'Sadistic and amoral': Mental health expert performs postmortem on the 'pathological' Trump presidency

Unprecedented. Unhinged. Unbelievable. All of these terms have been used to describe the publicly observed and documented behavior of the 45th President of the United States, most notably over the 5 weeks since he lost the election to Joe Biden. After many of us have had time to process and digest the immediate reactions, thoughts, and feelings to Trump’s loss, there will be decades spent in classrooms, lecture halls, conference centers, books, OpEds, Zoom calls, and documentaries to unpack what we all just witnessed and experienced.


Casually, Trump has been given the usual labels that are associated with his oftentimes bizarre behavior – pundits routinely referred to the sitting U.S. President as “crazy,” “nuts,” or “out of his mind.” There has been much debate and discussion about Trump’s possible psychiatric diagnoses as they relate to the Goldwater Rule and the Duty to Warn placed upon mental health providers whose clients reveal harmful, malicious, or violent intentions. Diagnoses are labels often used to facilitate discussion between mental health researchers and clinicians and for billing purposes. A specific diagnostic category is the result of hours of meetings and discussions among mental health experts who then publish their classifications in the most recent edition of the Diagnostic and Statistical Manual for Mental Disorders, or DSM.

We do not need to pin a label or diagnosis on Donald Trump.

We can be clear, Donald Trump likely meets criteria for multiple psychopathologies and disordered personality types.

Experts and laymen alike can argue over which ones specifically and the degree to which his abnormal behavior is psychological, neurological/medical, or intentional in origin.

What we all can agree on is that he is out of touch with reality and dangerous.

Trump’s behavior since he lost to Biden has placed his psychopathology and disordered personality at center stage nearly every day since Election Day.

There are several main themes of Trump’s behavior that are consistent with, and likely reflections of, antisocial personality, narcissistic personality, psychopathy, Machiavellianism (see Dark Triad literature), sociopathy, sadism, and authoritarianism.

  1. General Impressions – Trump is a 74-year old man who, based on thousands of pieces of audio, video, and written evidence, is not a complex individual. His thought process, written and speaking skills, and vocabulary are limited, immature, and concrete in nature. He often uses terms like “powerful” and “beautiful” for items and ideas that are abstract and not physically present. The content of his hundreds of rallies did not change substantively and were quite repetitive to the point of becoming overly trite. His emotional range is limited and largely “flat” with excitations seen in the form of anger, rage, and combativeness with positive emotions, as evidenced by laughing or smiling, in situations in which it is not appropriate (incongruent), sadistic, or as a result of narcissistic supply (i.e., someone has paid him a compliment or he is on a rally stage). In fact, it is in response to crowd chants such as “We love you!,” “Four more years,” and “Fight for Trump” that we see the biggest grins on Trump – in a manner very much akin to taking a drug “hit.”
  2. Grandiosity – Trump has routinely and chronically displayed grandiosity or the sense that he is superior, special, and without equal. His most commonly used phrases show this grandiosity: “the likes of which you’ve never seen,” “[never/for the first time] in history,” “more than anyone thought possible.” Trump uses this type of language so often that it becomes meaningless and it lacks any specificity or substance. The claims are so vague that they are, as many reporters have noted, exceedingly difficult to debate.
  3. Mendacity/Lying – Donald Trump has told over 20,000 lies since taking office in January of 2017 with PolitiFact recently naming the President’s lies about the deadly coronavirus (e.g., “we are rounding the corner on pandemic”) as the “lie of the year.” The sheer volume of lies, from little white lies to those with deadly consequences, shared by this President is enough to disorient and confuse the public. But, in general, these lies serve the purpose of creating and maintaining Trump’s narcissistic fantasyland. To be clear, while some are strategic and some are pathological, they are uttered in an in-the-moment-effort by Trump to “win” the moment, escape being cornered or exposed. As to whether he believes them or not, it depends on the circumstances. He only needs the slightest possibility of truth (i.e., that he was the victim of a deep state conspiracy) for the lie to soothe his fragile and often injured ego. Terrifyingly, most of the lies are not only untrue but the exact opposite of the truth. For example, we have had a 9/11’s worth of deaths daily for over a week; a statistic nowhere near “rounding the corner.”
  4. Ego Protection/Delusion/False Narrative/Alternate Reality – The inability to admit mistakes or flaws is not mutually exclusive from the aforementioned lying as the two behaviors are interrelated. In this disordered personality, there can be no flaws and, as such, one’s followers, colleagues, and the public should never see flaws, ever. This strict “code” explains why Trump will add the word “and” or “or” in between a misspoken word or phrase and the correct one. During his first State of the Union, for example, Trump referred to a member of our Homeland Security force as “DJ” before adding “He goes by DJ. And CJ. He said call me either one.” In recent rallies, Trump has referred to new missiles that are both “hydrosonic and hypersonic.”

Appearing as without flaw also underlies Trump’s curtailing of any legal or public process that would expose him as a fraud. This has manifested itself in the form of hush money payments, non-disclosure agreements, ignored subpoenas, repeated civil litigation, and even a Sharpie-altered weather map to change the course of a hurricane.

One mechanism to appear flawless is to seek and obtain constant adulation and reinforcement. Sycophantic enablers will often bring laudatory news clippings or severely skewed statistics to shine a positive light on this President. For example, after the election of Joe Biden, Trump and his team relied on GOP primary numbers (during which he ran unopposed) and record-breaking voter numbers (“74,000,000;” “More votes than any sitting President in history”) without mentioning the other guy got 81,000,000+ votes.

In other words, somebody in his orbit puts together statistics, not matter how meaningless, to soothe him.

