It is certainly the case that president Trump has engaged in numerous unusual behaviors since becoming our commander-in-chief.1 In fact, the entire history of Donald Trump is replete with stories of unusual behavior. Many of these behaviors are so unusual that it could lead one to conclude that he may be unfit to be president. Furthermore, a number of these behaviors appear to be ones that are listed as symptoms of mental illness in the Diagnostic and Statistical Manual of Mental Disorders- Fifth Edition (DSM-V).Mental health professionals have been studying how to assess and predict the future likelihood of an individual becoming dangerous or even violent for some time.2 This essay is an attempt to educate you about how to assess psychiatric symptoms and how to assess the potential for future violent behavior. Specifically, we are doing this relative to the 45th president of the United States.
Making an accurate diagnosis requires more than merely looking it up in a manual. It requires a bit of knowledge and expertise. That is why I spent four years in a psychiatry residency program and two years in a neurobehavior/geriatric psychiatry fellowship. In this brief essay, I hope to make it possible for you to better assess president Trump's mental health and the likelihood that he is at risk for ordering dangerous actions in the future.
It is first necessary to discuss the appropriateness of a psychiatrist speaking or writing publicly about the mental health of a politician.
Section 7 in the American Psychiatric Association's (APA) Principles of Medical Ethics states that it is unethical for psychiatrists to give a professional opinion about public figures whom they have not examined in person. This is called The Goldwater Rule.
The reason that the APA codified this stance is due to a successful lawsuit filed against fact: magazine by Republican Senator Barry Goldwater in 1964 after his failed attempt to become president of the United States. At that time there was no scientifically developed manual that could assist in making a psychiatric diagnosis. Nevertheless, 1,189 psychiatrists who were primarily trained in the psychoanalytic tradition and had never met the senator contributed their opinions, and/or guesses, as to his presumed poor mental health.
After the loss in court, Fact: magazine went out of business. I have always thought it ironic that the name of this publication was "Fact:"
Once a psychiatrist has examined someone in person, then he or she is under a legal duty to ensure confidentiality. (The Health Insurance Portability and Accountability Act (HIPAA) contains a privacy rule that creates national standards to protect individual's medical records and personal health information, including information about psychotherapy and mental health.)
A 1976 California supreme court decision makes an exception to this law when there is a direct threat of harm to a third party. In that case, the psychiatrist is under legal obligation to act to ensure the safety of the person or persons who have been threatened. (This "duty to warn" became law after a 20-year-old woman named Tatiana Tarasoff was viciously murdered by a man who was diagnosed with paranoid schizophrenia and who had informed his psychiatrist that he intended to kill her. The psychiatrist had the man placed in a mental health facility, but he was let go without anyone notifying Tatiana.)
Does the Goldwater Rule apply to the case of Donald Trump?
- It is very difficult to make an accurate psychiatric diagnosis by observing behavior without understanding motives. For example, a politician's behavior could be purposely designed to manipulate an audience.
- It is easy and very tempting to cherry pick symptoms and give a malicious diagnosis to someone you dislike or disagree with.
- Mental health professionals tend to be left of center in their political orientation.
- A person can have many psychiatric symptoms or even diagnoses and, yet, still be perfectly rational and able to make competent decisions.
- Psychiatric symptoms must be severe enough to cause distress, dysfunction and/or interference with interpersonal relationships in order to make a diagnosis.
Should the Tarasoff decision apply in the case of Donald Trump?>
- Physicians are legally obligated to break doctor-patient confidentiality when there is a threat of harm. They are also legally obligated to act in order to ensure the safety of the individual or individuals who have been threatened.
- There is an extensive literature on assessing risk of violence by obtaining and corroborating information from multiple sources without having the cooperation of the individual who poses the threat.2
- A diagnosis is not necessary to determine if a threat of danger exists.
- Certain behaviors such as previous violence, lack of empathy and specific clusters of psychiatric symptoms correlate highly with future risk of dangerous behavior.2
- Non-mental health professionals may not have the knowledge needed to assess this type of risk on their own without professional input.
Does the president suffer from mental illness? In order to figure out what the president's psychiatric diagnosis is, or if he has one at all, I should bring you up to speed on how to make a diagnosis in psychiatry. That will allow me to show you all the evidence. You can then come to your own conclusion.
