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:
- Has a grandiose sense of self-importance (e.g., exaggerates achievements and talents, expects to be recognized as superior without commensurate achievements).
- Is preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love.
- 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).
- Requires excessive admiration.
- Has a sense of entitlement (i.e., unreasonable expectations of especially favorable treatment or automatic compliance with his or her expectations).
- Is interpersonally exploitative (i.e., takes advantage of others to achieve his or her own ends).
- Lacks empathy: is unwilling to recognize or identify with the feelings and needs of others.
- Is often envious of others or believes that others are envious of him or her.
- 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:
- Failure to conform to social norms with respect to lawful behaviors, as indicated by repeatedly performing acts that are grounds for arrest.
- Deceitfulness, as indicated by repeated lying, use of aliases, or conning others for personal profit or pleasure.
- Impulsivity or failure to plan ahead.
- Irritability and aggressiveness, as indicated by repeated physical fights or assaults.
- Reckless disregard for safety of self or others.
- Consistent irresponsibility, as indicated by repeated failure to sustain consistent work behavior or honor financial obligations.
- 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.
From Peter Baker at the New York Times:
Trump’s Erratic Behavior and Extreme Comments Revive Mental Health Debate
Trump is re-writing history on official White House website. He put up a special page about January 6, 2021.
https://www.whitehouse.gov/j6/
Trump reposted that today. He’s butthurt over the fact that he’s not allowed to be Jesus, after Monday’s fiasco, but at least he can pretend to be Jesus’s best friend (and exposer of “satanic, demonic, child-sacrificing monsters”).
Can you imagine any other president being stupid and narcissistic enough to repost something like that?
Criterion #1 for narcissistic personality disorder:
This is disturbing:
Trump’s garbled speech
Those are phonemic paraphasias, and what’s especially disturbing is that he doesn’t recognize that the words are coming out wrong. That unawareness is a dementia indicator. This isn’t like those episodes where he says something wrong or misreads the teleprompter and then tries to pretend that it was intentional.
Trump confused by the term ‘corner store’
Who sets the standard (s) for mental health illness or issues?
J-Mac:
The DSM-5-TR. See the OP.
Dig We Must? Dig Me Wust??
From the New York Times, July 2, 1966:
Confusing 2026 with the 1960s? Thinking that you dig for oil? Thinking that you started Dig We Must? Not good. This man is not well.
I checked, and his father was diagnosed with Alzheimer’s at age 86, in 1991:
What credentials and experience do you have to interpret the DSM?
As far as I know you have been an engineer. This doesn’t disqualify you from become a mental health worker though. I used to work with a psychiatrist who had been a computer scientist. He was a pretty good psychiatrist but he quit because he hated Canadian bureaucracy….
J-Mac:
The ability to read and understand the English language. Look at the criteria for NPD and ASPD, as quoted in the OP. I don’t see any terms in there that are arcane or highly technical. Do you?
Second, thousands of mental health professionals agree with me that Trump is mentally ill. I commented on this in another thread:
Lastly, I’ve addressed your objection multiple times, both in response to you and in the OP itself, where I write:
White House Leak Reveals Trump Booted From Briefing After Hours-Long Freakout
Saw some heartwarming video of Obama and Mamdani interacting with kids at a childcare center in the Bronx yesterday, in support of free childcare.
Contrast that with Trump saying that the federal government can’t provide childcare, because we need that money to fight wars. And with his clueless performance on Christmas Eve, taking calls from children, in which he lied to them about winning Pennsylvania three times (as if they would have cared anyway), promoted “clean, beautiful coal”, and said
Pinball Wizard (Elton John’s version, anyway) was released 50 years ago.
About the mental state of Trumpites. If this is accurate, then Trumpites are a different species, found only in USA.
Trump is showing the signs of narcissistic collapse. No mystery why, given his Iran failures, his economic failures, his cratering poll numbers, the defections of high-profile former supporters. What’s interesting is how he’s trying to compensate. More on this later, but he posted something very telling on Truth Social today:
…followed by a screenshot of a 2004 New York Times article on his TV ratings.
2004! The guy is so desperate to find good things to say about himself that he’s dredging up stories from 22 years ago. He’s like the 40-year-old guy who’s still bragging about his glory days as a star high school quarterback.
