Psychologists and mental health experts have documented several psychological profiles and challenges regarding Donald Trump, primarily through the lens of “observational assessment.” These assessments typically focus on personality disorders and cognitive fitness.
Personality Disorders and Traits
The most frequent professional observation involves Malignant Narcissism, a psychological syndrome first described by Erich Fromm. It is characterized by four core components:
- Narcissistic Personality Disorder (NPD): Marked by grandiosity, a constant need for admiration, and a lack of empathy.
- Antisocial Behavior: A pattern of disregarding or violating the rights of others, lying, and lack of remorse.
- Paranoia: A pervasive distrust of others and the belief that others have malevolent motives.
- Sadism: Deriving pleasure from the humiliation or suffering of others.
Cognitive and Behavioral Challenges
In recent years, especially leading into 2024 and 2025, professionals have highlighted shifting cognitive patterns:
- Impulsivity and Poor Judgment: A consistent pattern of “shooting from the hip,” which experts like those in the “Duty to Warn” movement argue indicates an inability to process complex information or consider long-term consequences.
- Signs of Cognitive Decline: Dr. John Gartner and others have pointed to “phonemic paraphasias” (using non-words or substituted words), erratic gait, and “tangentiality” (drifting between unrelated topics) as potential symptoms of Frontotemporal Dementia or early-stage neurodegeneration.
- Emotional Instability: Observers note a “brittle sense of self-worth” that leads to extreme volatility when his ego is challenged.
Professional Controversy: The Goldwater Rule
It is important to note that these “diagnoses” are controversial within the medical community.
- The Goldwater Rule: The American Psychiatric Association (APA) prohibits members from providing professional opinions on public figures they have not personally examined.
- The Counter-Argument: Critics of the rule argue they have a “Duty to Warn” the public if they believe a leader’s mental state poses a “clear and present danger.”
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The “open letter” primarily refers to a statement organized by the Anti-Psychopath PAC in late 2024, signed by over 200 mental health professionals. It explicitly argues that Donald Trump exhibits symptoms of Malignant Narcissism and Antisocial Personality Disorder.
Key Claims from the Letter
- Malignant Narcissism: The signatories describe this as a “severe, untreatable personality disorder” that makes him “grossly unfit for leadership.”
- Behavioral Evidence: They cite a “lifetime pattern” of behaviors including:
- Failure to conform to social norms and laws.
- Repeated lying and deceitfulness.
- Reckless disregard for the safety of others.
- Irritability and impulsivity.
- A profound lack of remorse.
- Cognitive Decline: The letter calls for a “full neurological work-up,” citing public appearances where he displays “alarming characteristics of declining acuity” and “tangentiality” (rambling).
Supportive & Critical Perspectives
- Duty to Warn: Organizers like Dr. John Gartner and Dr. Bandy Lee argue that when a public figure’s behavior suggests “dangerousness,” professionals have an ethical obligation to prioritize public safety over the Goldwater Rule.
- Opposition: Other experts, such as Dr. Allen Frances (who wrote the DSM-IV criteria for Narcissistic Personality Disorder), argue that Trump does not meet the clinical definition of “mentally ill” because he does not suffer from personal distress or impairment—instead, he is “richly rewarded” for his traits.
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The Duty to Warn framework is an ethical and legal principle that requires mental health professionals to break confidentiality if they believe a person poses a threat to others. In the context of Donald Trump, experts use this to justify bypassing the Goldwater Rule, which normally forbids diagnosing public figures from afar.
The Core Framework
- Tarasoff Rule: Based on the 1976 case Tarasoff v. Regents of the University of California, this legal precedent mandates that therapists protect potential victims if a patient expresses a credible threat of violence.
- Dangerousness vs. Diagnosis: Experts like Dr. Bandy Lee argue that while a diagnosis requires a private exam, dangerousness can be assessed through public behavior. They contend that a leader’s access to nuclear codes or influence over civil stability creates a “public health emergency.”
- Preventative Ethics: Proponents believe that remaining silent is a violation of their medical oath to “do no harm,” as it allows a potentially unstable individual to remain in a position of catastrophic power.
