Donald Trump’s behavior is so far outside the norm that many people (including mental health professionals) have suggested that he is mentally ill. The most common suggestions I’ve seen are that he suffers from narcissistic personality disorder (NPD), antisocial personality disorder (ASPD, also known as sociopathy), or a combination of the two (known as malignant narcissism). There is also widespread concern about cognitive decline.

I looked up the diagnostic criteria for NPD and ASPD, and it’s shocking how many of the boxes Trump ticks. Here are the criteria for NPD according to the American Psychiatric Association’s diagnostic manual, the DSM-5-TR:

Narcissistic Personality Disorder (301.81 [F60.81])

Diagnostic Criteria

A pervasive pattern of grandiosity (in fantasy or behavior), need for admiration, and lack of empathy, beginning by 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.

I would argue that Trump meets all 9 of those criteria. Only 5 are required for an NPD diagnosis.

Here are the criteria for ASPD:

Antisocial Personality Disorder (301.7 [F60.2])

Diagnostic Criteria

A. A pervasive pattern of disregard for and violation of the rights of others, occurring since age 15 years, as indicated by three (or more) of the following:

1. Failure to conform to social norms with respect to lawful behaviors, as indicated by repeatedly performing acts that are grounds for arrest.
2. Deceitfulness, as indicated by repeated lying, use of aliases, or conning others for personal profit or pleasure.
3. Impulsivity or failure to plan ahead.
4. Irritability and aggressiveness, as indicated by repeated physical fights or assaults.
5. Reckless disregard for safety of self or others.
6. Consistent irresponsibility, as indicated by repeated failure to sustain consistent work behavior or honor financial obligations.
7. Lack of remorse, as indicated by being indifferent to or rationalizing having hurt, mistreated, or stolen from another.

B. The individual is at least age 18 years.

C. There is evidence of Conduct Disorder with onset before age 15 years.

D. The occurrence of antisocial behavior is not exclusively during the course of Schizophrenia or a manic episode.

I’d say that Trump meets all of the numbered criteria except #4. Only 3 are needed for an ASPD diagnosis. He’s certainly irritable and aggressive, but I haven’t heard reports of any physical altercations. He meets criteria B and D, but I don’t know enough about his early life to comment on criterion C, which is Conduct Disorder.

Anyway, the point is not whether Trump would qualify for a formal diagnosis. Diagnosis or no, any person who meets that many criteria for both NPD and ASPD is manifestly unfit for office.