Since the revision of DSM-III, high rates of co-occurring psychiatric disorders have been observed, particularly in cases of moderate and severe psychiatric illness.3 This is because the DSM is designed to be diagnostically inclusive and has no internal mechanism to exclude other conditions.4
In general medicine an effort is made to rule out other diagnoses or explanations for a set of symptoms. In psychiatry an effort is made to rule in as many diagnoses as possible. Treatment is more symptom based than diagnosis based in psychiatry.
The DSM has 5 diagnostic sections. Each section is called an Axis. A diagnosis on Axis I includes episodic and treatable psychiatric illnesses such as bipolar disorder, obsessive-compulsive disorder or paranoid delusional disorder.
Axis II includes lifelong characterological defects that are generally not treatable except with long term psychotherapy. Examples include anti-social personality disorder (APD), narcissistic personality disorder (NPD), and paranoid personality disorder (PPD).
Donald Trump has told us about many of his psychiatric symptoms.5,6(addendum 1) He has described symptoms that are consistent with bipolar disorder, obsessive-compulsive disorder and paranoid delusional disorder. We have heard from numerous individuals close to him that have corroborated many of these symptoms and we have witnessed him expressing them ourselves.7 If all these symptoms are genuine, then he meets the criteria for at least 10 separate psychiatric diagnoses on both Axis I and Axis II.(addendum 2)
Understanding that Donald Trump's nature is to deceive, embellish and manipulate, we must ask the question, "How real are these symptoms?"
We know that he has never sought professional help or said anything to indicate that he felt these symptoms were interfering in his life in a significant way.
If the symptoms are not severe enough, then we can't make a diagnosis. If he is embellishing any symptom for any reason, then that symptom needs to be deleted from consideration. If reports of a symptom are inaccurate, then that symptom can't be considered. If he has a healthy relationship with his friends and family members, then the likelihood that he has a significant psychiatric diagnosis is reduced.
I suggest that we do not attempt to make a diagnosis for the purpose of treatment since the president has never sought such help and since we have never met him. Rather, I suggest we examine these symptoms in order to assess the degree to which he may be at risk for future dangerous behavior.
Will the president become dangerously violent?
Many people assume that those who are mentally ill are at increased risk to do violence, but the opposite is true. The absolute risk of violence among the mentally ill as a group is very small and only a small proportion of the violence in our society can be attributed to persons who are mentally ill.8
However, there are certain clusters of psychiatric symptoms that we know correlate with a significant risk for future violence. These include the Axis II diagnoses of antisocial personality disorder, narcissistic personality disorder and paranoid personality disorder. The risk is especially high when all three occur together in the same individual.2
If I was the president's treating psychiatrist, I would want to error on the side of over diagnosing him so that I could provide him with all the treatments he needed. That is a very different task compared with assessing risk for dangerous behavior. Therefore, I am not doing the kind of assessment that I do most frequently, but I do have training in risk assessment for dangerous behavior.
As a risk assessor, I need to exclude any symptom that may not be real. I need to make certain that the cluster of symptoms that indicate there is a risk of violence are corroborated enough to create a high level of confidence that they are real. Obviously, you don't want to mess up this kind of assessment on anybody much less when it is the president of the United States.
I also need to make sure that I understand the motive of each symptom. For example, if he makes a self-aggrandizing statement, is this something he truly believes or is he making this statement on purpose in order to advance an agenda.
I also need to know if the symptoms are severe enough to cause significant distress in himself or significant disruption in his inter-personal and familial relationships. For example, he is on his 3rd trophy wife and he cheated extensively on all three. Is he a narcissist or is he simply unlucky in love?
Bob Woodward, one of the two Washington Post investigative journalists who broke the Watergate scandal, has been given extensive access to every White House since the Nixon administration. He has a track record of reliably recording the inner workings of each administration in an objective manner. He usually publishes his books after the person leaves office but in the case of Donald Trump he chose to publish at the one and half year point of his presidency.
He interviewed most, if not all, the individuals who surround president Trump and recently published the book entitled Fear.1 This tittle has a double meaning. The president stated in a 3/21/2016 interview with Bob Woodward, "Real power is---I don't even want to use the word---fear.1" Consistent with that statement, opponents of the president often voice the complaint that they feel intense fear as a result of his words and actions.
As an aside, and as a psychiatrist, fear is not the most effective way to rule.
