DUTY TO INFORM (PART 2)

The Impact of Donald Trump’s Diagnosed Personality Disorder on Key Cognitive Domains

By Vince Greenwood, Ph.D., founder of DutyToInform.org

In Part 1 of this article, we made a good-faith effort to evaluate President Biden and ex-President Trump for the possibility of neurodegenerative disease. That evaluation was based on whether either candidate displayed meaningful decline in one or more of six cognitive domains: language, memory, perceptual — motor, attention, executive functioning and social cognition.

President Biden was assessed in all six domains and did not exhibit any decline. Thus, he appears to have a healthy brain. Ex-President Trump was assessed in three domains: language, perceptual-motor, and memory. He did evidence meaningful decline in the language domain and thus deserves serious consideration for a diagnosis of Neurocognitive Disorder that carries with it a prognosis of further deterioration in cognitive functioning.

In this part of the article, we examine Trump’s low functioning in the remaining domains of attention, executive functioning, and social cognition; and explain how his personality disorder explains his poor performance in these areas.

Trump’s Struggles with Attention, Executive Functioning, and Social Cognition: What It Means

We have abundant material, in the form of biographies and insider accounts, to evaluate Trump in these domains. Many of the biographies cover not just his White House years, but his entire life span. Insider accounts include books and interviews with ex-cabinet officials and other high-level staffers who were Trump associates and supporters while working in his administration. However, after observing the man closely, they seemed to have developed their own “duty to warn” pangs of conscience. These biographical and journalistic efforts provide us with hundreds of anecdotes and scenes that can serve as data points to measure his attentional skills, executive functioning, and social cognition.

We know public perceptions of Trump are polarized. Many view him as a Christ-like figure, and just as many view him as a democracy-extinguishing existential threat. But what about those who observed him closely and off-camera, presumably in an executive rather than a political mode? What was their perception?

Like with Biden, their observations showed a good deal of unanimity. Unlike Biden, their review of how he performed in his executive role was (clinically speaking) quite the s___ show.

Trump is an outlier. We are familiar with his flamboyant, erratic, self-aggrandizing, and divisive public behavior. Well, in private, we now know, it was pretty much the same — all chaos. Much of that chaos can be laid at the doorstep of his abysmal functioning in the attention, executive functioning, and social cognition domains.

How did these deficiencies manifest themselves in the White House? A few examples:

• Trump’s notoriously short attention span forced accommodations upon all those in his orbit. An official from NATO described the task of preparing for a summit in the Trump era as “kind of ridiculous how they are preparing to deal with Trump… It’s like they’re preparing to deal with a child — someone with a short attention span and mood who has no knowledge of NATO, no interest in in-depth policy issues, nothing.”
• A head of state described a 60-minute meeting with Trump as “60 one-minute meetings.” John Bolton, Trump’s National Security Advisor, said that — except when it comes to being reelected — Trump has the “attention span of a fruit fly.”
• Trump brags about not reading briefing papers and scoffs about diving into the quotidian details of any project. Because of its length (2–3 pages), Trump refused to read the daily intelligence report. White House aides and intelligence officials coped by limiting memos to one paragraph and using visual aids. They discovered he might focus briefly if they “made sure his name was included in briefing documents.”

With regard to his executive functioning, it is no exaggeration to say Trump was never able to formulate, much less execute, a plan for any substantive or thorny issue during his term. He never even tried, really. He openly expressed disdain for the executive component of being Chief Executive. This dereliction and disdain masked his inability to solve any problem that required discipline, deliberateness, organization, and focus.

The evidence is everywhere.

Michael Lewis, in his book The Fifth Risk, describes Trump’s determination to shirk the administrative demands of the office. After he won the election, Trump actively undermined the transition process. He quickly disbanded the transition team headed by Chris Christie, telling him, “We can take an hour off from the (Inaugural) party to learn everything we need to know about running the government.” Conducting an orderly and substantive transition meant taking on the governance responsibility, and Trump wanted nothing to do with that.

The federal nonresponse to COVID-19 was the most tragic example of his fecklessness. The crisis demanded discipline and hard work. Trump had no interest in wading into those waters. He didn’t attend coronavirus task force meetings and became bored with the daily press conferences as soon as it became clear they were hurting his poll numbers. There was never even a plan of a plan. There was chaos and neglect all the way through.

Michael Wolff, author of Fire and Fury, Landslide, and other insider accounts of the Trump White House, had contacts with people who worked side by side with the president. In Landslide, he described Trump’s typical workday in the Oval Office:

…he was often pursuing a series of personal concerns, vendettas, fancies, most often figments of the moment, while the executive branch itself carried on its business. The job of aides was to snatch or negotiate time with him, or decisions from him, on pressing executive functions while he pursued his other concerns and to do this during his 11 a.m. to 6 p.m. schedule in the office.

Trump’s social cognition is deeply flawed. His self-awareness, ability to empathize, and capacity to work collaboratively with others are compromised. This is largely due to his inability to experience the emotions of shame or guilt. While painful, these emotions are instrumental in leading us to have an appropriate concern for the effects our actions might have on others and thus mitigate our selfish or immoral tendencies.

Trump’s bandwidth of emotions is limited to those associated with his drive to dominate others and prevail over his critics: anger, contempt, jealousy, feeling thwarted, mistrust, glee. He lacks the more tender emotions that could engender solidarity or trust. Indeed, Trump is reported to have few close friends.

He has an arrogant self-image that has undermined trust in the White House. As Politico’s Diamond reported, “Trump’s unpredictable demands and attention to public statements — and his susceptibility to flattery — have created an administration where top officials feel constantly at siege, worried that the next presidential tweet will decide their professional future, and panicked that they need to impress him regularly.”

