THE SCIENCE BEHIND DONALD TRUMP’S DANGEROUS PERSONALITY DISORDER

by Vince Greenwood, Founder of DutyToInform.org

I’m a clinical psychologist specializing in forensic evaluations. That’s the background I brought to the political arena in 2020 when I tried to contribute to the efforts of politically active mental health professionals who felt they had a duty to warn the public about specific psychiatric vulnerabilities in Donald Trump that could pose a threat to the Republic. With his defeat, we thought we had put the threat to rest, but it has come roaring back. Some of us in the mental health community felt our findings should have had a more significant impact. After all, many of us had spelled out psychological disturbances that demonstrated Trump was unfit for office, clinically dangerous, and really was and is an existential threat.

My goal in this article is to describe the scientific underpinnings that inform our duty to warn that Trump is a clear and ever-present danger. I hope this information can provide an additional vantage point, an additional plank in our argument, one with empirical support, to possibly influence persuadable voters.

Let me start by observing that Trump certainly is a unique character — flamboyant, politically incorrect, and enthralling to his supporters. He is the central protagonist in our current political crisis. Strikingly, he is unmoved by the wrath directed at him by his political opponents. This defiance, coupled with his ability to ‘troll the libs,’ is a central part of his appeal. Supporters and detractors would agree that he is riveting and seems to operate in a realm of his own making.

However, as I will argue, he is anything but unique. He is a garden-variety example of a particular and precisely delineated psychiatric condition. He is, sadly for him and dangerously for the rest of us, a prisoner of his psychopathology, a puppet on the strings of a set of destructive personality traits that dictate his behavior. He is at the mercy of those traits, and, by extension, so are we.

As mental health professionals, we have an ethical duty to not only inform but to warn: even with all he has done and all he has threatened to do, because of his condition, we are on solid scientific grounds to warn you that we are underestimating the danger he poses. We hope that this disturbing message can raise awareness of the threat that Trump, saddled with this condition, represents and mobilize us to do whatever we can to defeat him at the ballot box.

How can we assert that we underestimate the dangerousness of the man because of his condition?

Let’s start with a bit of history on this dangerous disorder. This condition has 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 a small group among us that are intellectually coherent but lack the capacity for moral reasoning. Such individuals do not seem to experience emotional suffering — there is no psychosis, no anxiety, no depression — but seem impervious to punishment. They display a constellation of personality traits frequently associated with immorality and criminality but also, in some cases, socioeconomic success, even if that success is gained through dishonest means. No culture or station in life is immune from this condition. It is described across all of written history, and we find it among the wealthy and the impoverished.

It wasn’t until the 19th century that the condition was named and attached to the small group of individuals in society who are devoid of moral sensibility. The term used comes from the German word psycho-pastiche, which translates to ‘suffering soul.’ The English word is a psychopath.

Our understanding of such individuals took a quantum leap in the 20th century due primarily to the work of two men. Hervey Cleckley, an American psychiatrist from Georgia, devoted his career to studying this condition and published his insights in a book titled The Mask of Sanity in 1941. Considered one of the great works in the field of psychopathology, it depicted the psychopath as an individual, while appearing to be a perfectly average person, indeed often a charming person, who nevertheless displays a particular set of traits which inevitably lead to menacing behavioral patterns that are harmful to others. The harm maifests itself at times in criminal acts, but always in exploitive behavior, marked by arrogance, cunning and deceit. Cleckley identified 16 such traits and behavior patterns. Examples include untruthfulness, lack of sincerity, superficial charm, inability to feel remorse or shame, and limited insight into their personality.

In the 1970s, Robert Hare, a Canadian psychologist, and his research team developed a checklist to diagnose the condition. This measurement tool enabled us to develop a detailed and scientific understanding of the condition since it generated many studies. As a result of that groundbreaking development in defining and objectively measuring the condition, we can now say that clinical psychopathy is one of the most thoroughly validated and best-understood conditions in the field of psychopathology.