I reviewed multiple sources for this essay and they generally seem to corroborate the Woodward book. According to these sources and the book, those closest to the president say he frequently displays many psychiatric symptoms.1,7(addendums 1 and 2) They also corroborate that he does have the constellation of symptoms that most correlate with future violent behavior.1,2,7
They report that President Trump does not appear to have healthy relationships with any of his staff or family members. They say that he is highly paranoid, self-centered and without empathy.1,7
They describe a man who is impulsive, unpredictable and given to fits of rage. For example, he has frequently demanded to sign orders for dangerous courses of action. Fortunately, those closest to him have prevented these orders from being given. They have distracted him in order to literally take the papers off his desk. Then, they say, he forgets to follow through.1
They report that he has little knowledge base of world history or current events and maintains fixed false beliefs that evidence will not alter. He has a very short attention span and lacks much desire to understand issues in depth. Therefore, the myriad of briefings that he should normally be getting as the president of the United States must be shortened, prioritized and/or deleted.1
After he selects an individual to be on his team, they say that he seems to love them intensely. He is then quick to hate them intensely given the smallest personal slight. His qualifications for keeping a staff member, or for appointing the person in the first place, seem to correlate only with how loyal the individual is to him at any moment. Therefore, his White House has devolved into disorganization with competing factions vying for his approval and individuals coming and going at a dizzying pace.1
President Trump is on pace to challenge, if not surpass, Richard Nixon as the president with the greatest number of staff and associates indicted and convicted of criminal activity. Robert Mueller (as of 11/11/2018) - 33 indictments, 30 sealed indictments and 8 convictions. Archibald Cox (Watergate special prosecutor)- 69 indictments, 48 convictions. As of 1/25/2019 the Mueller investigation has also indicted Roger Stone on 7 counts.
Tony Schwartz, the man who co-authored Trump's book entitled The Art of The Deal, says that he could not get Donald to sit still long enough to get an appreciable life history from him. He told the publisher that he was going to quit so they suggested that he just follow Trump around and see how he does business and talk to those with whom he interacts. That is how he was able to finish the book.
Predicting the risk of future violent behavior is primarily based on a history of violence, lack of empathy and current threat of severe insult to personal ego.2
Risk factors for future violent behavior based on childhood history include arrests, young age at first arrest, and a history of violence or fire-setting, substance use, cruelty to animals, and risk-taking, including behavior which demonstrates impulsivity or a loss of control.2
Risk factors that relate to a patient's adult life and present circumstances include youth, male gender, noncompliance with treatment, access to weapons, a provocative or otherwise unprotective home environment, lack of compassion or empathy, a stated intention to harm, and a lack of concern as to the consequences of acting violently.2
Donald Trump is a strict teetotaler. He never drinks alcohol or uses any other substances of abuse because his older brother died prematurely from alcohol abuse.
There is no evidence that young Donald was ever cruel to animals but as president he did eliminate animal welfare regulations and is the first president since Thomas Jefferson to choose not to have a White House pet of any kind.
There is no evidence that Donald Trump was a fire starter as a child.
It is hard to be certain what kind of home environment surrounded Donald as a young man. By all accounts, his mother was distant. His father has been described as harsh, demanding and critical.
There is no evidence that President Trump has ever been arrested. However, according to Edward Ericson, Jr. and the City Paper, there are at least five times as an adult that he could have been arrested on charges such as fraud, money laundering and obstruction of justice.9
Due to the Mueller investigation, we have now learned that federal prosecutors believe that President Trump is guilty of directing Michael Cohen to commit two counts of felony campaign finance violation that were over $25,000 and were for the purpose of influencing the 2016 presidential election. Both counts carry a potential 5-year prison term.
Numerous individuals including his long-time accountant, "fixer" and a long list of other associates have been indicted and/or agreed to a plea deal in exchange for incriminating information.
We do know that he settled three lawsuits for 25 million dollars over the now defunct for profit and fraudulent real estate school called Trump University. He violated the fair housing act in 39 properties denying black tenants' fair treatment in 1973. He and/or his business ventures have been involved in 4,000 lawsuits over the years for contract disputes, taxes, defamation claims, and allegations of sexual harassment.
Then, there is the lying. President Trump makes numerous verifiably false statements. I think he believes some of these statements to be true, some are clearly manipulative and still others seem to be to his detriment. If you enter the words "Trump" and "Lies" into your browser, you can review them at great length.
I have heard numerous people say, "I just don't understand the way he lies."
I do. He lies like someone who has anti-social personality disorder (APD). These folks are born without an emotional connection that provides positive or negative feedback. They can't learn how to behave in the normal way that children learn how to behave. When parents provide negative or positive reinforcement the child with APD has no negative or positive feelings.