There are many such examples of the consequences of Trump’s struggles with attention, executive functioning, and social cognition. However, the purpose of this paper is not to re-litigate how much dysfunction there might have been in the Trump White House. Instead, it is to closely examine the quality of Trump’s (and Biden’s) behavior to determine if they suffer from a degenerative neurological disorder. To note Trump’s significant difficulties in these neurocognitive domains would seem to confirm further that he is in the throes of such deterioration.

That line of thinking would be wrong. It is not so much that Trump is deteriorating in these domains, but that he is congenitally compromised.

Remember, diagnosing a Neurocognitive Disorder requires the demonstration of decline in one or more of the six cognitive domains. We have provided evidence for a decline in the language domain for Trump. However, we do not see evidence of a decline in attention, executive function, or social cognition. His functioning in these areas at present is, to put it mildly, problematic. However, his current level of functioning does not represent a deterioration from a previously higher level of functioning. In fact, his functioning in these areas has been stable throughout his lifespan.

While his performance in these domains has been consistent if abysmal, it does not mean that Trump’s struggles might not be related to brain abnormalities. As I will elaborate on below, they likely are. But, they are not the result of a degenerative disease process, but of an inherited neuro-developmental vulnerability.

Of all the biographies on Trump, some detail his early years, including his childhood and adolescence. Three particularly good example are Trump Revealed: The Definitive Biography of the 45th President by Michael Kranish and Marc Fisher, Too Much and Never Enough by his niece, Mary Trump (who has a Ph.D. in clinical psychology,) and The Strange Case of Donald J. Trump by the well-known personality psychologist Dan McAdams. Their accounts, among others, document severe and recurring difficulties with attention, self-regulation, and social cognition dating back to his childhood.

While his lifelong struggles in these areas are not the result of neurodegenerative pathology, they are psychopathological expressions of another serious condition. Yes, Donald Trump suffers from a condition that is more consequential, indeed more dangerous than his likely Neurocognitive Disorder. This condition explains his difficulties in these key areas of functioning. And a good deal more.

Psychopathic Personality Disorder: The Ultimate Trump Whisperer

Four years ago, I undertook a forensic investigation of whether Donald Trump met the criteria for a specific condition, Psychopathic Personality Disorder. The results of that examination:

Donald J. Trump meets the diagnostic criteria for a specific condition — Psychopathic Personality Disorder (PPD) — characterized by a trifecta of destructive personality traits that ensure he will inflict harm on those in his orbit. Since he entered the political arena, we have witnessed this pattern with its grievous consequences. We can predict it will continue.

Since he qualifies for this diagnosis, we can speak with authority and precision about how Trump thinks, feels, and will behave. Because of our knowledge of this disorder, we have a duty to inform that he is more dangerous than even his strongest critics exclaim. He is like a man behind a car’s wheel with no brakes (impulse control) or steering (executive functioning). He takes satisfaction in battering whoever crosses his path next (lack of empathy and remorse).

In short order, we will explain how the pathology of that personality disorder accounts for his deficits in attention, executive functioning, and social cognition. But first, we need to respond to critics of mental health professionals, some of whom are undoubtedly well-intentioned, who question whether such a diagnosis of the ex-president is well-founded or even possible. While these objections are not unreasonable on the face of it, concerning the diagnosis of Psychopathic Personality Disorder, we have solid rebuttals for each of them.

Objection #1: You have not added anything substantive to our understanding of the man. You are just affixing psychiatric labels to the behavior you find distasteful.

Rebuttal: Psychopathic Personality Disorder (PPD) is not just some kind of disparaging formulation but a precisely delineated condition that is one of the best-understood and thoroughly validated conditions in the field of psychopathology. If someone is diagnosed with this condition, there is a lot we can say about them, and we can say it with authority.

How did we arrive at our current, in-depth understanding of this disorder? A Brief history trip is in order.

The term psychopathy comes from the German word psychopastiche, which translates to “suffering soul”. In the early 19th century in Europe, the term became affixed to a small group of individuals in society who are devoid of a moral sensibility: those who lie, cheat, and steal with impunity. In the 1800s and early 1900s in America, the term “moral insanity” was often used to describe such individuals.

Psychopaths appear to have been with us from antiquity through medieval times to the present. Descriptions from Greek and Roman mythology, the Bible, and classical literature are remarkably consistent in revealing the presence of intellectually intact individuals who lacked the capacity for moral reasoning.

Historical accounts reveal that no culture or station in life is immune from this condition. Psychopaths are found in pre-industrial societies, past and present, as well as in modern states. They are found among the wealthy as well as the impoverished.

The advent of modern psychiatry — especially the establishment of reliability and validity in clinical diagnosis of disorders — has enabled us to confirm the descriptions from classical literature and history: that there is a distinct clinical entity called Psychopathic Personality Disorder (PPD) that is stable across history, culture, and socioeconomic status. PPD is also stable across the lifespan of the individual who displays it. Psychopathic Personality Disorder is not just a term of disapprobation for (mostly) men behaving very badly, but a diagnosis that reflects a real-world, clearly defined pathology with clearcut features.

Our ability to reliably diagnose psychopathy is largely due to the development of a rating scale, the Hare Psychopathy Checklist, designed by Robert Hare, a Canadian psychologist, and his colleagues in the 1970s to measure the degree of psychopathy in an individual.

Hare and his colleagues developed the checklists by listing over 100 behavioral, emotional, interpersonal, and lifestyle traits observed in criminal populations. They relied heavily on the work of Hervey Cleckley, considered the pioneer in the study of the “criminal mind” and author of Mask Of Sanity, published in the 1930’s. In that book he detailed the psychopath’s often “brilliant and charming” manner, which masked a predatory nature and a lack of conscience.

