It’s widely, if informally, recognized that Donald Trump probably suffers from narcissistic personality disorder. Lately, more people (at least here at DKos, if not elsewhere) have begun to wonder or have openly speculated that Trump instead or also suffers from antisocial personality disorder, or ASPD. ASPD, synonymous with what is colloquially known as psychopathy and sociopathy, is considered the worst of the ten personality disorders listed in the DSM-V.
I recently came across two very absorbing videos about psychopathy and malignant narcissism that I think will give a great introduction to these disorders, including underlying circuitry:
(cue to 13:05) (This video features gross anatomy, which may be off-putting to some viewers. Just a head’s-up.)
PET scans have been vital to mapping out brain regions based on function. At this point, we have a pretty decent understanding, at least generally speaking, about what’s going on and what’s being processed in specific areas of the brain. So when APD patients undergo PET scans and you ask to contemplate moral and ethical questions or dilemmas, something very fascinating is found, and that’s low activity in what’s called the prefrontal cortex, which is this region of the brain right here. {13:34}
So you’re looking at the anterior portion and we’re going toward the posterior side; this is a right hemisphere of the cerebrum. So you see low activity in the prefrontal cortex, and then in the limbic system. We can’t see the limbic system, because it’s embedded inside of this hemisphere, but it contains structures like the amygdala, or the hippocampus.
But when you ask these [psychopathic] patients to say, let’s say, give them a specific scenario. Maybe a child, a young child, tragically loses both parents in a tragic, horrifying car accident, and the child survives. And they are crying and obviously devastated by this, right? 99% of people, you would expect to see areas responsible for morality and empathy to light up. And those areas are going to be here. {14:24}
So if I turn this around, so if you look, you’re going to see this line here? This is dividing what I’m going to surround here. This is called the anterior cingulate cortex, and then this region here is called the ventromedial frontal cortex. Now both of these areas are strongly linked to morality and empathy.
And so when you put them through these types of moral and ethical dilemmas, what you see is that they’re completely underactive, to the point where you can make the argument that they don’t feel anything. Or, if they do, it’s such an extraordinarily small level we don’t know how to properly understand it. And that also means that their moral compass is completely skewed.
(cue to 2:54)
Interviewer (off camera): You mentioned a few minutes ago that the narcissist that, in a relationship, may feel they have nothing to offer, and therefore puff themselves up. Do they actually feel that they have nothing to offer? Or is that just the unconscious feeling that they’re trying to fight with their narcissism?
Frank Yeomans: That’s what I’m always trying to figure out when I’m dealing with someone with this condition. It’s never clear to me, at least at the start with a patient, if their defensive system—their grandiose narrative—truly relieves them of the horror of the internal emptiness, or if it works some of the time.
It’s hard to enter into total contact with the subjective experience of somebody like that. So we can only speculate. Some of the times, the person gives the impression of having a sense of satisfaction, and that may be true. Most often, one suspects that, underneath, they’re plagued by doubt, insecurity, anxiety.
But, the interesting thing is, the more they escape from the anxiety and the sense of inadequacy, the less they’re in touch with reality. Extreme narcissism borders on psychosis. So if the person is able to delude him- or herself adequately, maybe their subjective experience is gratifying to them. But they’re almost or perhaps are in a world of their own.
Elsewhere I speculated that Donald Trump took those ultra-sensitive documents due to psychopathology, specifically that his behavior matched that of a pathological collector. Someone asked in the comments whether that was a fair characterization, and I clarified what I meant by my attempt to classify him as an “avaricious megalomaniac”:
It’s kind of a kleptomania attached to a very specific delusion (or set of delusions). For example, to turn to a pop culture reference, take the Netflix series You. The main character suffers from delusional disorder where he deeply imagines—that is, takes to be true—that a certain woman is in love with him. I don't want to spoil the series for anyone who still wants to watch it, but I won’t be giving too much away to say that you get to see that type of behavior enacted for the audience’s observation, and we’re invited into the scene as spectators positioned to be sympathetic to the main character, who obviously suffers from this delusion.
That's just an example, but in other media you can see the trope: the creep who steals underwear from an unattended dryer in a laundromat; the stereotype of the serial killer who steals a piece of jewelry or such from each victim, etc. It’s a common enough trope.
Dr. Paul Bolin, in a segment on kleptomania, describes a differential diagnosis for, instead, ASPD:
(cue to ~6:55)
So, as you know, kleptomania is about stealing. These patients steal unnecessary objects. Why? Because they’re easy to steal. It’s easy to steal a couple, you know, candies out of the bulk container at the grocery store, or maybe you slip a package of gum into your purse. So they steal unnecessary objects. It’s not like they’re going and stealing money, when they don’t have enough money to feed their kids. That’s not kleptomania. So the object is not the goal. What the goal is here is to steal and to get the rush from stealing. They feel a pleasure out of stealing.
So, there are some psychiatric disorders that look similar to this.
- Antisocial personality disorder. These people might steal, but they don't steal to get the rush. They steal it because they want something and they don’t really give a crap if it belongs to somebody else. They steal it to hurt other people. They might steal something that belongs to somebody else, in order to get back at them. That’s antisocial personality disorder, and they might have other symptoms, too.
- A manic episode. They could also steal, but they’re going to have other symptoms of mania.
I defer to the differential diagnosis: Antisocial personality with kleptomanic features.
Narcissists, when they’re wounded, lash out, and when they do they often do so completely out of proportion to the harm suffered. In effect, the pain is distorted through the narcissistic lens that magnifies the slight to monstrous dimensions. Vindictive behaviors include destroying loved ones as they try to flee abuse. “If I can’t have you, no one can.”
This is Trump, after the election. He knew in his heart he lost. He knew right from the start. But he was perfectly willing to engage in the fantasy where this did not happen, and he is doing all he can after the fact to magically undo the loss of the election. (This is speculation.)
Either way, in the immediate aftermath of his loss, the wound must have been such that he got us back by stealing some of the most precious information America had in her store.
He took the most secret information that could harm not only us but our standing with our allies as well. He took something that, if even the news of it got out (which it has), it had the promise to inflict harm. He needn’t divulge anything to harm us. His action of theft did that all by itself.