We need to discuss that Checklist, called the Hare Psychopathy Checklist, briefly because it explains why we can speak with such authority and precision about Donald Trump’s dangerousness.

The Psychopathy Checklist has 20 items. These items reflect the very problematic but stable and long-standing traits and behavior patterns that Hervey Cleckley and some other leading experts in the field had identified. For each item, the diagnostician is asked to give a rating on the pervasiveness of the trait. The guidelines to diagnose psychopathy are straightforward, but the demands on the diagnostician are rigorous.

First, you are required to collect voluminous data, basically detailed life history information. The diagnostic process for this condition demands: (1) information from the patient’s childhood, adolescence and young adulthood since the condition of psychopathy expresses itself early in life.
(2) Life history information in which the trait is expressed in observable. behavior (e.g., evidence of lying is preferable to the accusation of his lying).
(3) Information that reflects the patient’s typical functioning and lifelong patterns rather than descriptions of more flamboyant, occasional behavior.
(4) And well-resourced information with some type of external validation.

Second, you are required to undergo specialized training to administer the Checklist. The training involves learning extensive definitions and behavioral examples of checklist items, how to collect and evaluate the quality of life history information from different sources, securing feedback on videotaped case studies to increase precision on the administration of the checklists, and other skills to ensure a reliable and valid diagnosis.

Before I give the findings for Trump with the Checklist, let me note that none of the items on the Checklist are good news — they all represent worrisome traits or behaviors. Some examples of the items include deception and gaslighting, callousness, promiscuous sexual behavior, history of juvenile delinquency, and lack of a conscience. For each item, you get a score of 0 (no meaningful expression of the trait in the person’s life), 1 (moderate expression of the trait), or 2 (strong expression of the trait — it is persistent and pervasive in the person’s life). With 20 items, a perfect score on the psychopathy end of the spectrum would be 40 (a very rare occurrence), and a perfect score on the non-psychopathy side would be 0 (also rare).

The average score for individuals in a maximum security prison setting is 22. I mention that because the typical cutoff to get a formal diagnosis of psychopathy is 30. It’s a high bar that even most serious criminals don’t meet. Remember, the essence of this condition, as identified by the experts, is more about traits than criminality or antisocial behavior. One in 140 (less than 1%) in the general population meets the criteria for the diagnosis.

The average score in the general population is 4 (few of us are perfect angels). Here, I suggest a thought experiment to emphasize a point. Imagine that your son or daughter is dating someone seriously, it looks like the relationship is headed toward an engagement. Somehow you could administer and see their score on the Psychopathy Checklist. If you saw a score of 10, I’m sure you would be worried, probably sick with worry. If you saw a score in the teens, I suspect you’d be trying to figure out ways to end the relationship. Scores in this range are a bit unusual, weird one might say, in a statistical sense. But something more than weird. Something ominous.

{For the evaluation of Donald Trump, we first need to ask and answer the question: Can you diagnose someone for clinical psychopathy at a distance? A strong “yes” is answered if you have sufficient life history data. Fortunately, with Trump, we are awash with information. He is arguably the most well-chronicled candidate in history. A partial list of informational sources would include 13 autobiographical efforts as well as his social media posts, 71 biographies, many of which are richly sourced, and hundreds of interviews from print, radio, and television. A clinical interview is not necessary to diagnose the former president for this condition. Indeed, there is research to indicate that the interview can detract from the assessment of a psychopath because of their facility for lying.}

Thus, we have abundant life history data for Trump, and I have had the advanced training to administer the Psychopathy Checklist, which I did in 2020, and again recently. Here are the results:

