Eventually perhaps the American Psychiatric Association will rewrite theIR Diagnostic and Statistical Manual, now the DMS-5 with a DSM-6 with chapter for Trump due to his unique psychopathology. It includes not just extreme narcissism and sociopathy but also pathological lying, paranoia, impaired reality testing, poor impulse control, frotteurism, sadism, possible delusions, Illeism, and more. In an interview with Chauncey DeVega published in Salon on Feb. 16th psychoanalyist Justin Frank asks whether Donald Trump is a "rageaholic" and anger addict?
Another concept in psychology that has relevance in understanding Trump is the dark triad. I wrote about this in June, 2019, “Therapists warning about Trump’s personality should explain the Dark Triad.”
We can see new wrinkles in manifest in his personality almost every day.
I made this tweet last night in response to his expressing a mix of rage and jealousy because Special Ops K-9 Conan got more attention than “Donald Trump” for killing the Big Bad terrorist.
As a therapist, albeit retired after 40 years of clinical practice, I am still qualified to make a diagnosis. The colloquial word bonkers doesn’t come close to doing justice to his psychopathology, but it is actually even closer than the frequently used description that he’s a malignant narcissist. This is a term which I think Dr. John Gartner first introduced into the public discourse by mental health professionals trying to understand Trump’s personality. He wrote Donald Trump's malignant narcissism is toxic in USA Today on May 4, 2017. 2017! I find his warning prescient. Reading it now it is easy to predict how being acquitted by the Senate has led to his most dangerous psychopathology being unleashed.
However Trump defies the kind of conventional diagnosis most clinicians have been required to make ever since the 1970’s when insurance companies required them for billing purposes.
According to Campbell’s Psychiatric Dictionary, malignant narcissism combines characteristics of:
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With all this I also add in identification with the aggressor (Daddy Fred Trump) as a dynamic of whatever part of his mixed personality disorders weren't genetic, the old nature vs. nurture conundrum. Had he identified with his mother my hunch is that he would have turned out very different. Instead, because of his behavior problems his parents probably did the worst thing possible by sending him to a military school at age 13 where identifying with the most aggressive and authoritarian role models enhanced both his self-esteem and social status.
Lack of bonding with his mother and how this may have effected his personality was the subject of
Donald Trump’s Mommy Issues: He may not have bonded successfully with his mother and that made him the adult—and the politician—that he is in a Politico Magazine article published for Mothers Day in 2018. It is by Peter Lovenheim who isn't a psychologist but researched the subject and who wrote The Attachment Effect: Exploring the Powerful Ways Our Earliest Bond Shapes Our Relationships and Lives.
Trying to shoehorn people into diagnostic categories is fraught with peril whether done after an in-depth face-to-face interview even with administering a battery of psychological tests or from a distance observing someone like Trump who demonstrates who he is in unscripted moments and his tweets as well as his decisions. The research into disorders with psychological and emotional symptoms is moving at a breakneck speed (no pun intended) what with advances in brain imaging and high tech 24 hour electroencephalograms (EEGs) which may lead to an entire reassessment of making a diagnosis while a patient is living. There is even a relatively new profession of neuropathologist who is a pathologist who specializes in the diagnosis of diseases of the brain and nervous system by microscopic examination of the tissue and other means.
There are even methods of treatment that don't involve medication and talk therapy like transcranial magnetic stimulation which is being shown to be effect for chronic depression even though nobody is sure why it works.
People are too complex to use a diagnosis to describe them. I don't know if anybody studied the influence of the MMPI which came out in 1943 on the variant of the ICD–6 that was published in 1952 as the first edition of DSM. For students of the history of diagnosis going from Freud’s errors in describing hysteria to his notion of penis envy to breaking down disorders into mainly into neurotic, psychotic, and character disorders it is a fascinating journey delving into how the DSM evolved from a thin plastic bound book into the giant tome it is today.
The second printing of the first DSM, used, goes for $500 on Ebay (left and middle top)
As for Trump, while the glove of malignant narcissism does fit, it is loose enough to have room for psychopathology that Erich Fromm and Otto Kernberg who delineated the characteristics of this syndrome (not a diagnosis per se) probably never envisioned.
Update: George Conway who knows as much about psychology as most psychologists agrees:
About the poll: Many Daily Kos readers, some of them mental health professionals, already were very knowledgable about psychology before Trump. However, not everyone paid much attention to more complex psychological matters like diagnosis of psychiatric disorders. I’d venture to say lots of Kos readers if they even knew there was a book titled DSM-5 about psychiatry couldn’t say what the initials stood for.
Since Trump came along a side benefit of this has been that many more politically engaged people have had what amounts to a college major in psychology. I wish the same could be said for Republican members of Congress.