They eventually pruned the Checklist to 20 items and established solid reliability and validity metrics for the instrument. It became the “gold standard,” the trusted and objective measurement tool for research on the disorder and generated an explosion of studies. By February 2020, there were over 69,000 studies on psychopathy, as documented by Google Scholar. These studies provide findings that address the causes of the disorder, including its underlying brain abnormalities, the course of the condition, the voluminous detail on its clinical features, including the dangers associated with it, and its poor response to treatment. Psychopathic Personality Disorder is now one of the best-understood and most thoroughly validated conditions in the field of psychopathology.

So, yes, we can say a great deal about someone if they meet the rigorous assessment criteria set out by the Hare Psychopathy Checklist. This brings us to…

Objection #2: You are unable to conduct a trustworthy evaluation on someone for Psychopathic Personality Disorder (PPD) if they refuse to collaborate on a clinical interview.

Rebuttal: The diagnostic process to determine if someone has PPD is rigorous. The evaluator must have specialized training in the assessment of PPD, and access to a large swath of information about the patient in order to make reliable ratings of cognitive and behavioral traits. If you can secure sufficient, high-quality information, you do not need a clinical interviewwith the patient. Indeed, research indicates that the clinical interview can detract from the evaluation because of the psychopath’s skill in lying and inability to see any of his behavior as problematic.

Fortunately, with regard to Trump, we have abundant, high-quality information available to make a possible diagnosis of Psychopathic Personality Disorder. Numerous biographies, insider accounts, and investigative reports depicting many life scenes enable us to make data-rich ratings on the Hare Psychopathy Checklist.

Training (which I undertook) is required to administer the Checklists. There are demanding criteria for the breadth and quality of the information (life history data points) needed to make an assessment. In the case of Trump, these included:

• Information from his childhood, adolescence, and young adulthood. The condition of psychopathy expresses itself early in life. Data is needed from these earlier stages of development to make an assessment.
• Information in which the trait is expressed in overt behavior (e.g., an instance of his lying is privileged over an accusation of his lying).
• Information that reflects his typical functioning and lifelong patterns vs. descriptions of more flamboyant, occasional behavior.
• Information that is well-resourced, substantiated, and has some external validation.
• Behavior that lends itself to coding and thus quantification (e.g., number of documented lies, lawsuits, or grandiose statements).

The evaluator then culls all this informational data and links it to each of the 20 items on the Checklist. From this, a rating for each item is generated: 0 (trait definitely not present), 1 (there is some data to support the trait, but it is not overwhelming), or 2 (trait definitely present). Thus, the highest score is 40 (a very rare occurrence).

Trump received a score of 32, which places him in the moderate to severe range of Psychopathic Personality Disorder (see here for detailed findings). Please note the mean score for those incarcerated for serious crimes is 22. It is a high bar to meet the rigorous criteria to be diagnosed with Psychopathic Personality Disorder. Only 1 in 140 do so. The implications of this diagnosis are serious and wide-ranging

Since Trump is in the well-researched PPD diagnostic group, we can now say a lot about the psychopathology of his condition, including how it relates to his struggles with attention, executive functioning, and emotional responsiveness.

The Three Core Traits That Define Psychopathic Personality Disorder

Factor analysis is a robust data reduction technique that enables us to explore and identify primary, underlying factors in a large data set, like the one available from so many studies on clinical psychopathy. Thanks to factor analysis and other multi-pronged validation studies, we now know that those that meet the strict diagnostic criteria for PPD possess three distinct clusters of traits (known as the “three factor model”): (1) An inability to inhibit impulses, leading to reckless and unreliable behavior, (2) An utter lack of conscience or remorse, marked by an inability to experience states of guilt, shame, or fear; emotions that might curb behavior that could harm others, and (3) A ferocious drive to dominate others, fueled by a manipulative, arrogant and deceitful mode of behavior.

Understanding the deep structure of these three traits affords us a glimpse of what it is like to be Donald Trump. It explains his limitations in executive functioning and inability to respond with empathy or compassion to any situation.

The Psychopath’s (Trump’s) Impulsivity Trait

The impulsivity trait for the psychopath does not just refer to difficulties in controlling impulses but also related traits, such as greater than normal need for stimulation, inability to plan, egocentrism, deficits in perseverance, inability to defer gratification, recklessness, and struggles in focus and attention.

What is it like to be in the throes of this impulsivity trait? One of the critical dimensions of this impulsivity cluster is reflected in the descriptor “egocentric”. The term egocentric has a negative connotation in the general culture but has a more precise clinical meaning in the study of psychopathy. Egocentrism is a pathology, a limitation that constrains both how the psychopath perceives the world and his ability to respond to it flexibly.

The psychopath’s attentional field is limited to an egocentric “what’s in it for me?” boundary. He cannot engage the world beyond the immediate present and personally relevant. His attention is tethered, captured by the moment’s immediate frustrations, provocations, and opportunities. Sizing up the situation according to his egocentric needs is automatic and natural. It is not complicated by other factors such as his deeper aims, accommodating other people’s interests, or worries about future consequences.

The psychopath does not struggle to bring his attention to thorny subjects. He is simply not equipped to take on subjects that require a sustained focus. He is helpless to curb the pervasive “what’s in it for me?” impulse, powerless to give any issue a second thought, much less careful deliberation. The psychopath is a stuck needle responding only to the thwarted needs of the moment. The daily struggle 99% of us have between “I want” (impulses at the moment) and “I should” (weighed against deeper aims or values) just doesn’t take place with the psychopath. All his battles are in one dimension with two moves: what’s in it for me? And how do I win the moment?

The hard-wired impulsivity trait also precludes any normal executive functioning. The trait guarantees the psychopath approaches the world in a way that is foreign to most of us. For him, it is an immediacy of reaction to a different order. The psychopath has a reflexive rejection to having any second thoughts, any hesitation, or any self-criticism. This antipathy to any inhibition undermines even rudimentary acts of reflection, reason, or judgment.

