With the Republican National Convention now completed, the question of whether Donald Trump would "pivot" to the general election and tone down his offensive and erratic behavior has been answered: absolutely not. In the aftermath of his angry, delusional acceptance speech and his subsequent actions (including his recent invitation to Vladimir Putin to commit cyber-espionage and his outrageous attacks on Khizr and Ghazala Khan), the question of Trump's sanity from a clinical, psychological perspective must be raised.

Amazingly, given his erratic behavior for more than a year, the issue of Trump's mental stability has received relatively little attention. The most comprehensive recent discussion of this subject was in the June issue of The Atlantic. There, a professional psychologist, Dan P. McAdams, provided a psychological profile of Trump for the purpose of assessing the potential impact of Trump's personality on his possible presidency. McAdams' portrayal of Trump was hardly flattering, but concluded that, although Trump's personality is "extreme," Trump was just as likely to be a good president as a bad one.

Unfortunately, McAdams' analysis completely missed the point. The question is not whether Trump's personality is "extreme." Rather, it is whether he is disturbed in a psychological sense and, if so, whether his possible personality disorders could lead to disastrous consequences if he were to assume the vast powers of the U.S. Presidency.



"Amazingly, given his erratic behavior for more than a year, the issue of Trump's mental stability has received relatively little attention."





Given Trump's obsessive focus on himself, his complete inability to tolerate criticism, his vindictiveness toward his opponents, his bullying and public insults, and his inappropriate and offensive public rhetoric, the disorder that comes most readily to mind is a narcissistic personality disorder. A narcissistic personality disorder is defined as a personality "characterized by exaggerated feelings of self-importance, an excessive need for admiration and a lack of empathy for others." It is classified as a cluster B personality disorder by the Diagnostic and Statistical Manual of Mental Disorders-5 of the American Psychiatric Association ("DSM") which currently represents the most definitive compilation of mental disorders followed by the mental health profession in this country.

A narcissistic personality disorder can be accompanied by a large number of deleterious traits and behaviors including arrogance, callousness and envy, and is associated with a preoccupation with power, prestige and vanity. Other negative characteristics include "grandiosity" and "a distain and lack of empathy for others." Worryingly, this condition is also characterized by exploitive behavior to achieve personal gain, exaggeration of skills and accomplishments and intolerance of the views of others. Pathological narcissism is also associated with derogation and insults of others and an inability to tolerate disagreements or criticisms.

Alternatively, Trump could also be suffering from an antisocial personality disorder. An antisocial personality disorder involves a pattern of disregard for, and violation of, the rights of others and includes such negative characteristics as deceitfulness as indicated by repeated lying or conning and manipulation of others, aggressiveness, and consistent irresponsibility. A person suffering from an antisocial personality disorder is often referred to as a sociopath. According to the DSM-5, narcissistic and antisocial personality disorders overlap with each other including in terms of lack of remorse and disregard for the wishes, rights, and feelings of others and can even co-exist, as in narcissistic megalomania.

Based on his bombastic and erratic behavior over the last year, and what is known about Trump's past (which McAdams and others have referred to), Trump exhibits characteristics of both types of personality disorders:

He is a serial and compulsive (pathological) liar. PolitiFact named Trump the winner of its annual "Lie of the Year" Award in 2015 - - a competition which PolitiFact said "was not even close," unquestionably in reference to the fact that it rated 72% of Trump's public remarks about factual circumstances as false. Any further doubt about Trump's capacity for truthfulness should be erased by even a cursory review of the website, Trumplies.com - - a vast compendium of misstatements, inaccuracies and outright falsehoods - - or his speech accepting the Republican nomination for president, or his defamation of Ted Cruz's father in his first post-convention news conference or his recent statement to the New York Times about NATO which was reported the next day and which he categorically denied. The Times then released a verbatim transcript of its interview with Trump which clearly showed that his denial of earlier in the day was patently false.

Trump's dishonesty in his business dealings is shocking and unprecedented for a presidential candidate. Recently, the New York Times published an investigation about Donald Trump's business dealings and discovered, inter alia, that Trump was a defendant in literally thousands of law suits primarily brought by service providers and vendors whom he failed to pay for services rendered to him or his business organizations. It is abundantly clear that failing/refusing to pay vendors is part of Trump's business model. What type of reputable businessman - - with a shred of integrity - - would conduct business in such a manner? For this, and other reasons, several major financial institutions including JPMorgan Chase and Goldman Sachs flatly refuse to do business with Trump. Indeed, Trump's reputation in business is as a scam artist; as Mitt Romney, the last candidate for president of the Republican Party, put it, Trump is a "con man" and "snake-oil salesman." Readers should look no further than the allegations involved in the Trump "University" scandal to find serious support for Romney's conclusions.