The narcissistic collapse continues. At a White House event describing plans to refurbish the Lincoln Memorial reflecting pool, Trump said:
This insecure man is bringing up (and lying about) crowd sizes at an event that happened seven years ago. He’s also confused. MLK’s crowd size was around 250,000 people, not a million. It’s probably jumbled up with the Million Man March in Trump’s addled brain.
While I was looking up the numbers, I ran across this:
His very first day in the White House, and his ego was already so bruised that he personally called the NPS director to demand that the photos be doctored. How pathetic.
Here are the comparative crowd sizes in photos taken by Reuters, not the federal government:
For the first time as president, Trump is attending the White House Correspondents’ Dinner, where the tradition is for a comedian to roast the president. Not tonight. I can’t say for sure, but it’s a safe bet that that decision was made in response to pressure from the White House, or at the very least that Trump wouldn’t have chosen to attend if there were going to be a roast.
Narcissists can’t handle being mocked.
ETA:
Watch Obama roast Trump
That was at the 2011 White House Correspondents’ Dinner. Look at how uncomfortable Trump is.
ETA2:
Since Trump won’t be roasted at the dinner, Jimmy Kimmel takes on the job.
The obsession continues. What a small, insecure man:
Stephen Colbert got in on the mockery:
Is it possible that Trump’s mental state has something to do with the Sate of Israel?
I don’t follow politics but it has come to my attention that Trump’s election was largely financed by Israelis who are so called Zionists. I don’t know what that means but sound pretty bad… if true…
J-Mac:
Trump’s been a malignant narcissist his entire life, so that has nothing to do with Israel.
Do you really need another conspiracy theory to latch on to? Your antivax views and virus denial should be enough.
Israel has undue influence on Trump and on US politics in general, but Trump is manipulated by everybody, not just Israel. Look at how Putin has been playing him during both presidential terms.
The Toddler-in-Chief is idiotically pulling 5,000 troops out of Germany in response to Friedrich Merz’s accurate statements about how the US has “no strategy” to end the war and how Iran has “humiliated” us.
Bill, do you think Trump should act in our country’s best interests, or are you fine with him being an insecure little boy who puts himself first and lashes out stupidly at a staunch ally, making damaging decisions because his feewings are hurt?
Marjorie Taylor Greene:
Is it true? I don’t know, but here’s the pathetic thing: if we find out that it’s true, it won’t be a surprise.
ETA: Note the similarity to what Trump said about Rob Reiner:
A second major defeat for Trump in his quest for tariffs:
Trade Court Rules Trump’s 10% Global Tariff Is Illegal
Given his tariff monomania and his emotional instability, he is not going to take this well.
The following letter was entered into the Congressional Record at the end of April by Sheldon Whitehouse and Jack Reed, the two senators from Rhode Island. It was signed by 36 physicians and mental health professionals, including two Nobel Prize winners, The original can be found here.
Medical Concerns about President Donald J. Trump and His Fitness for Office
The following is not a political statement. It is a medical one, made by individuals holding both conservative and liberal ideologies, identifying as both Republicans and Democrats, from different backgrounds, races, ethnicities, and religions.
We are a group of neurologists, forensic psychiatrists, general psychiatrists, and other physicians, along with other mental health professionals, experienced in the diagnosis of cognitive disorders and in evaluating dangerousness to self and others. Among us are professionals whom the courts and criminal justice system regularly turn to for our expert opinion in these matters. We are also consulted by governments in matters related to national security and the psychological profiles of world leaders. Prior to the presidential election in the Fall of 2024, a statement assessing Donald J. Trump’s mental fitness for the presidency was issued. At that time, serious signs of cognitive decline were identified, and in our expert opinion, these signs warranted disqualification from office.
It is our professional opinion, based on previous and ongoing assessments, that Donald Trump’s mental state since our 2024 statement has deteriorated even further. In keeping with our professional ethics, and for those of us who are physicians, with the Declaration of Geneva—the successor to the Hippocratic Oath that binds us to the humanitarian principles of medicine since the Nuremberg trials—we are compelled to warn of a President of the United States who is increasingly a danger to the public.
We do not take our statement, and the responsibility that comes with making it, lightly.
The President was not examined face to face, and he is not a patient of any member of our group. Rendering a formal diagnosis in this case is not our role. We have closely followed his behavior and his statements over the past year.
Objectively observable signs of serious medical concern include:
Marked deterioration in cognitive functioning, evidenced by disorganized and tangential speech, rambling digressions, factual confusions, unexplained sudden changes of course in strategic matters, both national and international, episodes of apparent somnolence during critical public proceedings.