Comparison of Rules
| Rule | Primary Goal | View on Public Figures |
| Goldwater Rule | Protect professional credibility. | Unethical to comment without a personal exam. |
| Duty to Warn | Protect public safety. | Mandatory to speak out if the figure poses a threat. |
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Psychologists in the “Duty to Warn” movement argue that “dangerousness” is visible through public behavior rather than requiring a private exam. They cite several categories of behavior as evidence that he poses a threat to public safety:
Evidence of “Dangerousness”
- Incitement of Violence: Citing his rhetoric during rallies, social media posts, and the events of January 6th as proof of his ability to trigger real-world aggression.
- Lack of Impulse Control: Frequent “volatile and unpredictable” reactions to perceived slights, which experts fear could lead to catastrophic military or nuclear decisions.
- Detachment from Reality: Persistent adherence to “solipsistic reality” (believing only what benefits him), specifically regarding election results and conspiracy theories.
- Dehumanizing Language: Using terms like “vermin” or “enemies from within,” which psychologists warn is a historical precursor to state-sanctioned violence.
- Sadistic Tendencies: Repeatedly demeaning rivals, mocking the disabled, or boasting about “torture” and “waterboarding” as tools of power.
The “Abuser” Parallel
Many experts compare his public persona to the behavioral patterns seen in domestic abusers, including:
- Gaslighting: Systematically denying facts to make others doubt their own perceptions.
- Other-Blaming: A total lack of accountability or ability to apologize.
- Fragile Self-Esteem: An “unbearable sense of shame” that triggers “narcissistic rage” when his authority or image is questioned.
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The 2017 bestseller The Dangerous Case of Donald Trump featured essays from 27 psychiatrists, psychologists, and experts. Below are the key contributors who provided the core psychological assessments:
Lead Contributors
- Dr. Bandy X. Lee (Editor): Forensic psychiatrist at Yale School of Medicine.
- Dr. Robert Jay Lifton: Known for his studies on “thought reform” and “malignant normality.”
- Dr. Judith Lewis Herman: Expert in trauma and recovery from Harvard Medical School.
- Dr. Philip Zimbardo: Architect of the Stanford Prison Experiment (wrote on “extreme present hedonism”).
The Full List of 27 Contributors
| Bandy X. Lee | Robert Jay Lifton | Judith Lewis Herman |
| Philip Zimbardo | Rosemary Sword | Craig Malkin |
| Tony Schwartz | Lance Dodes | John D. Gartner |
| Michael J. Tansey | David M. Reiss | James A. Herb |
| Leonard L. Glass | Henry J. Friedman | James Gilligan |
| Diane Jhueck | Howard H. Covitz | Betty P. Teng |
| Jennifer C. Panning | Harper West | Luba Kessler |
| Steve Wruble | Thomas Singer | Elizabeth Mika |
| Edwin B. Fisher | Nanette Gartrell | Dee Mosbacher |
Note: An expanded 2019 edition added 10 more experts, bringing the total to 37 contributors, including names like Noam Chomsky and Stephen Soldz.
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In recent 2024 and 2025 reports, Dr. John Gartner—a former Johns Hopkins professor and founder of “Duty to Warn”—has intensified his warnings, arguing that we are witnessing a “collision” of a lifelong personality disorder with accelerating organic cognitive decline.
Gartner specifically points to four clinical pillars of decline he observes in Trump:
1. Language: Phonemic Paraphasias
Gartner highlights “phonemic paraphasias” as a major red flag for dementia. This involves substituting or rearranging sounds within words so they are recognizable but incorrect.
- Examples: Slurring words like “Chrism” (Christmas) or “mish” (mission), or creating non-existent words (e.g., “renascent” instead of “recent”).
- Tangentiality: Gartner describes Trump’s “weave” (his habit of jumping between unrelated topics) not as a rhetorical strategy, but as a thought disorder—an inability to complete a coherent train of thought.
