Delving Further Into Trump’s Damaged Psyche: Defiance Disorder Is The New Buzz

-by Helen Klein

Trump’s mental health should continue to be front and center of our country’s concerns. Even perhaps above his obstruction, collusion with the Russians and money laundering. Unfortunately, it is not. It is not being taken seriously enough, not by a long shot, and the consequences may be devastating for us and for the entire planet.

In an interview for Salon in November, John Gartner, psychologist at Johns Hopkins, states, "This is the greatest psychiatric emergency in the history of the United States and maybe in the history of the world."

Donald Trump is going to be like Bonnie and Clyde; he’s going to shoot his way out. The best way for him to shoot his way out is to start a war and distract from his misdeeds, rally the country behind him and-- most importantly from a psychological perspective-- to transform the feeling of being a weak victim of a massive criminal investigation into that of an omnipotent destructive and powerful leader by destroying and killing millions of people.

The nature of malignant narcissism makes it impossible for someone to be a constructive leader.

I think Donald Trump is in a state of constant rage and agitation. We are hearing from sources inside the White House that he has dark moods, is yelling at people, screaming at CNN at 3 in the morning. This is terrifying, because you are right: Someone who’s in a state of agitation and anger is more likely to act out in a destructive and impulsive way. We have all the warning signs that this guy is ready to blow.

Much has been written about Trump’s psychiatric issues, including pieces by this writer in DWT. Dr. Bandy X. Lee, forensic psychiatrist at the Yale School of Medicine, has taken the lead in expressing alarm about Trump’s psyche, stating that he was "going to unravel, and we are seeing the signs." Lee is the editor of a book, The Dangerous Case of Donald Trump, which includes testimonials of 27 psychiatrists and mental health professionals, including Dr. Gartner. In December, she actually gave a two-day workshop for members of Congress (more than a dozen Democrats attended but only one Republican). Diagnoses for Trump have been tossed around like confetti at a Yankee parade on Fifth Avenue.

Just two weeks ago, related to his physical exam, Trump’s mental and cognitive functioning surfaced once again as a hot topic. However, due to the rapid Trump media churn, this is now in the rear view mirror for the time being. Yet the caution, "objects are closer than they appear," is apt. Apprehension about his fitness hovers in the background and can careen into view at any moment. Concerns ebb and flow in the media, depending on Trump’s faux pas du jour and the latest bombshells and distractions that keep on coming. The surges, unfortunately, have not reached a tsunami, yet.

There was much brouhaha about Michael Wolff’s book, Fire and Fury in the White House, the smash best seller about the chaos in the White House. Was it only a few weeks ago? It seems like a year in Trump time. Basically, the White House, the center of the executive branch of our government, is a big hot mess. One of the main take-aways from Wolff’s up front and personal experiences in the White House is his emphasis that 100% of the people around Trump question his fitness for office and his ability to do the job. Even family members, says Wolff. Like every other wave in the Trump ocean, the wave of this book has beached and new ones are materializing.

One of the waves now rolling into shore is the new book by Howard Kurtz, Media Madness: Donald Trump, The Press, And The War Over The Truth, to be released January 29th. According to excerpts from the Washington Post, aides have coined the term Defiance Disorder to describe Trump’s intransigence. "The phrase refers to Trump’s seeming compulsion to do whatever his advisors are most strongly urging against, leaving his team to handle the fallout."

Wow! Very interesting…another angle to explore in the fractured psyche of Trump. Yes, just when we thought we had most of the pieces of the jigsaw puzzle of Trump’s mental/cognitive malfunctions (Dr. Ronny Jackson, aside), another piece comes into play!

At this juncture, it would be important to reiterate that it does not take a mental health professional to see that Trump is clearly unfit for office. Any citizen with common sense and decent judgment who has been in touch with a schmear of "real" news, listened to a sprinkling of his statements, read a handful of his endless tweets and observed a modicum of his manner and behavior should be able to see this clear as day. A diagnosis is not required. In fact, it is detrimental and even dangerous to assume that this is even necessary, since this would give Congress, the Cabinet and the American people the impression that they cannot or should not act without it. This is false. Action is needed, now!

That said, it is interesting and informative to continue delving into Trump’s psyche from the perspective of formal psychiatry. Why not? It is a brief distraction from the seriousness of the nightmare we are living in with Herr Trumpf at the helm. Although official diagnoses are unnecessary to comprehend Trump’s disastrous personality make-up and its dangers to our country, perusing them provides further insight into what is going on here.

The Diagnostic and Statistical Manual of Mental Disorders—Fifth Edition, is the bible for psychiatrists. Various formal diagnoses for Trump that have already received considerable attention are Narcissistic Personality Disorder, Attention Deficit Hyperactivity Disorder and Antisocial Personality Disorder. When one reads the specifics of the attributes required for each diagnosis, "bingo" comes to mind. Trump clearly shows many of the characteristics of them all.