Insiders often described Trump’s behavior as impulsive, erratic, and unfocused, and it was. But beneath his volatile surface behavior, there was rigidity. He was a prisoner of this one-note focus on his needs and his inability to stop himself from immediately trying to satisfy them. He was a prisoner of his pathology.

How did this pathology express itself during his presidency? We get a sense from Michael Wolff’s book Landslide, where he gives a detailed chronology of Trump’s behavior from election night 2020 until he flew to Mar a Lago on Inauguration Day. Trump never made an attempt at executive functioning during this transition period. He was focused exclusively on “stop the steal.” Executive duties were patched together by other staff. GOP House and Senate leaders were delighted to fill the policy void. If we had a time-lapse video of the Oval Office from the day after the election until January 6th, we would see a one-act play repeated on a constant loop. It would show Trump in an constant garrulous dungeon, having one-sided conversations with whoever happened to be in the Oval Office (he wasn’t attending to the business of the country, so it was primarily political advisors who would drift in willy-nilly), or he could whine to on the phone. His manner was wheedling, petulant, hectoring. There were no substantive conversations about challenging the election results, and there was no hint of personal reflection about the facts on the ground regarding the so-called fraud. Instead, there were rants in which he would play the victim, lob wild accusations, and demand something “must be done” without any coherent sense of what that might be. Wolff summarized it well, “Beyond his immediate desires and pronouncements, there was no ability — or strategy, or chain of command, or procedure, or expertise, or actual person to call — to make anything happen.”

His behavior during the lead up to January 6th was the rule, not the exception.

It is hard to fully appreciate the chaos, recklessness, and dereliction that flow from the psychopath’s impulsivity trait. Because of it, Trump can’t help but:

• Act quickly without considering the consequences
• Take huge risks since he craves sensation-seeking
• Be driven by what captures his immediate self-interest
• Continue to display no aptitude for governance
• Fail to plan or persevere with any substantive task

The psychopath is helpless to curb their pervasive “what’s in it for me?” impulse; powerless to give any issue a second thought, much less careful deliberation. Trump is a prisoner of this pathology. Virtually all insider accounts underscore not only the limitations in his attentional field and executive functioning but also their particular quality. These accounts could be straight out of a clinical psychopathy textbook.

The Psychopath’s (Trump’s) Remorselessness Trait

There are two facets to the remorselessness cluster of traits: the inability to bond with or have empathy for others, which leads to callousness; and the inability to experience shame, guilt or fear, which leads to selfish, reckless, and dangerous behavior.

If someone cannot experience the deeper feelings of love, tenderness, or compassion, they have no motivation to protect, sacrifice, or feel responsible. If others don’t matter much, there is no basis for feeling obligated to another. Instead of expressions of empathy, there are acts of callousness and selfishness. Relationships — whether marriages, friendships, colleagues, or, in the case of Trump, a country — are one-sided, loveless, and instrumental.

Combine the inability to care for someone with the inability to experience guilt, shame, or fear, and you have an individual with no sense of limits on their behavior. What seems to separate psychopaths from the human pack is their callous treatment of others and the lack of remorse in any situation where they may have caused harm.

This remorselessness cluster of traits is all about the absence of humanizing qualities. Psychopaths appear to have an inherited, neuro-developmental abnormality whereby they simply cannot experience much, it at all, of three emotional states: fear, shame and guilt. Psychologists call these states “inhibitory” emotions because they guide us to be sensitive to and cautious toward threat situations; they also lead us to be appropriately concerned about the effects our actions might have on others, thus curbing our selfish or immoral tendencies.

What must it be like to live with such a hole in your psyche? We all know what the word remorseless means, and we may even have vivid associations with it. But we can’t quite grasp what it is like to have no conscience at all, to feel utterly undaunted by the fear of punishment, to have no limiting concern for the damage inflicted on others.

For the overwhelming majority of us, two quests make life precious: the pursuit and realization of love and the constant struggle to be our best selves, what the ancients called the pursuit of virtue. While these humanizing, life-enhancing drives may expose us to heartache and self-criticism, they give life meaning and depth. Such quests are simply off the table for the psychopath. Where love and conscience should be, lovelessness and guiltlessness reside. Compared to perhaps all other psychiatric conditions, this is the one you would take a bullet for to prevent your child from acquiring.

Psychopaths, particularly because of their remorselessness, have a “different creature” quality. It is difficult to see how terms like social cognition and emotional intelligence even apply to them. But remorselessness certainly impacts one’s executive functioning. Again, Trump’s behavior at the pandemic’s beginning is a good example.

Trump’s diminished capacity to experience fear and thus apprehend the presence of a threat no doubt contributed to his sluggish response to COVID-19, despite that we now know from Trump’s interview responses to Bob Woodward for his book Rage that he was fully briefed in January of 2020 about the lethality and transmissibility of the virus. Nevertheless, he seemed oblivious to the scale of the risk. Even into March, he described it as a “hoax,” although Asia and Europe were already undertaking massive mobilization efforts. He lied shamelessly to the public from the beginning about the threat (“It’s going to disappear. One day like a miracle, it will disappear”).

A core feature of psychopathic guiltlessness is the refusal to take responsibility for one’s actions because one feels no guilt for the harm one may have inflicted. This trait was on full display throughout America’s regrettable response to COVID-19. “Nothing more could have been done. Nothing more could have been done. I acted early. I acted early,” he blathered to Woodward. And was there any better, that is more odious, example of absence of shame or a moral heartbeat than his doling out of ventilators and protective equipment to governors based on their political leanings and sycophancy to him?

