Early in the recent Presidential campaign the American Psychiatric Association saw fit to remind its members of its so call “Goldwater Rule”. This rule had its origins when a group of psychiatrists decide to psychoanalyze Barry Goldwater from afar. The rule states:
On occasion psychiatrists are asked for an opinion about an individual who is in the light of public attention or who has disclosed information about himself/herself through public media. In such circumstances, a psychiatrist may share with the public his or her expertise about psychiatric issues in general. However, it is unethical for a psychiatrist to offer a professional opinion unless he or she has conducted an examination and has been granted proper authorization for such a statement.
In other words, keep your professional opinions about people in the public spotlight to yourself unless you have treated them and you have their permission to issue a public statement. In the most recent warning the association might have more plainly said, “Don’t say anything about Donald Trump’s obvious personality disorders no matter how tempting it might be to do so.”
Well, being a layman, I am not bound by the professional ethics of American Psychiatric Association. This subject has been subject of blog articles and has been discussed around water coolers and everywhere else Americans get together to chat. These discussions have mostly consisted of collections of personal opinions. I wanted to know what a well educated physiologist or psychiatrist would say about Trump based on his public behavior if he/she had permission to do so. However, since physiologists or psychiatrists are bound by the Goldwater rule, I think that the best we can do is compare Trump’s behavior to the American Psychiatric Association’s published criteria for determining if a person has any of the ten personality disorders the organization recognizes.
“From the Mayo Clinic site: “Many experts use the criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association, to diagnose mental conditions.”
DSM-5 criteria for Narcissistic Personality Disorder include following features – do they describe Trump?
- Having an exaggerated sense of self-importance – Definitely
- Expecting to be recognized as superior, even without achievements that warrant it – Yep, though he would point to many GREAT achievements while minimizing his failutes
- Exaggerating your achievements and talents – Absolutely
- Being preoccupied with fantasies about success, power, brilliance, beauty or the perfect mate – Definitely
- Believing that you are superior and can only be understood by or associate with equally special people – Yes, say people close to him say this is absolutely true
- Requiring constant admiration – Absolutely
- Having a sense of entitlement – Yes
- Expecting special favors and unquestioning compliance with your expectations – Yes
- Taking advantage of others to get what you want – Definitely
- Having an inability or unwillingness to recognize the needs and feelings of others – Yep; Trump appears to have no empathy for others
- Being envious of others and believing others envy you – Yep
- Behaving in an arrogant or haughty manner – Absolutely
Also from the Mayo Clinic website: “Narcissistic personality disorder crosses the border of healthy confidence into thinking so highly of yourself that you put yourself on a pedestal and value yourself more than you value others …… When you have narcissistic personality disorder, you may not want to think that anything could be wrong — doing so wouldn’t fit with your self-image of power and perfection.”
The American Psychiatric Association recognizes ten personality disorders in three clusters. Narcissistic personality disorder belongs to Cluster B – Dramatic, emotional or erratic behavior. Along with the narcissistic disorder there are three others disorders in Cluster B: Antisocial personality disorder, borderline personality disorder, and histrionic personality disorder. “Disorders in this cluster share problems with impulse control and emotional regulation.” It isn’t unusual for a person having one of these personality disorders to also have one or more of the other disorders in the same cluster. Again looking over the American Psychiatric Association’s criteria, Trump may also have histrionic personality disorder.
From the Mayo Clinic website: “Histrionic personality disorder: a pattern of excessive emotion and attention seeking. A person with histrionic personality disorder may be uncomfortable when he/she is not the center of attention, consistently use physical appearance to draw attention or show rapidly shifting or exaggerated emotions.”
Trump’s behavior may not fit the histrionic personality order criteria quite as well as it does the criteria for narcissistic personality disorder, but there is a lot of smoke here for there not to some fire.
DSM-5 criteria for Histrionic Personality Disorder includes following features – do they describe Trump?
- Shallow, changeable emotions – Hmmm….
- Assumed intimacy with others – Some signs of this
- Hypersensitivity to criticism – Absolutely
- Manipulative behavior – Definitely
- Disproportionate emotional reactions – Think tweet responses in the middle of the night
- Sexually provocative behavior – Absolutely
- A compulsive desire for attention – Definitely
- Preoccupation with appearance – Yep – but there is no accounting for his tastes
- Suggestible and easily influenced – Signs of this – think Bannon the puppet master.
Then of course are Trumps constant lying. While it is very tempting to label Trump a pathological liar, he doesn’t seem to fit the clinical criteria. From Psychiatric Times website: “PL is characterized by a long history (maybe lifelong) of frequent and repeated lying for which no apparent psychological motive or external benefit can be discerned. While ordinary lies are goal-directed and are told to obtain external benefit or to avoid punishment, pathological lies often appear purposeless.” I think that we can agree that Trump appears to lie either to make himself look good or to avoid blame, so he probably isn’t a pathological liar though he lies constantly. On the other hand, frequent lying is often associated with narcissistic personality disorder.