Hare Psychopathy Checklist-Revised (HCL-R)
1. Glibness/superficial charm — 2
2.Egocentricity/grandiose sense of self-worth — 2
3.Proneness to boredom/need for stimulation — 2
4. Pathological lying and deception/gaslighting — 2
5. Conning/lack of sincerity — 2
6. Lack of remorse or guilt — 2
7. Shallow affect — 2
8. Callous/lack of empathy — 2
9. Parasitic lifestyle — 0
10. Poor behavioral controls — 2
11. Promiscuous sexual behavior — 2
12. Early behavior problems — 2
13. Lack of realistic long-term goals — 1
14. Impulsivity — 2
15. Irresponsibility — 2
16. Failure to accept responsibility for own actions — 2
17. Many short-term marital relationships — 1
18. Juvenile delinquency — 1
19. Revocation of parole — 0
20. Criminal versatility — 2
Total = 33
Trump receives a score of 33. The diagnostic process to assess clinical psychopathy demands thoroughness and objectivity. This rating reflects a fair-minded effort to call balls and strikes. Donald Trump passes the threshold for a formal diagnosis of clinical psychopathy.*

What does the diagnosis tell us? The Hare Psychopathy Checklist came onto the psychiatric scene in the late 1970s. It became the gold standard for selecting subjects for research on the condition, with the cutoff score usually set at 30. The Checklist triggered an explosion of studies. Google Scholar now cites some 83,000 studies associated with the Psychopathy Checklist. Therefore, we can say a great deal about the condition, and we can say it with confidence and fidelity.

What have we learned about the condition? We have learned that the condition is more due to nature (what one inherits) than nurture (how the environment impacts us). And that what is largely inherited appears to be a different brain. Brain imaging technology has enabled us to pinpoint some of the distinctive features in the brains of psychopaths that help explain their hard-wired traits.

Most critically (and most relevant to the appraisal of Trump), we have achieved insight into the essence of the disorder, what psychologists call the deep structure of the condition.

How do you go about zeroing in on the essence of a psychiatric condition? The challenge with a large and expanding data set like that which exists for clinical psychopathy is to find a way to distill it. Investigators turned to factor analysis, a robust data reduction technique that enables us to explore and identify primary, underlying factors in a large data set. It is a tool often used in personality research to reduce findings of many specific traits, behavioral observations, and other meaningful data points into more basic underlying factors or clusters of traits.

What has come out of the empirical wash with these solidly-built statistical techniques is the clarity that the psychopath is ruled by three distinct clusters of traits (known as the “three factor model” of clinical psychopathy). The three core, governing traits of the psychopath are:
(1) Impulsivity — characterized by the inability to inhibit impulses or grapple with any issue that doesn’t serve the psychopath’s immediate, egocentric needs
(2) Remorselessness — characterized by an utter lack of conscience, linked to an inability to experience states of guilt, shame, and fear that might curb immoral behavior.
(3) Drive to dominate — characterized by a one-dimensional focus on “winning” in all relationships, fueled by an arrogant, manipulative, and deceitful mode of behavior.
All of the behavior and all of the choices of the psychopath flow from these three governing traits.

The Three Core Traits of Clinical Psychopathy
To understand the true nature, the hazardous nature of Donald Trump, let me try to portray what it is like for the psychopath to be at the mercy of these three traits.

Let’s start with the impulsivity cluster of traits. The impulsive way of being is captured by the descriptors egocentric, superficial, and irresponsible. These are words we all use and have associations with, but they have a specific and clinical meaning in the psychology of the psychopath.
Egocentricity, for the psychopath, refers to the fact that their attentional field is limited to a “what’s in it for me?” boundary. The psychopath, Donald Trump, cannot engage the world beyond his selfish interests. His attention is tethered, captured by the moment’s immediate frustrations, provocations, and opportunities. His sizing up of a situation along the lines of his narcissistic needs is automatic and hard-wired. It is not complicated by factors such as deeper aims, accommodating other people’s interests, or worries about future consequences.

The psychopath’s attention is confined to the “What’s in it for me?” And “How do I win the moment?” impulses. For Trump, these impulses are acted out immediately and with no possibility of reflection or restraint. His condition prevents him from ever getting beyond pre-school level with executive functioning.