Because of his remorselessness, Trump can’t help but:

• Blithely ignore norms, the tragedy of lost lives, or appeals from anyone to rein in his reckless and derelict behavior
• Set any limits on his behavior since he has no limiting sense of concern for the well-being of others
• Deflect all blame for any damage he may inflict.
• Have no feeling of discomfort to the suffering by others
• Have disregard and disdain for others

Trump is at the mercy of this trait, and, by extension, all of us in his orbit are as well.

The Psychopath’s (Trump’s) Drive to Dominate Trait

The remorselessness and callousness of the clinical psychopath represent deficits in his neurological hardware that result in the incapacity to experience love, fear, guilt, and shame. However, the psychopath is not a detached person. He is aroused by an intense drive to dominate. The wiring of the psychopath doesn’t allow him to care or have the humanizing emotion of remorse. Still, it does propel him to operate in the gear of “winning” in a relationship, whether with a spouse, friend, colleague, company, or country.

He has plenty of emotional fuel for that. Although bereft of the animating force that comes from love and empathy, the psychopath fully experiences emotions associated with the drive to dominate, such as anger, glee, resentment, envy, jealousy, consternation, and contempt. These emotions are often fleeting but can be intense at the moment and typically drive the psychopath’s behavior.

For the psychopath, relationships are instrumental. People are means, not ends in themselves. He will always look for actions that benefit him and disadvantage the other. With predation as an innate motivation, relationships go downhill fast. What may start as mere selfishness and lack of reciprocity inevitably moves to cheating, lying, and cruelty. Those are the attributes it takes to “win at all costs.”

Psychopaths (Trump) can only operate in the one gear of dominating relationships. There is no room for collaboration. Early in the pandemic, it became clear he could not work with or defer to public health professionals. He would subvert policy to divisive culture wars waged with deceit. Trump treated the crisis as a media spectacle that he was driven to dominate. By instinct, he did not view the pandemic as a threat to the country but rather to his re-election and his brand of “stable genius” and “I’d give myself a 10”. His primary mode was to tell a story about the crisis that made him look good rather than actually manage it (“always be closing”).

His rigid drive to dominate trait was calling the shots in the weeks after election night in 2020. As the clock ticked down to the certification of the election results in Congress, he became more cajoling and then intimidating. His possible illegal call pressuring the Georgia Secretary of State to “find” more votes was recorded for the world to hear. He made a similar call to Michigan lawmakers to demand the appointment of new electors who would vote for him despite losing the popular vote by 154,000 and to the Speaker in the Pennsylvania House to help overturn the election results there. And then there were meltdowns. He lashed out at Vice-President Pence, Bill Barr, the White House counsel — people he viewed as subordinates now committing insurrection by refusing to kowtow to the “Stop the Steal” mission.

It was all one gear. He would bully and bluster his way to retaining the presidency. After all, that mode had certainly paid off in his real estate ventures and his pursuit of the nomination and presidency in 2016. But it wasn’t a strategy. It was preternatural, the only mode available to him.

Because of Trump’s drive to dominate and arrogant, deceitful mode, he can’t help but:

• Lie with impunity to get others to bend to his will
• Demand fealty from others
• Engage in frantic efforts to avoid loss of status
• Focus on “winning at all costs”
• Foment divisiveness

At every choice point for the clinical psychopath, in their work and their relationships, power, and dominance will prevail over the welfare of others. The drive to dominate set of traits captures the innate predatory nature of the psychopath. But it also explains how many psychopaths, especially those raised in families with wealth and standing, move through the world in a way that can lead to prosperity, even fame.

This leads us to the third criticism of mental health professionals who put out informed opinions on Trump.

Objection #3: If Trump supposedly has a serious psychiatric condition, how do you account for all his success?

Rebuttal: His psychopathic traits explain his success in certain arenas. The way he goes about achieving real-world success only provides further confirmation of his diagnosis of Psychopathic Personality Disorder.

There is no denying that Donald Trump has been successful in certain arenas — real estate, reality TV, and, most critically, in consolidating political power. That a person with a severe personality disorder became president is extraordinary but not incomprehensible. Psychopathic traits are a good fit for the Machiavellian dark arts associated with political success. These traits convey certain advantages to the clinical psychopath in the political arena.We can see this more clearly through the lens of the three governing traits of the disorder.

Impulsivity

The psychopath is chained to the immediacy of a “What’s in it for me?” and “How do I win the moment?” state of mind. His attention is unburdened by deeper aims, other people’s interests, or concern about future consequences. Second thoughts are for losers. This hard-wired, rapid-fire, egocentric self-interest is an asset, not a liability, in the current media and political landscape.

He may be a prisoner of his psychopathic trait structure and markedly incompetent in tasks that require planning, discipline, and sustained focus. However, this “win the moment” impulsive nature enables him to be successful, particularly in the dog and pony show dimension of politics. We need to acknowledge that man has skills. These include: how to read a crowd; how to move a crowd; how to brand and make a label stick (“sleepy Joe”); how to get GOP rivals to “bend the knee”. He is a ratings wizard.

He also knows how to throw a rally. His rallies are mostly riffs, as expertly executed as Chris Rock’s: a display of narcissistic preening, Mussolini-like gestures, and scatological rhetoric. Burlesque and politically incorrect authenticity fused in his performance, resulting in a gay dance between the cult leader and his minions.

Superficial charm and lack of sincerity are traits in the impulsivity cluster and specific items on the Hare Psychopathy Checklist. In the service of always selling himself, the psychopath exudes glibness and superficial charm. He can be entertaining and seductive. He lies casually and comfortably to win favor or just spin a good yarn. Trump seems able to effortlessly turn failure and disgrace into gold — “I’d give myself a 10” (on handling the COVID-19 crisis). He can skillfully cast himself as a heroic protagonist in the capitalist fairy tales of Art of The Deal and Celebrity Apprentice. What he cannot do is be sincere.

