Donald Trump and The Definition of Insanity

58,000 mental health professionals say Donald Trump is too unstable to be president. Here’s a deep dive into the diagnosis and what could happen because of it. (tl;dr here)

So why are psychologists breaking with tradition now?

A big problem during the Goldwater scenario was that there weren’t objective criteria for diagnosing mental health conditions at the time. Therapists used all sorts of jargon and their best judgment—but they were all over the place. Since then, however, the community has put in place official, objective standards in their bible, the Diagnostic and Statistical Manual of Mental Disorders (DSM for short). This makes it possible to unanimously agree on diagnoses.

“I genuinely do not think this is a mentally healthy president.” — Eliot Cohen, US State Department under George W. Bush

Decoding Donald Trump’s Mental Condition

“I’ve been a specialist in personality disorders for 35 years,” Gartner says. “Trump is the most severe case I’ve seen in my career.”

The DSM is clear about what constitutes the three personality disorders that add up to Malignant Narcissism. Here they are broken down:

Antisocial Personality Disorder

Diagnostic and Statistical Manual of Mental Disorders, 5th Edition
Donald Trump’s diagnostic scorecard for Antisocial Personality Disorder

Failure to conform to social norms with respect to lawful behaviors

Trump consistently qualifies for this one. Here’s an abridged list:

Deceitfulness: Repeated lying, use of aliases, or conning others for personal profit or pleasure

The list of Trump’s public lies is extensive and well-known. Politifact has tracked his public statements and found that Trump says things that are completely and demonstrably false more than he says things that are true or even half-true.

Impulsivity, or failure to plan ahead

According to Pew, most Americans think Trump is too impulsive. Here are a few recent examples:

Irritability and aggressiveness

Trump’s irritability is well documented. He’s proud of his aggressiveness (he even has a book called Time To Get Tough), which we repeatedly see in his debates, interviews, and tweets that he calls “smackdowns.”

Reckless disregard for safety of self or others

This one there’s not much (clinical) evidence of so far.

Consistent irresponsibility, as indicated by repeated failure to sustain consistent work behavior or honor financial obligations

Trump’s having not honored his financial obligations is well documented. Here’s a recent report on the hundreds of contractors and workers he ripped off as a hotel developer. He’s declared bankruptcy six times and walked away from his debts over and over. The list of his failed business ventures is extensive due to inconsistent management behavior.

Lack of remorse, or being indifferent to or rationalizing having hurt, mistreated, or stolen from another

Trump’s 8 books are full of insults toward everyone from models to celebrities to random private citizens. He relishes tearing people down on Twitter, and refused to apologize for insulting the parents of a dead U.S. soldier, or to the black community for his racist campaign against Barack Obama’s citizenship. In fact, here’s a list that Mashable put together of all the times Trump refused to apologize for things.

Paranoid Personality Disorder

Diagnostic and Statistical Manual of Mental Disorders, 5th Edition
Donald Trump’s diagnostic scorecard for Antisocial Personality Disorder

Suspects that others are exploiting, harming, or deceiving him

During his presidential campaign, Trump repeatedly accused the media of being biased against him. He claimed, with no evidence, that the election was going to be rigged against him.

Preoccupied with doubts about the loyalty of friends or associates

It’s hard to get Trump’s trust, and easy to get him to fire you for perceived disloyalty. He doesn’t trust his staff, except for a few in the inner circle. He doesn’t trust the intelligence agents who work for him. Federal workers don’t trust him to not spy on them. And it didn’t look like he trusted his wife to vote for him:

Reluctant to confide in others

Trump is mostly paranoid of people he sees as outside of his circle of trust. He’s keeping top officials out of his inner circle and elevating a few loyalists to lofty places. But he has a close circle of confidants that he shares information with (Bannon, Conway, Kushner, etc.). So it would be hard to conclude that he qualifies for this one.

Reads hidden demeaning or threatening meanings into benign remarks or events

Trump believes in various conspiracy theories based on vague information from tiny corners of the Internet (falsehoods like Barack Obama’s not being born in the US, Hilary Clinton using performance-enhancing drugs for the debates, Ted Cruz’s father assassinating JFK, etc.), which is the definition of finding hidden meanings in benign events. His favorite writer is conspiracy theorist Alex Jones, who among other things helped get the “9/11 was an inside job” conspiracy theory going.

