, features would surely affect the functioning of a President. There are two aspects: Inattention and Hyperactivity-Impulsivity. The focus below is on Inattention, as this realm may be most relevant regarding Trump, especially in light of Tony Schwartz’s descriptions of him.

Inattention: Six (or more) of the following symptoms have persisted for at least 6 months to a degree that is inconsistent with developmental level and that negatively impacts directly on social and academic/occupational activities:

• Often fails to give close attention to details or makes careless mistakes…
• Often has difficulty sustaining attention to tasks…(e.g., has difficulty remaining focused during lectures, conversations or lengthy reading).
• Often does not seem to listen when spoken to directly (e.g., mind seems else where, even in the absence of obvious distraction).
• Often does not follow through on instructions…(starts tasks but quickly loses focus and is easily sidetracked).
• Often has difficulty organizing tasks or activities…
• Often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort…
• Often loses things necessary for activities.
• Is often easily distracted by extraneous stimuli…
• Is often forgetful in daily activities…

Impressions? A good bet?

In light of all of the above, there are very clearly extremely serious concerns about Trump’s psychological makeup for President. It is critical for all Americans to recognize his tremendous shortcomings and ensure that he does not get into office. The potential damage such an individual could do to the American people, our country and the world is monumental. No Armageddon, please!