The clinical meaning of the term superficiality refers to the psychopath’s inability to process his triggered emotions in the upper parts of the brain, where crude impulses for almost all of us are refined to more complex, “deeper” states (e.g., tenderness, melancholy, pride, empathic pain, gratitude, enchantment, and so on). The psychopath’s brain is deficient in areas instrumental in developing deeper aims and values. Thus, he has no bedrock of complex emotions or values that could bolster his efforts to persevere or even take on nuanced or demanding situations that call for emotional depth and perspective. The psychopath is a different creature, and a rather compromised one.

The flavor of the irresponsibility component of the impulsivity trait for the psychopath is mostly about not getting the job done and not following through on one’s obligations or promises. Psychopaths avoid responsibility because they recognize they have neither the skills nor the temperament to handle complex problems. This is what Tony Schwartz, ghostwriter of The Art of the Deal by Trump, observed in his 18 months at Trump’s side. In recent reporting Schwartz testified to Trump’s disorganized, unfocused, easily bored, and undisciplined way of being (personal communication). This set of traits leaves him overmatched in trying to take on a thorny or complex issue that requires sustained focus.

Trump’s disdain for the details of governing masked his inadequacy to solve problems that required discipline, deliberateness, and focus. He bragged about not reading briefing papers and wouldn’t even tolerate PowerPoint presentations. He fired Chris Christie as head of his transition team, telling him they could take an hour off from the Inauguration party to figure out how to run the government.

Now let’s turn to the cluster of traits we refer to as remorselessness. This is what we most closely associate with psychopaths, what particularly gives them their ‘just a different creature’ reputation noted by almost all who work closely with clinical psychopaths . What seems to separate psychopaths/malignant narcissists from the human pack is their callous treatment of others and the lack of remorse in any situation where they may have caused harm. It is hard for us to grasp what this is like — to have no capacity for shame or guilt, no matter what selfish or harmful behaviors one might commit. Distress in others simply does not register in the brains of psychopaths.

Psychopaths/malignant narcissists are utterly insensitive to the threat of punishment. The daily struggle 99% of us have between “I want” (what’s in it for me) and “I should” (weighing that impulse against deeper values or concern for others) just doesn’t take place with the psychopath. At an emotional level, there is nothing there to curb their selfish, cruel, or immoral tendencies.

Note that this remorselessness cluster of traits is about the absence of emotions instrumental in our concern for others. Thanks to advances in brain imaging technologies, we now have accumulating evidence that this deficit in humanizing emotions is reflected in structural brain abnormalities of psychopaths. There are differences between psychopaths and 99-plus percent of us in parts of the brain responsible for processing feelings of empathy and the emotions of shame, guilt, and fear. Many psychopaths are extroverts, even charming extroverts, but at the core of their being, there is a coldness, a deadness concerning humanizing emotions. The title of the landmark book on the condition — Mask of Sanity — captures this gap between what you see (a charming but superficial extrovert) and what is underneath (a cold and callous calculator).

This brings us to the third cluster of traits: the drive to dominate. Although deprived of the capacity to care or empathize, the psychopath is not detached in his relationships with others. He is very engaged, turbo-charged, in the game of dominating others. His focus is one-dimensional and aggressive. Since dominance and “winning” are the only dance cards available to him, the psychopath often becomes adept at them.

Psychopaths tolerate two kinds of relationships: transactional and fawning admiration. The transactions are one-way and exploitative. All of life is a game to be won. If you are in the psychopath’s orbit, you will be used and eventually harmed. What may start as selfishness and lack of reciprocity inevitably moves to dereliction and cruelty.

When we crunch the numbers on this drive to dominate cluster of traits, two themes emerge with the psychopath: first, there is a kind of hostile aggressiveness of manner, as captured by the traits antagonistic, arrogant, and garrulous; second, there is a default mode of lying and cheating to get the upper hand, as captured in the traits deceitful, manipulative, and insincere.