The trait of “superficiality” is not used here simply as a criticism. The clinical meaning of this term refers to the psychopath’s specific inability to process emotions in the upper parts of the brain where crude impulses are refined to more complex, “deeper” states, such as tenderness, melancholy, pride, empathic pain, gratitude, and enchantment. However, as we will describe shortly, the neurological infrastructure to develop deeper feeling states or values is either deficient or not functioning with the psychopath. His bandwidth of emotion is tied to the immediate present and limited to states of frustration, irritability, resentment, envy, greed, sensual pleasure, and a uniquely psychopathic state called duper’s delight.

David Shapiro, a respected early theorist of psychopathology, makes the point in his classic text, Neurotic Styles, that psychopaths possess the “malignant charms” that can result in real-world success:

It is well to remember, however, that the impulsive (psychopathic) style may, in some regions of living, be quite adaptive. These areas seem to be ones where readiness for quick action or expression and/or a facility and competence of a sort that be developed in pursuit of immediate and egocentric interests can be useful. It is well known, for example, that many impulsive people possess considerable social facilities and are often socially very charming and engaging. They may also be quite playful, in contrast, for instance, to the heavy, over deliberate, and somewhat dull quality of some obsessive-compulsive people, and, given a good intellectual endowment, they may be witty and entertaining. There is no doubt also that many actual as well as fictional “men of action” have excellent practical competency and a capacity for quick and unhesitating action…. They have a keen, practical intelligence that is suited to the competent execution of their short-range, immediate aims. (p. 147)

The impulsive character, unfortunately, is often a step ahead of those who try to conduct themselves with integrity and purpose. Everyone else is playing chess, and Trump is playing checkers. Everyone else (at least in Blue America) may cry “foul” or wag their finger. Trump simply sneers and declares himself the winner. And those traits are at the heart of his success in putting a significant swath of the country into his thrall.

The psychopath’s inability to defer gratification or focus on any endeavor outside their instant appraisal of ‘what’s in it for me?’ compromises their way of life. And to be clear, most psychopaths’ lives end in ruin. The card cheat eventually gets caught, but in the short run, he may walk away from the table with all your money.

Trump has cards to play. He may be helpless to curb his egocentric impulses, but this only leaves him with a heightened understanding that works in the political arena (remember how he demolished his GOP rivals in the 2016 debates without possessing a hint of policy expertise). We cannot underestimate him.

To bring the conversation back to whether Trump may also display a Neurocognitive Disorder, we must resign ourselves that there is no way to measure decline in one of the six key cognitive domains: executive functioning. The infrastructure for executive functioning that we all take for granted is of a different order for the psychopath. Trying to place Trump on any normal executive functioning scale would be misleading. Though we can’t measure it, we can call it out: Trump’s executive functioning is abysmal largely due to his impulsivity cluster of traits. Trump’s personality disorder is the worst imaginable fit for the Oval Office, but not for our hyper-partisan, performative, beyond truth and shame contemporary political arena.

We might say Trump’s impulsivity is a two-edged sword and I suppose it is for him. But for the rest of us facing the consequences of his personality disorder it has just one edge, razor sharp, ready to draw blood from whomever crosses its path.

Remorselessness

As noted above, remorselessness is not only considered the most chilling aspect of the psychopath’s makeup but also its most central feature, the one that gives him that “different creature” quality. How might such a destructive trait contribute to the psychopath’s success in moving through the world? Martha Stout, one of the leading contemporary experts on psychopathy, provides as good an answer as I have seen in the introduction to her landmark book, The Sociopath Next Door:

Imagine — if you can — not having a conscience, none at all, no feelings of guilt or remorse no matter what you do, no limiting sense of concern for the well-being of strangers, friends, or even family members. Imagine no struggles with shame, not a single one in your whole life, no matter what kind of selfish, harmful, or immoral action you have taken… Now add to this strange fantasy the ability to conceal from other people that your psychological makeup is radically different from theirs. Since everyone simply assumes that conscience is universal among human beings, hiding the fact that you are conscience-free is nearly effortless…You can do anything at all, and still your strange advantage over the majority of people, who are kept in line by their conscience, will most likely remain undiscovered… Maybe you are someone who craves money and power, and though you have no vestige of conscience, you do have a magnificent IQ. You have the driving nature and intellectual capacity to pursue tremendous wealth and influence, and you are in no way moved by the nagging voice of conscience…You choose business, politics, law, banking, or any of a broad array of other power professions, and you pursue your career with a cold passion that tolerates none of the usual moral or legal encumbrances. When it is expedient you doctor the accounting and shred the evidence, you stab your employees (or your constituency) in the back, tell lethal premeditated lies to people who trust you, attempt to ruin colleagues who are powerful or eloquent, and simply steamroll over groups who are dependent and voice- less… You have a special talent for whipping up other people’s hatred and sense of de- privation… And all this you do with the exquisite freedom that results from having no conscience whatsoever… You become unimaginably, unassailably, and maybe even globally successful. Why not? With your big brain, and no conscience to rein in your schemes, you can do anything at all. (pg. 1)

Even though it sounds like his bio, Stout wrote that description before Trump entered the political scene. Her description of the psychopath as an almost otherworldly supervillain may seem exaggerated but is consistent with the observations from the pioneers in psychopathy research — Hervey Cleckley, Robert Hare, and Kent Kiehl.

We need to recognize the political power of remorselessness.

It provides the psychological platform for Trump to execute his “win at all costs” moves. It enables him to lie, cheat, and divide with impunity. There is no ember of shame or guilt to constrain him.

It enables him to effortlessly, naturally, and often persuasively blame others. Any hesitation in his speech does not burden him, and there is no conflicted look on his face or any qualm whatsoever in delivering his self-serving messages (30,573 documented lies over the past four years, but who’s counting?).