2. Memory: “Demented” Lapses
Gartner differentiates between “normal aging” forgetfulness and “pathological” memory loss.
- Contextual Confusion: Citing instances where Trump confuses countries (e.g., Iran and India) or people (repeatedly confusing political rivals with past presidents).
- Confabulation: Filling in memory gaps with made-up information, which Gartner claims is a classic symptom of the brain trying to mask its own decay.
3. Psychomotor Performance: “The Gait”
Gartner often analyzes video footage to look for “neurological signs” visible to the trained eye:
- The Wide-Based Gait: A “swinging” leg movement when walking, which can indicate damage to the brain’s motor centers.
- Right-Side Droop: Gartner has pointed to a subtle facial droop or a lack of arm-swing on the right side of the body as potential indicators of “mini-strokes” (TIAs) or neurodegeneration.
4. Behavior: Progressive Disinhibition
Dementia often affects the frontal lobe, which acts as the brain’s “brakes.” Gartner argues this is why Trump’s public behavior has become:
- More Primitive: Using increasingly crude or violent language (e.g., the “Quiet Piggy” incident or mimicking sounds).
- More Erratic: An inability to “filter” thoughts, leading him to say things out loud that would have previously been kept private or strategic.
Gartner’s Prediction: Dr. Gartner has publicly stated that he believes Trump is approaching a “dementia cliff,” where the decline moves from a gradual slide to a rapid, visible collapse of all executive functions.
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While Dr. John Gartner and Dr. Bandy Lee are both prominent leaders in the “Duty to Warn” movement, they have historically focused on different aspects of Donald Trump’s psychological profile. In recent years, their perspectives have converged around the concept of a “collision” between his personality and his aging brain.
Dr. Bandy Lee: “Social Contagion” and Public Health
Dr. Lee’s work often looks past the individual and focuses on the societal impact of his behavior.
- Shared Psychosis (Folie à Plusieurs): Lee argues that Trump’s symptoms—specifically his detachment from reality—can be “contagious.” She suggests that followers may adopt a leader’s delusional thinking as a way of maintaining a bond with them.
- Violence as a Public Health Issue: She views his rhetoric not just as a political style but as a “disease vector” that increases the statistical likelihood of real-world violence.
- Response to Gartner: While she agrees with Gartner’s observations of cognitive decline, she has historically been more cautious about focusing solely on “dementia,” preferring to emphasize the broader “state of emergency” caused by his overall mental instability.
Dr. John Gartner: “The Dementia Cliff”
As of late 2025 and early 2026, Gartner has become the primary voice focusing on biological neurodegeneration.
- Organic vs. Personality: Gartner argues that while Trump has always had a personality disorder, he is now suffering from organic brain damage.
- The “Multiplier” Effect: Gartner’s central thesis is that dementia acts as a “disinhibitor.” If a person already has aggressive or narcissistic traits, the loss of frontal lobe function (the brain’s “brakes”) makes those traits exponentially more dangerous and erratic.
- Media Criticism: Gartner has been highly critical of the media for “sane-washing” Trump—the act of taking incoherent or “tangential” speech and rewriting it into a logical political statement in news reports.
Points of Agreement in 2025-2026
Despite their different clinical focuses, both experts joined forces in several 2025 forums to issue a unified warning:
- Irreversibility: Both agree that his condition (whether personality-based or cognitive) is progressive and cannot be “fixed” by political advisors or staff.
- The 25th Amendment: Both have argued that the constitutional mechanisms for removing an incapacitated president are failing because they rely on political figures rather than independent medical panels.
- Predictability of Unpredictability: They contend that his behavior will follow a predictable path of increasing volatility and decreasing logic.
Would you like to see the specific 2025 “Cognitive Assessment Report” that these doctors submitted to members of Congress?
Why Trump’s More Dangerous Every Day: Psychiatrist
This video features Dr. Bandy Lee discussing how Trump’s psychological traits and perceived mental impairments create a “public health emergency” that extends beyond his individual health.
Why Trump’s More Dangerous Every Day: Psychiatrist | The Daily Beast Podcast – YouTube