Found in a scholarly article on narcissistic personality disorder “….lying is the most common complaint about narcissists and that, in many instances, defects of empathy lead narcissists to wildly inaccurate misinterpretations of other people’s speech and actions, so that they may believe that they are liked and respected despite a history of callous and exploitative personal interactions.?”
From an article, “Why do Narcissists Lie?”: “Narcissists may lie for a variety of reasons which include seeking admiration or to hide their flaws or mistakes. They commonly lie to seek attention. In some cases, a person with this type of personality disorder will lie in order to make the person(s) he is lying to question their own sense of reality. Narcissists use lying and deception as handy tools to get whatever they want. A narcissist will look you right in the eyes, without blinking, and lie right to your face. Narcissists become so skilled at lying that many of them believe that they are telling the truth. Others use constant lying as a way of controlling the people around them.”
Let’s sum up what we have learned from this analysis. It is clear to me at least that Donald Trump’s behavior meets every criterion used to diagnose narcissistic personality disorder. His constant lying is but another classic characteristic of a narcissist. He also exhibits some, if not all of the characteristics of someone who also has histrionic personality disorder, but perhaps not all of them.
It is well established that if you are in a relationship with a narcissist, he/she can be dangerous to your emotional health, but what does it mean for our country when a narcissist is the leader of the free world? Well we know that a prevalent symptom of Trump’s narcissism is his constant lying. Lying destroys trust and trust is absolutely necessary for establishing, maintaining and improving relations with our country’s allies. Trust is also necessary to establish, maintain and improve relationships with the President’s subordinates and members of the legislative branch. We have already seen Trump’s willingness say anything on the spur of the moment which he believes will make him appear to be stronger, more able leader or which affirm his “greatness”. Sooner or later his cabinet secretaries and members of his staff are going to tire of having to clean up after his ill thought out statements like the people following elephants in a circus parade cleaning up their poop.
In addition, two other characteristics of a narcissist are “taking advantage of others to get what they want” and “having an inability or unwillingness to recognize the needs and feelings of others”. Trump considers himself to be a great negotiator. Frankly I doubt that. The best negotiators endeavor to create win-win situations. That would be extremely difficult for narcissists like Trump. Since they are unable or unwilling to recognize the needs of others, they don’t know or don’t care what their negotiating partners need to achieve in the negotiations. Instead they always seek to deal from a position of strength and try to force or manipulate other parties into doing what they want them to do.
Think about how you would feel if someone tried to “negotiate” with you in that manner. Then you will understand what members of Congress or the Judiciary (co-equal branches of government with the Executive) and leaders of other sovereign countries will experience when dealing with Trump.
We already have indications of how Trumps tactics will work out for him. Remember what happened when he bashed the Judiciary before the 5th District Court of Appeal rendered its verdict on the immigrant ban? The President of Mexico, Pena Nieto, canceled his state visit after he clashed with Trump over immigration and trade policy and consequently enjoyed a popularity bump in his home country. Chinese President Xi Jinping required Trump to provide assurances that he would continue the recognize the one china policy before he would even talk to him on the phone. Trump is not going to be able to bully coordinates in Congress and the Judiciary or foreign leaders like he did his contractors in his business dealings. And they aren’t going to sign non disclosure agreements.
It is also well established that Trump has at least one of the characteristics of Histrionic personality disorder: “Hypersensitivity to criticism. When coupled with the Narcissistic personality traits of “Expecting to be recognized as superior” and “Requiring constant admiration” it is easy to see how someone like Trump can be manipulated on world stage. All Putin had to do was complement Trump and he became putty in the Russian Presidnt’s hands. Imagine instead that in the middle of a future crisis Putin decided to call Trump a clown and a weak leader and then insinuate that has been manipulating him with praise all along. How would Trump react? Or more plausibly, what if the Ayatollah in Iran challenged Trump’s manhood? Would we suddenly be in the middle of a shooting war?
From the article “The Unstable Narcissist”: A narcissist is a person who derives his Ego (and Ego functions) from the reactions of his human environment to a projected, invented image call False Self. Since no absolute control over such feedback of Narcissistic Supply (positive feedback of self worth) is possible – it is bound to be volatile – the narcissist’s view of himself and of his surroundings is correspondingly and equally volatile. As “public opinion” fluctuates, so do his self-confidence, self-esteem, generally, so does his self. Even his convictions are subject to a never-ending voting process by others. The narcissistic personality is subject to instabilities in each and every one of its dimensions. It is the ultimate hybrid: rigidly amorphous, devoutly flexible, reliant for its sustenance on the opinion of people, whom the narcissist undervalues. … Instability is so ubiquitous, so all-pervasive, and so prevalent and dominant – that it might well be described as the ONLY stable feature of the narcissist’s personality.”
If you think of Trump when reading this excerpt, it is no accident. When I first read it I thought about the way he has been all over the map over time on issue after issue. I think of him lashing out in the middle of the night on Twitter and in his ad libbed speeches at anyone who criticizes him or dares not to do his bidding. I think about him calling the press the “enemy of the people” because they continue to investigate “irregularities” in his organizations which have often put him in a unfavorable light. This description of an unstable personality is picture of Trump. The question is, what can we do about it? I haven’t figured that out yet.