Donald Trump has DSM-5 Antisocial Personality Disorder (ASPD)

I am going to lay out the case for why Donald Trump meets criteria for ICD11/DSM-5 Antisocial Personality Disorder (ASPD). While many pundits and armchair psychiatrists as well as psychologists have labeled the President of the United States (POTUS) as narcissistic or, using Erich Fromm’s construct, a “malignant narcissism (MN).” I believe there is good reason to avoid these labels and to stick with a tried and true diagnosis in the context of mainstream academic psychiatry, namely ASPD. I will discuss some implications of POTUS meeting criteria for ASPD for society.

While I am fond of Fromm’s construct of MN, it is not in the current psychiatric nomenclature; therefore, from a rhetorical point of view, it is less valid than a formal DSM diagnosis in the context of mainstream psychiatry. Narcissistic Personality Disorder (NPD) is a problematic diagnostic syndrome from a construct validation standpoint. Because of the weak empirical and theoretical basis for the DSM-IV-TR definition of NPD, it was proposed for removal in the DSM-5 (although ultimately retained).

In addition, every politician is narcissistic and probably would meet criteria for NPD. Narcissism is practically a pre-requisite for running for office. ASPD, on the other hand, has a long history in psychiatry and refers to a small, subset of particularly dangerous individuals. It has well established construct validity and reliability. It’s rather difficult to meet criteria for this disorder, and most who do meet for it are incarcerated. The DSM-5 holds that 0.2 to 2.8% of the population meet criteria for ASPD. This low prevalence contrasts significantly with the popular psychology constructs of the “psychopath” or “sociopath,” syndromes with reported prevalences upwards of 25%. Nonetheless, the DSM-5 describes the terms as interchangeable with ASPD, indicating a wide semantic gap in how the public understands sociopathy.

Conduct Disorder Requirement

Turning to the case for Trump meeting criteria for ASPD, it’s necessary to review its diagnostic criteria. The first pre-requisite for this diagnosis is evidence of Conduct Disorder (CD) before the age of 15. In order to assess for the presence of CD, questions about certain behaviors must be answered. Core features of CD include lying, bullying, and physically aggressive behavior/intimidation. According to the book, “Too Much is Never Enough” by clinical psychologist, Mary Trump, Ph.D, (Also Trump’s niece), Donald lied as a way of life as a child to get ahead, ruthlessly bullied his younger brother, and was sent to military school for disruptive behaviors at the age of 13. In addition, she reported that he paid someone to take the SATs for him, and his older sister did his homework, indicative of a pattern of deceitfulness. Extant news sources report that Donald engaged in acts of physical aggression towards his peers before the age of 15 and met the Conduct Disorder diagnostic requirements of bullying as well as lying.

Source: APA DSM-5

DSM-5 Diagnostic Criteria for Antisocial Personality Disorder (ASPD)

Having met the criteria for CD, we can turn to the diagnostic criteria for Antisocial Personality Disorder (ASPD). There are seven criterion but only three need to be present for a diagnosis. Due to time and space constraints, I will restrict this discussion to three criteria that Donald trump objectively, behaviorally observably meets.

• One criteria is recurrently engaging in acts that are grounds for arrest. Extant evidence in the Mueller report highlights a pattern of obstruction of justice. It is common public knowledge that Trump could have been indicted for obstruction if he was not the sitting president given the rules and policies of the Office of Legal Counsel (OLC). In addition, there is considerable circumstantial evidence to suggest of a history of money laundering. In fact, one condo owned that he sold in Trump Tower, Unit 63AB, was explicitly identified for seizure for money laundering by the SDNY in an indictment (see pp. 74 of the indictment; however, the condo was later dropped as a target for seizure by the prosecution). Furthermore, The Trump University (a fake University) scam was another instance of behavior that is grounds for arrest. A history of money laundering at the Taj Mahal, Casino as well as other incidents that are grounds for arrest have been detailed by the media.
• Deceitfulness as indicated by recurrent lying for personal gain, such as use of an alias is another criterion. The Washington Post has documented over 20k lies and historical sources point to evidence that Donald has used two prior aliases for his own benefit.
• A third criterion for antisocial PD is irresponsibility as indicated by failure to honor financial obligations. Trump has declared bankruptcy over five times and numerous contractors have reported that they had been left unpaid by trump.