The research findings about these three central and unyielding traits enable us to understand and explain Trump’s destructive behavior. As an example let’s take his disastrous response to Covid-19. Studies indicate that 40% of the 1.1 million who died in America were due to The Trump administration’s mishandling of the crisis (more needless deaths than all of the deaths in WWII, the Korean War, and the Vietnam War combined)

Trump’s impulsivity trait guaranteed a botched federal response to COVID-19. The crisis demanded discipline and hard work. Trump 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. The crisis demanded a set of executive skills to develop a detailed and comprehensive response. Trump’s impulsive nature precluded that.

In theory, Trump could have delegated authority to others who were capable, he could have collaborated with public health officials, or consulted any number of think tanks that had detailed plans on how to manage a pandemic. After all, it would have made him look good. But the drive to dominate trait ensured that was never going to happen. Collaboration is anathema to the psychopath. The psychopath is like a leopard who rejects traveling in a pack and relies solely on their cunning to seek out their prey.

From the outset, Trump treated the crisis as a media spectacle that he was driven to dominate. By instinct, he did not view the crisis as threatening the country but as a way to promote his brand of “stable genius.” His primary mode was to tell a story about the crisis that made him look good rather than actually manage it.

Lacking any gear of compassion, Trump barreled forward in the only gear he possessed: win-at-all-costs-political-domination. He refused to wear a mask and mocked those who did; he tweeted out support to protestors who flaunted social distancing guidelines; he doled out ventilators and protective equipment to governors based on their political leanings and loyalty to him; he peddled exaggerations about the administration’s achievements; he promoted bogus treatments; and he conducted rallies and White House events that became super-spreader events.

And his destructive response to Covid was platformed by his hard-wired trait of remorselessness. Trump had no moral fear of the consequences of his neglectful and divisive behavior. Feelings of shame and guilt are totally foreign to him. A psychopath does not have the emotional infrastructure to care about overflowing morgues or peddling false claims to an anxious and vulnerable public.

Trump, being a psychopath, has no capacity for shame or guilt, feelings which might have slowed his impulse to deceive and divide. We now know from Trump’s interview responses to Bob Woodward for his book Rage that he was fully briefed in January 2020 about the lethality and transmissibility of the virus. And yet, he lied shamelessly to the public from the beginning about the threat out of concern for his political standing.

America’s response to COVID-19 left the world stunned. I would contend it was not simply the result of a “bad” or incompetent president but a “mad” president, the madness being the psychopathology of clinical psychopathy/malignant narcissism, especially the traits of impulsivity, drive to dominate, and remorselessness.

As another example, let’s examine Trump’s behavior from election night in 2020 through the January 6 attack on the Capitol from the perspective of these three governing traits. At 2:30 am on election night, Trump came on TV and, in a combative and petulant mode, declared that he had won the election, indeed won in a landslide. He claimed that he was a victim of fraud and the election was being stolen from him. “Stop the Steal” was launched with a direct assault on our democratic system without a moment of reflection.

During the next two months, Trump’s impulsive traits of irresponsibility and failure to plan were on full display. However, in this case, that set of traits worked to the country’s advantage (that is, assuming you are in the camp that believes liberal democracy is a good thing). It was clear that Trump wanted to subvert a free and fair election that he had lost. It was also clear that he was incapable of pulling it off.

His task, the coup, required a modicum of planning, focus and organization. As we saw with the response to COVID-19, he was incapable of such organization. What did he do during that period? Insider accounts reveal he just yelled and whined at whoever was in his proximity or who he had on the phone. Oh, and he would fulminate at the TV screen. He hectored (only hectored) his advisors, the Vice President, the Attorney General, election officials, and GOP allies about the steal and demanded that it be stopped. They, in turn, kept their mouths shut but inched away from him, recognizing his absurd claims and that he didn’t have the executive skills or temperament to pursue them to pull off his coup. It was time to send in the clowns: there was a second tier of conspiracy theory types waiting in the wings to step in: Sidney Powell, Michael Flynn, the My Pillow Guy, the return of Rudy Giuliani.

