Medical Examiner

No Matter How Bad It Gets, Trump Will Never Give Up

We’ve been thinking about Trump as a world-class narcissist, but really, his psychological afflictions are slightly more specific, and this distinction can give us insight into the months ahead.

Collage of Donald Trump speaks during an event to announces a grant for drug-free communities support program, in the Roosevelt Room of the White House in Washington, DC, on August 29, 2018.
Photo illustration by Lisa Larson-Walker. Photos by Mandel Ngan/AFP/Getty Images.

Nearly two years into this presidency, it’s become all but normal for pundits and professionals alike to regularly express concerns about Donald Trump’s mental health. Most speculations focus on Narcissistic Personality Disorder, and it’s easy to see why. If you look at the DSM-5 criteria for NPD, Trump’s public behaviors are consistent with all nine diagnostic criteria. Even further, because only 5 of 9 criteria are needed for an NPD diagnosis, Trump getting 9 of 9 is huge; perhaps no one has ever seen a narcissism quite so obvious. Nevertheless, we still can’t diagnose Trump with NPD, because it’s unethical to diagnose anyone without first conducting a professional, in-person evaluation. Besides, what good would it do? Trump doesn’t seem to care, and also, Trump doesn’t meet the distress or impairment criteria required for a mental disorder diagnosis, anyway.

At any rate, as disturbing as observations of Trump’s narcissism may be—and as frustrating as it is that none of it seems to matter at all—what I find most frightening about his personality isn’t the narcissism. Narcissistic traits among politicians and presidential candidates, who often have big personalities, are common. Far more worrisome and dangerous is that his statements and behaviors fit so well with a different personality style. This style is what the renowned psychologist Theodore Millon called “The Aggrandizing-Devious-Antisocial Personality,” aka antisocial personality.

Millon summarized these personalities as “driven by a need to … achieve superiority.” They act “to counter expectation of derogation and disloyalty at the hands of others,” and do this by “actively engaging in clever, duplicitous, or illegal behaviors in which they seek to exploit others for self-gain.” Sound familiar?

What follows are summary descriptions of Millon’s formulation of antisocial personality. Millon’s statements are not diagnostic criteria for a mental disorder (the purpose here is not psychiatric diagnosis), they are simply psychological observations that can help us to better understand and describe Trump, speculate on his future behaviors, and consider how antisocial behaviors can be contained.

Impulsive imprudence. Millon described antisocial personalities as “ … shortsighted, incautious, and imprudent. There is minimal planning, limited consideration of alternative actions, and consequences are rarely examined.”

Blaming others for shirked obligations. Antisocial personalities “frequently fail to meet or intentionally negate obligations of a marital, parental, employment, or financial nature.”

Pathological lying. Millon wrote, “Untroubled by guilt and loyalty, they develop a talent for pathological lying. Unconstrained by honesty and truth, they weave impressive talks of competency and reliability. Many … become skillful swindlers and imposters.”

Declarations of innocence. During times of trouble, antisocial personality types employ an innocence strategy. “When … caught in obvious and repeated lies and dishonesties, many will affect an air of total innocence, claiming without a trace of shame that they have been unfairly accused.”

Empathy deficits. Antisocial personalities are devoid of empathy and compassion.
Millon called this “A wide-ranging deficit in social charitability, in human compassion, and in personal remorse and sensitivity.” He added that “many have a seeming disdain for human compassion.”

Counterattacks. Millon noted that antisocial personalities are hyperalert to criticism. He “sees himself as the victim, an indignant bystander subjected to unjust persecution and hostility” feeling “free to counterattack and gain restitution and vindication.”

Moral emptiness. Antisocial personalities have no ethical or moral compass. As Millon described, they “are contemptuous of conventional ethics and values” and “right and wrong are irrelevant abstractions.” Antisocials may feign religiosity—when it suits their purpose. But the moral litmus test will always involve whether they stand to gain from a particular behavior, policy, or government action.

Clinicians have observed that some individuals with antisocial personalities burn out. Over time, negative family and legal consequences take a toll, prompting antisocials to conform to social and legal expectations. However, when antisocial personalities wield power, burning out is unlikely. Power provides leverage to evade personal responsibility for financial maleficence and sexual indiscretions. Antisocial personalities who have the upper hand will increase their reckless, impulsive, and self-aggrandizing behaviors in an effort to extend their ever-expanding need for power and control. This seems to be the case with Trump: He will continue to be drawn toward authoritarian leaders, for example, because they symbolize his interpersonal goal of gaining even more power and authority over everyone.

Because antisocial personalities don’t change on their own and don’t respond well to interventions, containment is the default management strategy. Without firm, unwavering limits, the antisocial’s deception, law-breaking, greed, manipulation, and malevolent behaviors will increase. An antisocial person in a position to self-pardon or self-regulate is a recipe for disaster. Containment must be forceful and uncompromising, because if an antisocial personality locates a crack or loophole, he will exploit it. Staff interventions, comprehensive law enforcement, and judicial systems that mandate accountability must be in place. The three main containment strategies that remain in play for Trump are Republican power checks, the Robert Mueller investigation, and the potential for a November blue wave.

It seems near certain that the first option is not moving forward. Although many Republicans profess to be concerned about Trump’s behaviors, they have not managed to stand up to their president. Defying Trump has proven too costly; he can make Republicans pay with electoral consequences. Like him or not, Republicans have little motivation for clashing with a powerful leader who promises them judicial appointments and legislative opportunities. This leaves the Mueller investigation and a November blue wave as the main means of checking Trump’s power.

As we contemplate how these strategies might work to check the antisocial dimensions of Trump’s personality, it’s important to return to what Millon posited as the core distinction between the pure narcissist and the antisocial. Having a deeper understanding of this distinction can help predict and contextualize Trump’s future behaviors and potential response to containment efforts.

Although pure narcissistic personalities are profoundly egotistical and perpetually preoccupied with grandiose fantasies of admiration, idyllic love, and eternal success, they differ from antisocials in that they aren’t constantly striving to achieve advantage over others via aggression, deceit, and manipulation. Narcissistic personalities love to be revered and may experience narcissistic rage when criticized, but they prefer voluntary reverence. In contrast, the antisocial dynamic is far more active; it’s also based on an underlying assumption that the world is unsafe, unfair, and that all others—at their core—are untrustworthy. This translates into a combination of paranoid thinking and living with the mantra “I can only trust myself” and it requires continuous and active deception and manipulation. Antisocials are allergic to passivity and drawn to coercive control.

What does this say about how Trump will respond to containment strategies? We should be ready for a pattern of increasing denial, increasing blame of others, increasing lies, declarations of complete and total innocence, and repeated claims of mistreatment. He will protect and insulate himself from critique and responsibility through active counterattacks, along with alignment, even briefly, with whatever sources of power, control, and dominance he can find. This might mean further alignment with Vladimir Putin, more campaign rallies, and an additional need to gather others around him who will offer only adulation. He will gleefully throw anyone and everyone who betrays him under the bus. As he escalates, his insults toward others will become increasingly demeaning—virtually everyone questioning his superiority will be labeled a dog or disgrace or traitor.

The antisocial personality is a force that requires an equal or greater counterforce for containment. This is not a man who will slip quietly into the night. In fact, if we don’t gather together an adequate counterforce, Trump’s antisocial behaviors will continue, expand, and potentially lead us toward an international crisis. In the meantime, we should collectively buckle up. Trump won’t be waving a white flag any time soon, and the fight to contain him promises to be an ugly one.

Disclaimer: The views expressed here are not representative of the University of Montana or the Montana University System.