None of these, however, fully explain the wrecking ball that Trump has taken to virtually every institution in our government or his constant tangling with the people around him. While Narcissistic Personality Disorder reflects his superior view of himself, his belief that he knows better than everyone and his reliance on his own opinion bar none, what else is there in his psyche that would explain his contrariness? Trump tends to do the opposite of what his advisors recommend. He loves sticking it to everyone, including the entire country. Numerous examples have been evident in the media. Why just this week in an interview with Fox News, John Kelly, Trump’s chief of staff, said that the president’s views on immigration and his proposed border wall were not "fully informed" during the 2016 campaign and have since "evolved." Trump had "changed his attitude" toward his long promised wall after being told by experts that there were placed along the US-Mexico border where "a wall would not be realistic." Well, Trump went ballistic. He hated Kelly’s comments and “fumed” about them all night. Early Thursday, he tweeted, "The Wall is the Wall, it has never changed or evolved from the first day I conceived it." Trump does not care whatsoever what experts say. He went on to tweet that Mexico would pay for the wall, directly or indirectly.

By coining the term, Defiance Disorder, White House staff has zeroed in on the obvious: his defiance of rules, ethics, values, and advice. Yes, just when we thought we had a handle on Trump’s mental/cognitive malfunctions (Dr. Ronny Jackson, aside), there is another aspect to highlight and delve into!

Like Malignant Narcissism, a term that appears to fit Trump like a glove, Defiance Disorder is not an official DSM-5 category. Yet it is closely associated with an official one, Oppositional Defiant Disorder. Interestingly, this diagnosis is most often used with children who have substantial behavior problems, although it can also be applied to adults. What better fit for Trump? Wolff notes of White House staff, "I will tell you the one description that everyone gave-- everyone has in common-- they all say he is like a child." Senator Corker’s comment is consistent: "It’s a shame the White House has become an adult day care center."

Here are the features of Oppositional Defiant Disorder from the DSM-5:

A. A pattern of angry/irritable mood, argumentative/defiant behavior, or vindictiveness lasting at least 6 months as evidenced by at least four symptoms from any of the following categories, and exhibited during interaction with at least one individual who is not a sibling.

Angry/Irritable Mood

1- Often loses temper.
2- Is often touchy or easily annoyed.
3- Is often angry and resentful.

Argumentative/Defiant Behavior

4- Often argues with authority figures or, for children and adolescents, with adults.
5- Often actively defies or refuses to comply with requests from authority figures or with rules.
6- Often deliberately annoys others.
7- Often blames others for his or her mistakes or misbehavior.

Vindictiveness

8- Has been spiteful or vindictive at least twice within the past 6 months.

B. The disturbance in behavior is associated with distress in the individual or others in his or her immediate social context (e.g., family, peer group, work colleagues), or it impacts negatively on social, educational, occupational, or other important areas of functioning.

C. The behaviors do not occur exclusively during the course of a psychotic, substance use, depressive, or bipolar disorder. Also, the criteria are not met for disruptive mood dysregulation disorder.

Specify current severity:

Mild: Symptoms are confined to only one setting (e.g., at home, at school, at work, with peers). Moderate: Some symptoms are present in at least two settings.

Severe: Some symptoms are present in three or more settings.

Trump seems to have many if not all of these features. Another slam dunk? Furthermore, the scale of severity appears "severe," as features that have been alluded to in three or more settings: with his spouse and children, with his "friends" (whom he would betray at the drop of a hat) and definitely at work. As far as the school setting, as Bannon was quoted in Wolff’s book, "He's just a guy who really hated school, and he's not going to start liking it now." Trump has made it clear that he does not believe he has anything to learn, so in a sense the learning environment seems to be another setting for defiance, albeit passively. At Wharton, as per other students, Trump flaunted being unprepared for class. Other presidents, after all, were motivated to learn, studied up on issues and sought input and analyses from knowledgeable individuals (George W. Bush notwithstanding). Trump is quick to defy input from anyone within his sphere. Only Putin and other autocrats are worth listening and “sucking up to;” he “shits down” on virtually everyone else. Is there anyone in government whom he listens to or takes advice from? No one comes to mind.

This is scary. We have a President who delights at flipping the bird to authority and doing the opposite of what he has been advised. This is what Trump does. This is who he is. No one can control him. Has he been "spiteful and vindictive within the past 6 months?" Hell yes! Now that he is more and more cornered by his lies, obstruction and blatant history of offenses, he is saying FU to the FBI and the Justice Department. Is this oppositional and defiant? Yes!

There is considerable data indicating that Trump is a basket full of diagnoses, a hot cauldron of psychiatric disturbance bubbling and swirling around. No one can say we have not been warned.

To sum it all up, we have a President who is a supreme narcissist, has attention deficits, is highly impulsive, has antisocial tendencies, delights in defying authority and flaunts rules. Trump has enjoyed being oppositional and defiant his whole life. It has worked for him. He gets a kick out of destruction. As said earlier, you don’t need a psychiatrist to see that this is a nightmare scenario for the leader of the free world who has his finger near the nuclear button. While his first year in office was a disaster in the making, the second year bodes poorly and the monstrous effects of his fractured psyche will likely be of extraordinary proportions. The Dreamers, for one, are now feeling the consequences of his destructive nature. This is the tip of the iceberg of what is to come. Trump is Putin’s dream-- the destruction of America.

Will Mueller, the FBI and the Democrats bring Trump and his crew down or will Trump and his crew bring the country and possibly the world down? Your guess is as good as mine.