Grandiose and delusional beliefs, including assertions of infallibility, imagery of himself as Pope suggestive of a divine mission, being a mythical warrior hero, depicting himself as combat pilot—dropping feces on civilians, and claims that his decision-making authority is unlimited—with no need to consider domestic and international laws and constrained only by his “own morality.”
Severely impaired judgment and impulse control, reflected in reckless threats of violence, advocacy of lethal force against civilians, encouragement of extrajudicial actions by armed supporters, repeated threats and often actions—judicial, prosecutorial, police, military, and by invoking emergency powers—against political opponents and others who disagree with him.
Significant loss of self-control (disinhibition) and getting stuck on the same thoughts or actions, unable to let go or move on (perseveration), including seemingly compulsive, manic-like late-night communications—e.g., 150 social media posts in one night—fixation on perceived enemies, persecutory ideas, and prolonged, disproportionate attacks on specific individuals and institutions.
Escalating violence that threatens national and global stability. As Commander-in-Chief of our military—more than 5000 nuclear warheads in inter-continental missile silos, on submarines, and in bombers around the world, are ready for launch solely upon his order, and no one now has the authority to countermand his order.
On August 7, 1974, as President Richard Nixon’s impeachment loomed, White House Chief of Staff, General Alexander Haig, was so alarmed by Nixon’s wandering the halls of the White House at night, sleepless, distraught, and heavily intoxicated, talking out loud to portraits of past presidents on the walls, that he alerted Defense Secretary James Schlesinger. Equally alarmed, Schlesinger directed Chairman of the Joint Chiefs of Staff, General George S. Brown, that any military orders from Nixon—especially nuclear ones—first be cleared through him or Secretary of State Henry Kissinger. It has been reported that the nuclear “football” that contains the codes for a nuclear launch was then quietly removed from Nixon’s control.
The public and those with the power to address such potentially catastrophic conditions must ask themselves if they—and we—are confident that officials such as Secretary of Defense Pete Hegseth and Secretary of State Marco Rubio would do the same.
It is our professional opinion that the behaviors of Donald Trump, tragically, are neither momentary lapses nor political theater. It is our professional opinion that they reflect a rapidly worsening, reality-untethered, increasingly dangerous decline. If we were called upon under the 25th Amendment to judge the President’s present ability to discharge the duties of his office, we would have to conclude that he lacks the capacity to do so.
For the reasons cited above, emphasizing that he presents a clear and present danger to our country and to the world, it is our expert opinion that Donald J. Trump is mentally unfit to be the President of the United States, and that steps to remove him from office must be undertaken with the greatest urgency, with vital responsibilities on the shoulders of those in positions of leadership.
8th grader demos his air cannon for Obama
Notice that for Obama, it’s all about the kid, the air cannon, and the people watching. Think about Trump in that situation. Can you imagine him handling it in the graceful way that Obama did and not looking for some way to make it about himself?
It’s nice to be reminded of what it’s like to have a decent president, worthy of respect.
Meanwhile, how does Trump interact with kids? By lying to them on Christmas Eve about how many times he won Pennsylvania:
Or telling a girl who said she didn’t want coal in her stocking:
To a kid from Oklahoma, he said:
Santa as illegal immigrant. Jesus H. Christ.
And since the kid was from Oklahoma, Trump added that Oklahoma was “very good to me in the election.” It’s always about Trump.
Then there was the White House Easter egg hunt, at which he said this to a group of kids:
It gets even weirder and creepier. In 1992, on a hot mic, he asked a young girl whether she was going up the escalator and then said “I’m going to be dating her in ten years. Can you believe it?”
Talking to a couple of girls who were part of a youth choir singing outside the Plaza Hotel, he asked them how old they were. They said they were 14, and he replied “Wow! Just think — in a couple of years, I’ll be dating you.”
He isn’t just awkward and self-centered around kids, he’s downright creepy. Obama puts him to shame.
The news coverage of Trump’s decrepitude, both physical and mental, is clearly getting to him, so he’s compensating:
The reality:
The White House responded on X:
Unfortunately for them, there’s video. Worse still, that meeting was in the middle of the day, around 11 AM.
Think about that every time you hear Trump refer to “Sleepy Joe Biden”.
Those must be fake polls, because as Trump said in March, “I’m more popular than I ever have been.”
Malignant narcissism. He simply cannot cope emotionally with his unpopularity.