And yes, his new minions came up with a few Hail Mary plays, such as the fake elector scheme. At the 11th hour, he tried to intimidate Mike Pence and prevent him from certifying the election. But that was it. Michael Wolff, in his book Landslide, which gave the inside account of the Oval Office during the transition, 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.” Trump’s contribution was limited to belligerent, bloviated bleating.

Trump’s drive to dominate trait dictated that he could never accept electoral defeat. “Win at all costs” took over. During the interregnum he made no pretense of attending to the business of the country. All efforts to return his attention to pandemic issues, vaccine rollout, or security matters failed. There was no possibility of engaging him in, or even discussing with him, an orderly transition to the new administration.

It was all one gear. Trump would bully and bluster his way to retaining the presidency. But it wasn’t a strategy. It was preternatural, the only mode available to him. It mostly took the form of meltdowns. He lashed out at the Vice President, the Cabinet, his staff, and the sycophants — people he viewed as subordinates who were now committing insurrection by refusing to kowtow to the “Stop The Steal” mission.

That mission culminated on January 6 when he implored his supporters, “We will never give up… we will not take it anymore… we will stop the steal… if you don’t fight like hell, you’re not going to have a country anymore.” If that rhetoric meant delegitimizing a duly elected president, taking a wrecking ball to our democracy, so be it. He would have no remorse, no embers of shame, guilt, or concern that might give him pause.

His set of psychopathic traits powered the failed effort to undermine a free and fair election and the peaceful transfer of power. We can predict these traits will infuse his efforts between now and election day and beyond. A man with no capacity for restraint or remorse is an alarming opponent. He will do anything to win, whatever the risk, whatever the collateral damage.

Because of our natural ability to empathize and care, and to assume that others have such humanizing emotions, we underestimate the threat posed by diagnosed psychopaths and their set of destructive traits. Thus, we need to drive home certain truths about Donald Trump.

Because of his impulsivity, Trump can’t help but:
Act quickly without considering the consequences
Take huge risks since he craves sensation-seeking
Continue to display no aptitude for governance, and
Fail to plan or persevere with any substantive task

Because of his drive to dominate, Trump 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
Foment divisiveness and polarization, and
Privilege power and dominance over the welfare of others

Because of his remorselessness, Trump can’t help but:
Blithely ignore democratic 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 is undaunted by the fear of punishment
Deflect all responsibility for any damage he may inflict.
Have no feeling of discomfort at the suffering of others, and
Be lax in his response to legitimate threats because of his inability to process emotions related to danger

In conclusion, like any diagnosed psychopath/malignant narcissist, Donald Trump has had to suffer a life devoid of love, depth, conscience, or any hope of self-discipline. It is a life incapable of developing a caring obligation toward others, incapable of remorse for callous or immoral behavior, and incapable of pursuing anything beyond his immediate self-interest.

And it is also a life destined to inflict harm and suffering on others. With the empirical support of thousands of studies on his condition, we have to warn that Donald Trump, because of his hard-wired and immutable traits, is more dangerous than even his harshest critics exclaim.
Please be informed. November is coming.

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• Please note that the term malignant narcissist is also used frequently to describe the psychopathology of Donald Trump. There are a number of thoughtful discussions, especially by Dr. John Gartner, about the construct of malignant narcissism and how it explains Trump’s aberrant behavior. I use the term clinical psychopath because much of my analysis is based on the voluminous research associated with the Hare Psychopathy Checklist whose developer, Robert Hare, chose that term. There is substantial overlap between the construct of malignant narcissism and the diagnosis of clinical psychopathy. You would not be wrong in equating the two terms: they are essentially describing the same creature.

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 subject, Donald J. Trump, public figure. 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.