• Source: Shutterstock

Accordingly, Trump meets criteria for ASPD. Just for further reference, the remaining criteria are lack of remorse, impulsivity, physically assaultive behavior, and reckless disregard for the safety of others. In my personal and professional opinion, behaviors displayed by Trump prior to and during his presidency meet these other criteria as well. However, providing the evidence for each of these criteria is beyond the current scope.

What are the implications of POTUS having ASPD?

It is generally agreed that the duties of POTUS include upholding the Constitution of the United States. The Constitution is a set of laws, rules, and principles. Given the criterion of recurrently engaging in behavior that violates the law In ASPD, it is predictable that Donald will continue this longstanding pattern of criminal behavior. In short, Trump is incapable of upholding the Constitution by virtue of the symptoms of his personality disorder. The symptoms of ASPD are in direct contradiction to the US Constitution — in letter and spirit — descriptively on its face.

Source: Shutterstock

Further, in the Preamble of the US Constitution, the purpose of government is laid out: “to promote general welfare” and “ensure domestic tranquillity.” Given the ASPD criteria of lack of remorse and reckless disregard for safety as well as failure to plan ahead, it is predictable based on his PD that Trump will act in ways that directly contradict promoting “social welfare” and ensuring “domestic tranquility.” In sum, his PD, ASPD, directly contradicts the core principles of the US Constitution, rendering anyone who meets full criteria ASPD incapable of carrying out the duties of POTUS.

Throwing the Gold out with the Water

Some have argued that it is irresponsible, improper, invalid, inaccurate, and/or unethical to proffer a mental disorder diagnosis of a public figure one has not personally interviewed. This is sometimes referred to as the “Goldwater Rule.” While there is merit to this line of reasoning, not all mental disorder constructs are equal in connection to the nature of their diagnostic criterion. Some mental disorders are defined by internal states and subjective criteria making it impossible to diagnose from afar. However, other diagnoses, specifically ASPD are defined by a set of homogenous behaviorally observable and/or historically verifiable data. Most mental disorders are defined by heterogeneous diagnostic criteria, with a mix of personality traits, affective states, observable behavior, and physical variables some being moods, others behaviors. On a side note, this has been a long-standing criticism of post DSM-III psychiatric classification. The diagnostic criterion for ASPD are remarkably uniform and objectively knowable. They are anomalous for their objective homogeneity, making this PD particularly suitable for assessment without in-person interview.

Furthermore, recent scholarly literature has evaluated the applicable of the “Goldwater Rule” in light of recent events. Experts in the fields of personality disorders as well as psychiatric risk and violence prevention have concluded that the Goldwater rule is inapplicable, outdated, and applied clumsily as well as overly broadly. For example, Lilienfield et al. (2018) argues that an individual with the appropriate training and expertise can reliably diagnose certain syndromes without interview in some cases and holds that the Goldwater rule is based on “dubious science” and is outdated (also see Lee, B. X., 2020, for a related discussion).

Furthermore, the ethics governing the professional practice of psychology highlight the need to educate the public about psychological matters relevant to public welfare. Explaining what ASPD is and how it applies to leaders, specifically POTUS when applicable, and the implications of this pathology for society is certainly warranted. Lastly, while it wouldn’t change my argument, the Goldwater Rule is officially a provision of the American Psychiatric Association, not the American Psychological Association. While this last point is moot because it might as well apply to psychologists, I thought it worthwhile to highlight this technicality. In general diagnoses should only be made after a careful review of history, interview, and over a period of time. Collateral reports help. There is no one size fits all when it comes to psychiatric diagnosis. It is a process that unfolds uniquely between each doctor-patient dyad with some core commonalities.