Trump will also “self-soothe” when he perceives ego injury. If you noticed during one of his post-Election speeches, he repeated some form of the phrase “can’t let it happen” “can’t accept it” at one point saying “you’ll never be able to look yourself in the mirror.” All of these statements were made to his audience members, but it doesn’t take an advanced degree in psychology to know to whom he was speaking.

This President has also used merging or conflation to protect his ego from injury. He repeatedly synonymized himself with America, patriotism, and the flag. By attaching himself to these terms and objects (in some cases actually hugging the flag), Trump can use attacks or criticisms of him the person as attacks on America, its flag, or its heroes. In a recent rally, he said that two Georgia Senate seats were “the last line of defense for America” but in many ways those seats represented a last defense for him.

Lastly, he will immerse himself in echo chambers, yes-men, and “safe zones” such as on for Fox News (as long as they are pro-Trump), OAN, or Newsmax with help from “friends” Hannity, Ingraham, Carlson, Pirro, Watters, Hesgeth, and others.

  1. Projection – this is one of the most commonly discussed ego defense mechanism in psychology and psychodynamics and it is, simply put, accusing others of that which you are guilty. In the five weeks since Election Day, Trump has called Democrats “radical” when he was in fact pushing an illegal, extra-Constitutional overturning of an election adding that Democrats will “do anything to win,” “they’ll do anything to beat you. They don’t care. These people are sick. In addition, he recently claimed that “Democrats are vicious,” “Republicans are too nice,” and “the Democrats cheat at elections.”
  2. Lack of Blame, Responsibility, Accountability – Again, the appearance of existing without flaw also requires Trump to deny any direct responsibility or accountability for the negative aspects of his behavior. In short, he takes no responsibility for failures (“Election was rigged”) and all responsibility for successes (“we got vaccine done in record time”). After initially claiming that the virus was a “Democrat hoax,” Trump went on to deflect responsibility for its raging outbreak and massive death in America by referring to it as a “freak” event that “should never have happened” as if it was an unexpected weather event with Pearl Harbor element of surprise. Trump’s own discussions with Bob Woodward show a completely different story.
  3. Lack of Empathy/Cruelty/Sadism/Sociopathy – Trump is the first President in decades to intentionally place others in harm’s way with no remorse or foresight. This was seen in his stalwart belief that cities and states “should open up” despite spiraling infections and deaths; a policy recently revealed by one his appointees as “We want them infected.” This President consistently showed himself to be the President for his supporters and not for all Americans. He demonized others and used racism as a “currency” with which to engage his base. He mocked non-English speaking voters, the disabled, and those who showed public emotion (“Cryin’ Chuck Schumer”). In a combination of moves, he called COVID-19 the “China virus,” and something “that hit from China,” and, as such, shifting blame and using racist currency.

As an antisocial individual with no empathy for others nor a moral compass, Trump expected those loyal to him to break laws, ethics, norms, and precedent FOR him. For example, in his failed attempt to perpetrate a coup, Trump called on the Governor and Secretary of State of Georgia to have “courage to do what they have to do” which in this case was break the law and overturn the will of the voters. For Trump, laws don’t apply to him, checks and balances don’t apply to him, the U.S. system of government that has existed for 2 centuries doesn’t apply to him.

His antisocial, sadistic, and amoral ways were not limited to the living. Trump routinely spoke of the dead as criminals (e.g., dead people who allegedly voted for Democrats) but not as victims of a modern-day plague (e.g., those lost to COVID). Bizarrely, Trump also spoke for the dead – on different occasions he described a recently deceased person as looking down (presumably from heaven) to talk about him (e.g., a campaign staffer killed in car accident was “looking down and is pleased.” The late SEAL Ryan Owens and the murdered George Floyd were also included in Trump’s “heavenly praise.” In other words, Trump’s solipsistic manner (i.e., only Trump’s mind exists), has hijacked the eternal fate of the dead to serve his own ego-driven purposes.

Lastly, all of his relationships with other people are transactional. He uses you until you are no longer of use (for recent examples see William Barr and Georgia Governor Kemp who “should be ashamed of himself” for not overturning the election to Trump; a feat in Trump’s eyes that could be done “very easily if [Kemp] knew what the hell he was doing.”

  1. And, of course, the Ridiculous:

The themes described above fall into general categories that underlie psychopathologies and disordered personality types that share common features and etiology. But this was not the case for all things Trump. In some cases, there were fantastical utterances whose origins and logic lay beyond our understanding. People were accused of wanting “to build buildings with no windows,” to “win back Christmas,” and to save animals and humans alike from the dangers of windmills. There is much to be written. I will stop here.

About the Author: Seth D. Norrholm, PhD (Twitter: @SethN12) is the Scientific Director of the Neuroscience Center for Anxiety, Stress, and Trauma and an Associate Professor of Psychiatry and Behavioral Sciences at Wayne State School of Medicine in Detroit. Dr. Norrholm has spent 20 years studying trauma-, stressor-, anxiety-, depressive-, and substance use-related disorders and has published over 110 peer-reviewed research articles and book chapters. The primary objective of his work is to develop “bench-to-bedside” clinical research methods to inform therapeutic interventions for fear and anxiety-related disorders and how they relate to human factors such as personality, genetics, and environmental influences. Dr. Norrholm has been featured on NBC, ABC, PBS, CNN.com, Politico.com, The Atlantic, Salon.com, The Huffington Post, Yahoo.com, USA Today, WebMD, The History Channel, and Scientific American. In 2019, Dr. Norrholm was recognized as an Expertscape world expert in Fear and Posttraumatic Stress Disorders.