And it underscores his failure to accept responsibility, the psychopathic trait about not caring if one’s actions have hurt others. Remember his “I don’t take responsibility at all” retort in March 2020 when asked about testing snafus and the Administration’s sluggish response to COVID.

A man with no capacity for guilt or shame is an alarming opponent. He will do anything to win, whatever the risk or collateral damage.

Social cognition, one of the six domains to measure possible decline for a diagnosis of Neurocognitive Disorder, refers to qualities such as empathy, self-awareness, and the ability to manage one’s emotions and defuse conflict. With a clinical psychopath, you can highlight their deficit in social cognition. Still, you cannot measure decline because there is no meaningful baseline to compare current to past functioning. The psychopath appears to have a neurodevelopmental brain abnormality which prevents them from processing the humanizing emotions of empathy, guilt, shame, and fear. Their remorselessness is hard-wired and usually emerges in childhood and certainly by adolescence.

Drive To Dominate

How does the psychopath’s “drive to dominate” contribute to his success in the political arena? As noted earlier, since the psychopath is unable to participate in the game of love, his energy and focus are freed up for the game of status-seeking through domination. The psychopath is most comfortable in the arena where he can dominate others and declare himself a “winner”. An election fight, of course, is just such an arena. Trump transforms all endeavors into a game of winners and losers, which he gleefully referees. Like a predator, his focus is one-dimensional (“always be selling”) and aggressive (“grab ’em by the pussy,” “We pledge to you that we will root out … the radical left thugs that live like vermin within the confines of our country that lie and steal and cheat on elections,”).

We now live in a country where one’s vote is influenced less by positive connections to one party and more by hatred for the other. Trump has played this negative partisanship card skillfully. No one has made liberals more enraged than Donald Trump. No one has thrilled Republicans with the politics of resentment more than Trump. His rallies have been described as hate fests. But they are more like love fests where Trump and his supporters bond over their hatred of Democrats.

Polarization and domination are preternatural skill sets for Trump. “Love to have enemies,” he told an interviewer from Time magazine in 1989. “I fight my enemies. I like beating my enemies to the ground.”

Psychopaths are also adept at stoking grievances in others. Since they often feel aggrieved, they know how to tap into that feeling in others. They know the language of victimization. They are skilled in the art of trolling. They have exceptional skills in whipping up people’s resentments. Trump could teach a master class on this political art.

Arrogance is one of the “drive to dominate” subtraits. An arrogant demeanor is appealing to some. Many take this for self-confidence or even a kind of “bad-boy” charisma. Add his Realty TV skills to these “malignant” charms, and you will have a formidable political animal.

Brain Abnormalities in Clinical Psychopaths

For a diagnosed clinical psychopath such as Trump, measuring decline in the domains of attention, executive functioning, and social cognition is not a plausible endeavor. Yes, he would receive markedly below-average ratings in these areas but the ratings would hold throughout his lifespan. There is simply very little room for decline.

His poor functioning should not be viewed as a matter of degree but more as a matter of kind. The critical distinction with Trump is less that he functions poorly and more that he is so different from others because of his extreme personality traits. Paradoxically, as we have seen, these traits actually account for some of his success in the political arena.

To rate Trump in these essential areas of functioning is to elide the “different creature” quality of the psychopath. It would be like asking a color-blind person to distinguish different hues in a painting. Trump is not in the game of complex attention, executive functioning or social cognition, or at least not in the way we normally recognize those skill sets.

And now we have accumulating evidence that this “different creature” quality is reflected in functional and structural brain abnormalities of psychopaths, like Trump, who have met the strict criteria of the Hare Psychopathy Checklist.
Key functional deficits in the emotional processing abilities of diagnosed psychopaths were identified in some creative studies by Robert Hare, the creator of the Hare Psychopathy Checklist. In a seminal study in 1991, Hare presented a series of neutral words (e.g., table, house, tree, lap) and then a series of emotional words (e.g., love, pain, mother, hate) to a group of prisoners who scored in the psychopathic range on the Psychopathy Checklist. He compared their brain activity to a group of non-psychopaths presented with the exact words. The non-psychopaths reacted more intensely and rapidly to the emotional words. The psychopaths reacted to the emotionally charged words the same as to the neutral words.

More critically, brain imaging showed that psychopaths processed these emotional words in the upper part of the brain (temporal lobe area), which is responsible for understanding language and problem-solving. In contrast, non-psychopaths processed the emotional words in the midbrain (paralimbic area), which is responsible for emotional regulation.

These findings were reinforced in later studies by Hare and his colleague, Dr. Kent Kiehl, the leading expert on brain imaging and psychopathy. In one study, he asked diagnosed psychopaths to rate morally offensive statements compared to neutral statements (e.g., having sex with a mother vs. listening to music). In another study, he showed psychopaths gruesome or morally offensive images (e.g., a man’s face beaten to a bloody pulp, a picture of Osama Bin Laden). In both studies, psychopaths reacted less intensely, and in the part of the brain designed for language and problem-solving. They simply do not experience the appropriate emotional reactions to moral wrongs or situations that commonly evoke compassion.

When almost all of us see a gut-wrenching or morally offensive situation, we automatically and rapidly react to it in the emotional part of the brain. But for the psychopath, that part of the brain seems to have gone cold. The empathy response is just not there. Instead, they react to such situations more neutrally and analytically, tapping into the part of the brain that, for example, is trying to write a term paper. Hare notes, “it was as if they could only understand emotions linguistically. They know the words, but not the music, as it were.”

We now know that psychopaths respond radically differently to three types of situations: those involving threat, the possibility of punishment, and witnessing the distress of others. Psychopaths are famously calm in situations that most of us would find frightening or heart-breaking.

