During Donald Trump’s first term, I wrote a lengthy article describing why many psychiatrists and psychologists believe Trump meets clinical criteria for a psychiatric diagnosis. I entitled the article “Why Trump is Full Tilt Bozo,” a reference to the late comedian Robin Williams’ use of the phrase to describe someone who goes all-in on an absurd idea, without regard for others, to the point of insanity.
I intend on updating the composition to reflect Trump’s fixation with losing the 2020 election. And given his speech on election fraud and interference it is worth taking another look at how Trump’s mental state influences his behavior.
Donald Trump, President of the United States, meets all the clinical criteria for narcissistic personality disorder and antisocial personality disorder, and many of the indicators for paranoid personality disorder. The list of criteria and description of the disorders are easily found by doing a Google search and as many mental health professionals have pointed out, Trump puts his behaviors out into world to be seen. So, while a formal assessment is needed to confirm a diagnosis, there is plenty of objective evidence to support this observation. Because the behaviors for these diagnostic categories overlap, the President presents as a narcissistic, paranoid, sociopath. Yeah, that’s a scary thought.
When it comes to Trump’s fixation on losing the election, I see something else which belies the potential for dangerous behavior. Trump is preoccupied with losing the election. His narcissism tells him he is special, superior and entitled, so how could he have possibly lost? His paranoia tells him that people are against him and that there were plots and conspiracies to assure he wouldn’t be reelected. Consequently, he cannot let go of his resentment toward others for losing including members of his own party, such as Vice President Mike Pence.
His sociopathology releases him from social norms so he has no boundaries when it comes to lying about election fraud. And to save face (narcissism), he perpetuates the lies, even to the point that he may actually believe the lies he created, i.e., it is becoming a delusionally-based obsession.
However, there is another factor I see at play and that is Trump’s preoccupation with losing. The clinical term is “rumination,” which is a fixation on negative thoughts. Eventually, the continued obsession with these negative thoughts can lead to uncontrolled brooding, depression, a lack of sleep, dissociation, and an inability to focus on other issues productively. Rumination can lead to the individual making poor choices to relieve the perceived problem. Which is why rumination is often observed in people who commit mass murder, attempt assassinations, or attack others due to perceived slights.
Not surprisingly, these individuals also display behaviors associated with antisocial personality disorder, including impulsivity, a lack of remorse, difficulty maintaining interpersonal relationships, deceitfulness, and irritability.
In Trump’s case, the rumination is leading to a hatred of all political and media opposition, both real and perceived. This has led to a sociopathic obsession to destroy the voting process which is at the heart of our democracy. He is intent on creating an autocratic state where the wealthy can thrive and the middle class can believe in but rarely achieve the American dream. In mental health terminology, he is a danger to others.
I make sense of Trump’s words and behaviors by understanding his underlying mental state and have therefore long advocated that Democrats respond to Trump in part based on his mental status. They could put together a team of mental health experts and petition a judge to order the President undergo an independent psychiatric evaluation. The Supreme Court ruled that a president cannot be charged with a crime while in office; the executive must be impeached and removed from office first.
However, that ruling does not apply to a court order for a mental health examination. I have no doubt this would provide sufficient evidence to demonstrate that Trump is mentally unfit and should be removed from office under the 25th Amendment.
Interestingly, while Democrats are unlikely to take action regarding Trump’s mental fitness for office, it appears that the Iranians do. For example, when they agree to a cease fire, the narcissist president uses it to boast about his ability to make a deal and end the war. Then the Iranians break the cease fire. This has happened repeatedly to the point that other than his MAGA followers, Americans are increasingly unhappy with Trump’s performance handling the war. It is likely the Iranians will continue in this fashion knowing that due to his narcissism he is oblivious to their pattern of behavior and how incompetent it makes him appear.
Trump has been ruminating over his election loss and has been peddling his election fraud story for over five years now. He used it to influence his supporters to attack the Capitol on January 6, 2021, he repeatedly tells the story to rile up his MAGA base, and now he is using it to disrupt the 2026 election cycle.
Nothing good can come of this.
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