Persistently bears grudges

Trump readily admits to this one. “When people treat me unfairly, I don’t let them forget it,” he said. Here’s an abridged list of people and organizations Trump has had public grudges with:

  • CNN
  • Congressman John Lewis
  • Judge Gonzalo Curiel
  • The family of Captain Khan
  • Rosie O’Donnell
  • Rev. Faith Green Timmons of the United Methodist Church
  • Nordstrom
  • Alicia Machado

Perceives attacks on his character or reputation and is quick to react angrily or counterattack

See the above list of grudges. Trump is infamous for publicly lashing out at people for slights big and small, from Meryl Streep to random blue collar workers. The New York Times put together this handy list of 307 people, places, and things Trump has insulted.

Has recurrent suspicions, without justification, regarding fidelity of spouse or sexual partner

There’s not enough public information to conclude anything on this one.

Narcissistic Personality Disorder

Donald Trump’s diagnostic scorecard for Narcissistic Personality Disorder

Grandiose sense of self-importance

Exaggerates achievements and talents — check. (Size of election win, size of inauguration crowd, number of jobs saved in Carrier negotiation, and so on.)

Preoccupied with fantasies of unlimited success, power, brilliance; Believes he is “special” and unique

Nobody knows more about taxes than I do, maybe in the history of the world.”

Requires excessive adoration

Trump’s ego-stoking “victory tour,” obsession with ratings before and after entering politics, and fixation on the size of his electoral win, inauguration crowd, and his (false) claim of having received the biggest standing ovation ever easily check this one off.

Has a sense of entitlement

He certainly grew up with a silver spoon, but it’s unclear how entitled he thinks he is, in the clinical definition. So no check for this one.

Interpersonally exploitative

This post on Medium by my colleague Brad Hamilton (editor of The Contently Foundation and former investigations editor at New York Post) recounts how Trump exploited several people, including Brad, in order to get publicity for his golf course one time. This type of behavior, to use a regrettable pun, is par for him. Trump’s own books talk a lot about his strategies for exploiting people.

Lacks empathy

We covered the evidence for this one pretty thoroughly earlier. Trump is not remorseful about his hurting people. He’s dismissive of many people’s pain — even pain he’s caused them — while simultaneously claiming that “no one understands” them better than he does.

Often envious of others or believes that others are envious of him

Trump’s been jealous of his senior adviser being put on the cover of Time Magazine, his running-mate having a great debate performance, and the fact that Jay-Z and Beyonce performed for Clinton instead of him. And he claims that Republicans are “jealous as hell” that Russian president Vladimir Putin likes him.

Arrogant: haughty behaviors or attitudes

We’ve now thoroughly established this one. But here are a few more quotes by Mr. Trump that remove any doubt about his arrogrance:

From Donald Trump’s diagnostic scorecard for Antisocial Personality Disorder


Trump has been a bully since he was a child. We’ve already gone over some of his well-documented history of relishing humiliating people and groups weaker than himself. This is classic sadism.


Many politicians could be categorized as manipulative. Trump is not a typical politician, but he literally wrote books on manipulation. His history and tactics of manipulation — from his followers to opponents to the media — are well-documented.

Use of projection

When Trump defends accusations of racism by calling someone else a racist, that’s psychological projection. He does this sort of thing all the time. One of the most surprising moments of Trump’s presidential debates with Hillary Clinton was the time she accused him of being a Russian puppet, and he automatically projected the accusation — with nothing close to evidence — directly back on her:

Here’s Donald Trump’s scorecard for Malignant Narcissism:

So what now?

We need President Trump to undergo a psychiatric evaluation. If he refuses to do so, that’s bad news. Refusal itself could be validation of his personality disorder. People with personality disorders generally won’t consider that they might not be all right, whereas mentally healthy people will generally want to know if they have a problem.



Explorer, journalist. Author of Dream Teams and other books. My views are my own. For my main body of work, visit

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Shane Snow

Explorer, journalist. Author of Dream Teams and other books. My views are my own. For my main body of work, visit