A child with APD will focus on non-verbal behavior in others. This child will use that information to figure out what others want to hear. Then, they tell people what they want to hear in order to manipulate them and get what they want.
Most of us value the truth because we are aware that if we get caught in a lie, others will do things that will make us feel bad. Without that emotional feedback mechanism there is no reason to care about truth. Someone with APD learns how to survive in this way.
APD can create a very smooth lying manipulator whose heart rate never changes as he does bad things. A classic example would be someone like Ted Bundy. When serial killers such as him get emotional it is due to frustration that they can't immediately get what they want. They don't get upset because they perceive injustice in the world or lack of fairness or that someone other than themselves is suffering.
A serial killer is the worst-case scenario for someone who has APD and Donald Trump is no serial killer. Trump's symptoms are the same just not as severe. He is a closer fit to what we casually call a "white collar APD." Someone, for example, who works on wall street and does not care that he is stealing money from a little old lady's life savings.
Usually, someone with APD does not also have narcissistic personality disorder (NPD) but when that happens you get someone who, in addition to having little or no empathy, has very thin skin. Such an individual will lash out quickly in response to the smallest threat to their ego. This type of person is given to fits of rage and risk for future violent behavior is increased.
We don't know of any legal involvement on the part of the president as a child, but it is conceivable that his wealthy father was able to get any such information removed from the record.
Multiple Washington Post investigative journalists interviewed numerous people who knew Donald Trump as a child and as an adult and published a highly aclaimed book in 2017 called Trump Revealed: The Definitive Biography of the 45th President.10
In this book there are accounts of violent behavior such as pulling a girl's hair for fun, throwing rocks at the toddler who lived next door, attempting to throw a classmate out of an open window and physically assaulting a boy who was riding his bike home from school. His former teachers describe him as a self-aggrandizing bully who showed little empathy or remorse for those he picked on. He has been known, even today, to describe bullying behavior he did as a child in a boastful way.
In elementary school he was put in detention so many times that his classmates renamed it "DT." Teachers described him as impulsive, thin-skinned and quick to retaliate. Unlike any of his siblings, at age 13 he was sent to a private military school due to his unruly behavior.
Interestingly, Donald has boasted about giving his music teacher a black eye. This was likely an exaggeration but the teacher, Charles Walker, said on his death bed after learning that Trump was running for president, "Even at the age of 10, he was a little shit."
Bandy Lee, MD, M.Div., is a clinical professor of law and psychiatry at the Yale University School of Medicine. She co-founded Yale's Violence and Health Study Group and leads a violence prevention collaborator's group for the World Health Organization. She edited the 2017 book entitled, The Dangerous Case of Donald Trump. In this book 27 psychiatrists and mental health experts provide assessments of Donald Trump's psychiatric symptoms in relation to his fitness to be president.
John D. Gartner Ph.D., MD, is a psychiatrist who created a website called a duty to warn. This site promotes the idea that President Donald Trump has a mental illness, and should be removed from his job because of it.
Let's put some of these behaviors in perspective.
The combination of Narcissistic Personality Disorder (NPD) and Anti-social Personality Disorder (APD) correlates with a significant risk of violent behavior. This risk is greatly increased when the individual is threatened with loss of personal status or wealth or when catastrophic failure is eminent. Many psychiatrists are convinced that this situation exists with Donald Trump and the Mueller investigation. Thus, you can understand why they are so concerned.
NPD- Does president Trump have NPD or just a higher than average level of healthy narcissism?
With NPD the hyper-inflated self-worth is a defense mechanism to compensate for an extremely low self-concept which would explain being hyper-sensitive to criticism. If he has a healthy amount of narcissism, then he truly believes he is a good or above average person and he would be able to comfortably make self-deprecating humor and laugh about it. Most people who are highly successful and, indeed, most presidents have a higher than average degree of healthy narcissism. This is often a good thing.
APD- Does president Trump have APD or just a lower than average ability to feel empathy?
If his ability to be empathic is low, then he would still have some empathy. He would still have feelings for others just a higher threshold to feel it. If he has APD, then he will have no feelings for other people. For example, he could kill someone or watch a child taken from its parents without feeling any anxiety or remorse.
It was reported that when he saw pictures of Syrian children who had been attacked with chemical weapons he appeared to be genuinely overcome with emotion. It is hard to know if these were real emotions of compassion for the children or hostility towards Assad for testing Donald so soon after he took office.