Thanks to the ground-breaking imaging research by Kent Kiehl and other investigators, we see how these functional deficits are linked to structural abnormalities in the brains of clinical psychopaths. Brain scans reveal structural differences in three brain parts: the paralimbic area (midbrain), the amygdala, and the prefrontal cortex.

Kiehl emphasizes that psychopaths have inherited a brain abnormality in the paralimbic area that is responsible for processing the “inhibitory” emotions of fear, shame and guilt. Psychologists call these states “inhibitory” emotions because they guide us to be sensitive to and cautious toward threat situations and lead us to be appropriately concerned for the effects our actions might have on others, thus curb our selfish or immoral tendencies. Absent these humanizing emotions, psychopaths cannot establish an empathic or loving connection to others.

The amygdala regions of the brains of psychopaths have been found to be significantly smaller than with non-psychopaths. The amygdala is instrumental in processing states of fear and anxiety. Psychopaths are famously calm in situations that most of us would find frightening. A telling anecdote from the biography, “Trump Revealed” (2016), comes from a babysitter. With all the good judgment typical of an adolescent, this teenage babysitter takes his five-year-old charge on an urban adventure. They venture into a sewer system under construction in Manhattan. Shortly after entering, the teenager quickly becomes panicky, “it was pitch black, and you couldn’t see the entrance.” But the five-year-old pressed on into the gathering darkness. “The thing that amazed me,” that teenager, now in his late 80’s, said, “was that Donny wasn’t scared. He just kept walking.” A defective amygdala might explain young Donny’s fearlessness.

Studies also reveal that, for psychopaths, there is not only less volume of grey area in the prefrontal cortex, but also less connectivity between it and the amygdala. This has been linked to the psychopath’s impulsivity, inability to defer gratification, difficulties responding to facial expressions, and the capacity to experience self-conscious emotions such as embarrassment.

Individuals who score in the psychopathic range on the Hare Checklist appear to come into the world with brains that are insensitive to punishment. This neurological deficit is a crucial factor in understanding the development of psychopathy. After all, childhood punishment or the fear of such punishment for breaking the rules, acting selfishly, and so on, sets the stage for developing a moral code and for considering the rights and feelings of others. Recent studies reveal that psychopaths display this lack of anxiety at a very early age. This insensitivity to punishment undermines their ability to develop a conscience. At best, they only consider whether they might get caught for their deceitful, rule-breaking, or callous behavior.

There is a good deal of anecdotal evidence that Trump displayed this neurologically-based emotional processing deficit characterized by fearlessness, lacking remorse, and not being fazed by punishment. We noted earlier his babysitter’s report of his fearlessness as a five-year-old in the gloom of the Manhattan sewer system. By all accounts, Trump’s father, Fred, was a harsh and intimidating man. Trump’s older brother, Freddy, was traumatized by his father’s critical and demanding manner and succumbed to death at age 43 to alcohol-related conditions. Donald Trump bragged that he had never been intimidated by his father, unlike his other siblings. Mary Trump, Fred’s daughter and author of Never Enough and Too Much: How My Family Created the World’s Most Dangerous Man, reports that Trump’s fearlessness was the impression of other family members as well. Trump was a constant and unrepentant rule-breaker, both at school and home. Trump spent so much time in detention at Kew-Forest elementary school that his classmates nicknamed the punishment “DT’s”, which was short for “Donny Trumps”. He was in constant arguments with his teachers. At home, his mother acknowledged she couldn’t control him. He comes across as a child who never backed down.

Many remember Trump as a bully, and there are numerous examples of callous behavior. For example, Mary Trump reports he “tormented” his little brother Robert and stole his toys. A neighbor told biographers that, after she had put her son in a playpen in the backyard and then went inside for a few minutes, she returned to see that Donald, five or six at the time, was throwing rocks at the toddler. Another neighbor remembers seeing Donald jump off his bike one day and thrash a little boy. When he was a bit older, Trump and a friend, imagining themselves being gang members, began collecting switchblades. Fred Trump discovered the cache of knives when Donald was in the seventh grade, which reportedly triggered his time in military school.

Thus, there doesn’t appear to be any meaningful decline in Donald Trump’s social cognition or emotional intelligence. His brazenness and remorselessness were on display from an early age, likely due to inherited brain abnormalities that sealed his fate with regard to the possession of these and other destructive traits.

In summary, Trump’s unique challenges with attention, executive functioning, and social cognition are long-standing and have been well-documented. While his likely Neurocognitive Disorder may exacerbate such difficulties, they are not the cause of them. Trump’s struggles in these areas are mainly due to his diagnosed Psychopathic Personality Disorder. Individuals with diagnosed PPD have been found to have inherited brain abnormalities. Such abnormalities help account for his limited functioning in key areas of what it means to be human. They also highlight the neural infrastructure, or lack thereof, that produces the governing traits of remorselessness, impulsivity, and drive to dominate that determine the dangerousness of the clinical psychopath.

More On Trump’s Psychopathic Personality Disorder

A Duty to Differentially Diagnose: The Validity Underpinning the Diagnosis of The Ex-President

The Open and Shut Case of Donald J. Trump

Same Psychopath, Different Year

Trump’s a Clinical Psychopath: Explained

Please note: This article is not financed by or related to any political campaign and may not be considered political advertising or action on behalf of any political candidate. All statements and opinions are those of the author alone, including any political endorsements made. The information published in this article is for information only and is not intended to provide psychological therapy or diagnostic advice and/or recommendations to any persons aside from its subjects, Donald J. Trump and Joseph R. Biden, public figures. The content of this article is intended to provide informational, scientific and educational material based on psychological science. The content of this article solely reflects the views and perspectives of its author and does not necessarily reflect the views or positions of the American Psychological Association, medium.com, or any other person and/or entity not otherwise listed as an author.