This is my first post on Daily Kos. I am a practicing physician. I am not a psychiatrist, but like all physicians, I have received some basic training in the field and have read the DSM-IV and, more recently, the DSM-V. I have always felt that Trump had a personality disorder. Recently, I have heard more and more talk about Trump’s mental health and this time it is not in a joking manner. Lawrence O’Donnell raised the issue on his show. Dr. Drew Pinsky spoke about this on CNN.
From Rawstory:
The physician and media personality appeared Monday night on CNN, where he told Don Lemon that Trump does not fit the stringent legal definition for insanity — but he does show signs of multiple mental illnesses.
“There’s two definitions of sanity, one is legal definition, and that is somebody who is so out of it they don’t know the difference between right and wrong,” Pinsky told CNN’s Don Lemon. “That is a very high standard for insanity, (and) very few people meet that standard. When you’re legally insane, you’re really not functioning. Clinically, medically, usually when we talk about insanity, we mean psychotic, hearing voices, hallucinations.”
He told Lemon that Trump did not fit either the legal or clinical definition of insane, and then he discussed the candidate’s apparent narcissism.
“People want to label him with a narcissistic personality disorder, and that is a pretty tough, tough thing to do at a distance,” Pinsky said.
While I agree that Trump may not fit the definition of “insane” and that one cannot “diagnose” a person at a distance, I would submit that one can read the DSM-V criteria and observe a person’s behavior, and logically get a pretty good idea of the probability of a person having narcissistic personality disorder. It is one of the disorders where the symptoms tend to often play out in the public. I am very surprised that reporters and news outlets have not brought out the DSM-V and looked at the criteria. I submit for all of you the following from the DSM-V:
Criteria for Narcissistic Personality Disorder
A. A pervasive pattern of grandiosity (in fantasy or behavior), need for admiration, and lack of empathy, beginning in early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:
1. Has a grandiose sense of self-importance (e.g. exaggerates achievements and talents, expects to be recognized as superior without commensurate achievements)
2. Is preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love
3. Believes that he or she is “special” and unique and can only be understood by, or should associate with, other special or high-status people (or institutions)
4. Requires excessive admiration
5. Has a sense of entitlement i.e. unreasonable expectations of especially favorable treatment or automatic compliance with his or her expectations
6. Is interpersonally exploitative i.e. takes advantage of others to achieve his or her own ends
7. Lacks empathy; is unwilling to recognize or identify with the feelings and needs of others
8. Is often envious of others or believes that others are envious of him or her
9. Shows arrogant, haughty behaviors or attitudes
The essential features of a personality disorder are impairments in personality (self and interpersonal) functioning and the presence of pathological personality traits. To diagnosed narcissistic personality disorder, the following criteria must be met:
A. Significant impairments in personality functioning manifest by
1. Impairments in self functioning (a or b)
a. Identity: Excessive reference to others for self-definition and self-esteem regulation; exaggerated self-appraisal may be inflated or deflated, or vacillate between two extremes; emotional regulation mirrors fluctuations in self-esteem
b. Self-direction: Goal setting is based on gaining approval from others; personal standards are unreasonably high in order to see oneself as exceptional or too low based on a sense of entitlement, often unaware of own motivations
AND
2. Impairments in interpersonal functioning (a or b)
a. Empathy: Impaired ability to recognize or identify with the feelings and needs of others; excessively attuned to reactions of others, but only if perceived as relevant to self; over or under estimation of own effect on others
b. Intimacy: Relationships largely superficial and exist to serve self-esteem regulation; mutuality constrained by little genuine interest in others’ experiences and predominance of a need for personal gain
B. Pathological personality traits in the following domain:
1. Antagonism, characterized by:
a. Grandiosity: Feelings of entitlement, either overt or covert; self-centeredness; firmly holding belief that one is better than the others; condescending toward others
b. Attention seeking: Excessive attempts to attract and be the focus of the attention of others; admiration seeking
C. The impairments in personality functioning and the individual’s personality trait expression are relatively stable across time and consistent across situations
D. The impairments in personality functioning and the individual’s personality trait expression are not better understood as normative for the individual’s developmental stage or sociocultural environment
D. The impairments in personality functioning and the individual’s personality trait expression are not solely due to the direct psychological effects of a substance abuse (e.g. a drug of abuse, medication) or a general medical condition (e.g. severe head trauma)
I think if one looks at Trump’s public behavior and written evidence of his private behavior, you will see that it is more than likely that he would meet criteria for a diagnosis of narcissistic personality disorder. I submit a few examples just of how he meets criteria of section A:
1. Has a grandiose sense of self-importance- Stating he is “the only one” who can solve the country’s problems.
2. Is preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love- Exaggeration of his business success, monetary self worth, how much women love him and want to sleep with him.
3. Believes that he or she is “special” and unique and can only be understood by, or should associate with, other special or high-status people (or institutions)- Surrounding himself with a limited number of people who are in lock step agreement with him.
4. Requires excessive admiration- His need to be constantly in the public, over reaction to negative comments.
5. Has a sense of entitlement i.e. unreasonable expectations of especially favorable treatment or automatic compliance with his or her expectations- Demanding that debates be modeled in accordance to his specific demands is one of many examples.
6. Is interpersonally exploitative i.e. takes advantage of others to achieve his or her own ends- No paying contractors, failing to produce for Trump U students, and many other examples.
7. Lacks empathy; is unwilling to recognize or identify with the feelings and needs of others- The Khans are a prime example. Another is when the veteran gave him his Purple Heart. He didn’t mention how honored he was that than man gave it to him. He just said he had always wanted one and this was an easy way to get it.
8. Is often envious of others or believes that others are envious of him or her- He said the other Republican candidates were jealous of him and detractors are jealous of Putin’s praise of him. These are just a couple examples.
9. Shows arrogant, haughty behaviors or attitudes- There are a number of examples of this in his public behavior. You just need to watch one of his rallies.
It is true that many people have tendencies toward self-importance. As Dr. Pinsky also pointed out, sometimes these traits are beneficial in certain professions, like a fighter pilot or a surgeon (sorry couldn’t help throwing that in!). However, narcissistic personality disorder is more than traits. It causes serous impairments in a person’s life and interactions with others.
If one looks at Trump with this suspected diagnosis in mind, it will allow for better understanding of him as an individual, a candidate, and a potential (shudder!) president. Despite hopes of those in his party, he is not going to drop out voluntarily. And the intervention that other Republicans are attempting is very unlikely to be productive. He would not govern to the benefit of the people of the United States of America. Everything he would do in office would be to benefit himself. It is a part of the disorder. He is not going to change.