It is possible that the president has empathy for Americans who suffer from drug use and criminal behavior. Perhaps, that is why he is so invested in stopping what he perceives as criminals crossing our southern border. It is also possible that he knows his supporters have an unreasonable fear of this and he uses it to manipulate them.
There is, of course, ample evidence of a seeming lack of empathy as well as thin skin on the part of the president. For example, (a.) ordering cruel and unusual enforcement of an immigration law that separates children as young as 2 years old from their parents at the border, (b.) making fun of a disabled journalist, (c.) directly insulting a specific women who accused him of sexual harassment as being too ugly for him to harass, (d.) degrading Gold Star parents who criticized him at the DNC convention, (e.) criticizing John McCain for being a bad soldier because he was captured and so on and so on.
One way to measure a person's ability to feel empathy, especially in a multi-billionaire, is to examine the different kinds of charities that they sponsor. Donald Trump has a long history of giving to multiple politicians on both sides. He claims business interests as his motive, however, he is not well known for charitable contributions to the needy. His Trump Foundation which is tiny for an individual of his self-proclaimed wealth has often been criticized as a tax haven or for the purpose of money laundering. Today, Dec. 18, 2018, New York Attorney General Barbara Underwood announces that the Trump Foundation is dissolving, amid allegations the president misused funds.
We know that high levels of paranoia in a leader have correlated with severe suffering in the past. On the other hand, any good leader should have a healthy amount of fear that there is a risk that he or his countrymen could suffer a violent attack. The question is whether this rises to a level in Donald Trump that he is likely to start taking pre-emptive action to imprison, torture or kill people due to his abnormally high level of paranoia? Obviously, past leaders have famously done exactly that.
Was he serious when he threatened to have our military fire upon Honduran asylum seekers at our southern border? Or, was he simply saying what he knows would influence people to vote for Republicans in the mid-term elections?
The number one predictor of future violent behavior is past violent behavior. The book entitled, "Trump Revealed10," makes a strong case from multiple sources that he does have a history of violent behavior.
Another strong predictor is direct threats of future violent behavior such as saying to the North Korean dictator, "My nuclear button is bigger than yours." Or, saying, "Any guy who can do a body slam, he is my type!" Or, "If you see somebody getting ready to throw a tomato, knock the crap out of them, would you? Seriously, OK? Just knock the hell ... I promise you I will pay for the legal fees. I promise, I promise," he said on Feb. 1, 2016.
Also, numerous women including one of his ex-wives say that he was so aggressive during sex that they felt they were raped.11 However, there is no evidence of any arrests for violence such as physical assault, rape or murder.
In conclusion, Donald Trump has a history of violent behavior for which he is boastful and lacks remorse. He meets DSM-V diagnostic criteria for APD and NPD plus he displays an abnormally high level of paranoia. He is exquisitely sensitive to criticism and often retaliates disproportionately. He is self-centered and seems to lack empathy for others. He is impulsive and given to angry outbursts. He currently makes clear and direct threats of violence. Due to the Mueller investigation he may soon face indictment and/or impeachment. Therefore, in my professional opinion, Donald Trump does pose a threat of future harmful behavior.
(As a disclaimer, my friends who support Trump have told me that I am the victim of fake news. I think the same about them. Therefore, despite the fact that this essay was extensively researched and only the most reliable sources were cited, I can't absolutely know for sure that it is totally unbiased. I suggest that you review the evidence for yourself so that you can draw your own conclusion.)
Addendum 1: Donald Trump's possible psychiatric symptoms
- Obsessive fear of germs
- Obsessive dislike of imperfections or blemishes
- Compulsive hand washing, straw usage, hand shake avoidance, avoids touching or being touched, eats only fast food because he perceives that it is prepared in a very clean environment
- Compulsive re-arranging of things on the table in front of him
- Compulsive avoidance of people or places with minor visual imperfections
- Extreme paranoia about being poisoned which is another reason he eats only fast food that is obtained each day at random restaurants
- Prone to conspiracy theories
- Pre-occupied with perceived disloyalty
- Quick to counter-attack aggressively due to the slightest affront
- Grandiosity or exaggerated sense of accomplishment and status
- Excessive need for adoration
- Exaggerated sense of entitlement
- Hyper-sensitive to criticism
- Flight of ideas (jumps from topic to topic without a clear linear train of thought)
- Sleeps 3-4 hours per night
- Difficulty maintaining focus
- Extreme mood swings
- Overly dramatic
- Unpredictable behavior
- Difficulty assessing or caring about consequences
- Frequent transparent lies
- Purposeful and manipulative lying
- Fixed beliefs that are verifiably false and are not politically advantageous to him
- Frequent disinhibited and inappropriate comments
- Impulsive
- Self-Centered
- Possible (perhaps likely) law breaking
- Lack of moral conscience
- Manipulative
- Deceitful
- Lacks empathy or remorse
- Seems to take pleasure in hurting or humiliating others
- Possible memory problems
- Reduced complexity of thought
- Diminished vocabulary
- Frequently mis-pronounces words
- Frequently repeats phrases and stories multiple times
Addendum 2: Donald Trump's symptoms organized into clusters that suggest a diagnosis.