There is overwhelming evidence that Trump cannot tolerate any form of criticism no matter how slight and that he is vindictive in the extreme. The confrontations that Trump had with reporters and news organizations during the primary process, particularly his weeks-long attack on Megyn Kelly are illustrative of this point, as is his shameful, despicable conformation with Khizr Khan and his wife. There is also evidence that has not been publicly disseminated that Trump has misused officers of the New York City Policy Department to retaliate against his perceived enemies in New York City and to harass and threaten the personal safety of his opponents.

Trump never apologizes for any missteps or intemperate attacks and has demonstrated a remarkable lack of empathy for persons whom he has attacked, injured, or harmed. Numerous incidents, both recent and historical, establish Trump's utter lack of either accountability or empathy.

Trump has a fixation with the idea of "winners" and "losers" - - a frequent mantra of his campaign for the Presidency. Trump's universe consists of "winners" and "losers" and Trump particularly focuses on losers - - which includes any opponent or person who disagrees with him. Losers are people who "deserve to lose," a clear indication of his indifference to, and rationalization for, injuring or humiliating others.

Trump's angry, menacing Convention acceptance speech can only be regarded as delusional and demented and gave the appearance of the ravings of a lunatic. The arrogance and delusional nature of the mantra, "I alone," repeated in his acceptance speech is a clear indication of the presence of both disorders.

Trump's reaction to protesters during the primaries and to critics at the Democratic National Convention by threatening their physical safety ("I want to hit them"; "They should be carried out on a stretcher") is highly indicative of antisocial behavior.

Although initially regarded benignly by the media as being "unconventional" ("This year is different"), Trump's failure to conform to established norms for behavior in public and in running a national political campaign for president is also highly sociopathic.

Although a number of commentators on Trump's mental state (including McAdams) have documented many characteristics of Trump's possible personality disorders, they scrupulously refrain from exploring the strong possibility that Trump may be mentally disturbed in a clinical, psychological sense and the nature of such disturbances. They refer only obliquely to a possible narcissistic personality disorder by characterizing Trump's behavior as "grandiose" in nature - - but without any further explanation. They also eschew any reference to Trump as a psychopath or a sociopath.

However, more important than the labels, these commentators fail to consider the potential adverse consequences, if a person like Trump were to acquire the powers of the modern U.S. presidency. Of prime consideration, the president is both Commander-in-Chief of the armed forces and heads up the national security agencies responsible for both the internal and external security of the United States. These powers include control of the FBI, the NSA, the CIA, DHS, and other federal agencies, whose operations are largely carried out in secret. Most of the president's national security powers are historically broad either in the form of inherent powers or as broadly delegated by Congress and, as a practical matter, are typically unreviewable by Congress or the courts, particularly in an emergency.

Predictions - - both good and bad - - as to the possible consequences of a Trump presidency are, of course, a matter of speculation at this point. McAdams, for example, implicitly concludes that, notwithstanding his personality flaws, Trump was just as likely to do good things as bad, citing the presidency of Andrew Jackson as a "populist" precedent.

However, even assuming that Jackson is a helpful historical analogy, McAdams never seriously considered the potential downside of a Trump presidency in light of his personality flaws. Given the strong possibility of one or more disorders in Trump's personality, Trump represents an extraordinary danger and risk to the nation in the form of abuses of power.

This danger and this risk are not purely conjectural: Trump has already threatened to abuse these powers should he obtain them. The single most disqualifying action Trump has engaged in to date relates to Jeff Bezos and the Washington Post. In response to criticism by the Post and the possibility that a large number of its journalists have been tasked to investigate Trump's past (as is true of any presidential candidate), Trump has indicated that should he become president, he will launch an IRS investigation of Bezos--the owner of the Post and CEO of Amazon--and an antitrust investigation of Amazon.

Use of federal agencies for political purposes by a president is a flat-out abuse of power and an impeachable offense punishable by removal from office. Indeed, Article III of the Impeachment Resolution that the House of Representatives passed against Richard Nixon in 1974 involved just such uses of the Department of Justice, the FBI, and the CIA. In other words, before even assuming office, Trump has threatened to engage in an abuse of power, rising to the level of an impeachable offense!

Under the circumstances it would be prudent to take Trump at his word and, at least, consider the possibility that he would engage in significant abuses of power, if he were elected. Given Trump's evident ignorance of the complex constellation of policy issues facing the nation from both a domestic and international perspective, his apparent lack of understanding of the constitutional division and separation of powers between our three branches of government and, given his personality flaws and/or disorders, it would not only be foolish, but foolhardy, to turn over the powers of the U.S. presidency to Trump.

In this light, and faced with this reality, all persons of good will who care about the future of the country should do everything within reason to prevent Trump from obtaining these powers.