Axis I (primary psychiatric illness)
Obsessive-Compulsive Disorder (OCD)
Bipolar Disorder- Mania
- Obsessive fear of germs
- Obsessive dislike of imperfections or blemishes
- Compulsive hand washing, straw usage, hand shake avoidance, avoids touching or being touched, eats only fast food because he perceives it is prepared in very clean environment
- Compulsive avoidance of people or places with minor visual imperfections
Delusional disorder
- Flight of ideas
- Tangential and sometimes circumferential thinking
- Sleeps 3-4 hours per night
- Inability to maintain focus
- Extreme mood swings
- Overly dramatic
- Unpredictable behavior
- Difficulty assessing consequences
- Impulsive behavior
- Frequent disinhibited and inappropriate comments
- Fixed beliefs that are verifiably false
Axis II (lifelong characterological traits)
Paranoid Personality Disorder
Narcissistic Personality Disorder
- Extreme paranoia about being poisoned
- Prone to conspiracy theories
- Pre-occupied with perceived disloyalty
- Quick to counter-attack over the slightest affront
Anti-social Personality disorder
- Grandiosity or exaggerated sense of accomplishment and self-worth
- Excessive need for adoration
- Exaggerated sense of entitlement
- Hyper-sensitive to criticism
Sadistic Personality Disorder
- Impulsive
- Self-centered
- Frequent lying
- Law breaking
- Lack of moral conscience
- Manipulative
- Deceitful
- Lacks empathy or remorse
Axis III (primary medical conditions)
- Seems to take pleasure in hurting or humiliating others
Dementia12
- Possible memory problems
- Reduced complexity of thought
- Diminished vocabulary
- Frequently mis-pronounces words
- Frequently repeats phrases and stories multiple times
- Often forgets or fails to follow through with important items on his agenda
References
- Woodward B. FEAR: TRUMP in the WHITE HOUSE. New York, NY: Simon and Shuster; 2018.
- Buchanan A, Binder R, Norko M, Swartz M: Psychiatric Violence Risk Assessment Am J Psychiatry 2012; vol. 169 issue 3.
- Kessler RC, Chui WT, Demler O, Walters EE: Prevalence, severity, and comorbidity of 12-month DSM-IVdisorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry. 2005;62:617-627.
- Tew J, Pincus H. The Conundrum of Psychiatric Comorbidity. Psychiatric Times, 2007, vol. 24, issue 14.
- Sinclair, H. Trump Says He Is Scared of Germs and Needs to Drink from a Straw to Avoid Contamination. Newsweek, 9/26/17.
- Brantly, K. Is sleeplessness REALLY the key to Donald's success? Researchers are baffled after Trump's doctor praised the president's four-hour sleep cycle. Daily Mail.com 1/18/2018
- Lee B, Schwartz T. Inside the Mind of Donald Trump He's grandiose, deceitful and paranoid—but don't let him drive you crazy. POLITICOMAGAZINE, 7/27/2018
- Mulvey EP: Assessing the evidence of a link between mental illness and violence. Hosp Community Psychiatry.1994;45(7):663-668.
- Ericson E, Jr. Five times law enforcers could have arrested Donald Trump but didn't. City Paper March 6, 2017.
- Kranish M, Fisher M. Trump Revealed: The Definitive Biography of the 45th President.New York, NY: Simon and Shuster; 2018.
- Relman The 22 women who have accused Trump of sexual misconduct. Business Insider, 7/26/2018
- Hamblin, J. Is Something Neurologically Wrong with Donald Trump? The Atlantic, 1/3/2018
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