This question seems to have exercised plenty of people recently, including many US voters, his fellow politicians, other world leaders, worried citizens of the rest of the world, - and a number of prominent psychiatrists and, as it is my area of specialty, it's something I keep being asked. Hopefully, by the end of this article you may be able to make some better informed guesses yourself....
It is an interesting question isn't it?
Most of us are interested in people – we get intrigued by the inner lives of others - we're interested in personality. But what exactly is personality? Most people would probably say something like - someone's personality is how someone usually is. So that is how they think, respond emotionally, behave, and what their relationships are like - and this is a useful way to think about the subject: how one thinks, feels, behaves and is in relationships is really just how one lives. So when aspects of someone's personality constantly lead to problems in their lives for the individual or those around them, a psychiatrist would say that this may indicate a Personality Disorder (PD).
Can you give an example of someone with a Personality Disorder - anyone I know?
There are several different categories that we use to describe personality disorders. While you may not know the specific diagnoses, you certainly will have come across some of the ways that someone with a personality disorder behaves (hopefully more in the movies or in books than in your personal life). For example, Girl, Interrupted or Betty Blue – both of which portray examples of Borderline Personality Disorder or We need to talk about Kevin, which is about someone with an example of an Antisocial Personality Disorder. However, given that 1-3% of people in the community actually do have a diagnosable personality disorder, you may well know someone with one of these sorts of conditions in your personal life.
What should I do if I think I – or someone I care about has a Personality Disorder?
That's a complex question and needs careful thought. If you feel that you, or one of your loved ones, does have personality aspects which are having a serious life impact, then it may be worth taking this further. The first step is to ensure that the diagnosis is accurately made. It is not an easy diagnosis to be certain about and there is a bit of a tendency for non-professionals to throw around accusations of personality disorder in a pejorative way at the moment. Therefore it is best if one sees a psychiatrist who has specialist medical training and the experience to diagnose this condition. If the diagnosis is confirmed, the next step is for the person concerned to decide if they want treatment for it.
When and how is PD treated?
This depends on a number of factors including whether the individual with PD considers it serious enough to need treatment. This is important because the only recognised treatment is through undergoing some quite intensive psychotherapy, which needs considerable commitment on the part of the individual. There is no clear evidence that medications are helpful for PD.
Does the treatment for PD work?
This the good news – over the last few years there has been emerging evidence for effective treatment for personality disorders (in fact the evidence shows psychotherapy is far more effective for PD, than, for instance, antidepressant medications are for depression). There have also been a number of recent studies reporting on specific treatment approaches which have shown that, in particular, people with Borderline Personality Disorder can especially benefit from the correct treatment. This is relevant because if you, or someone you know, are seeking treatment for Borderline Personality Disorder, it is very important to know that there is an evidence base for the approach the therapist is using.
The research shows that there is a good evidence base for Transference Focused Therapy (TFP), Mentalization Based Treatment (MBT), Dialectical Behavioural Therapy (DBT), and Schema Focused Therapy (SFT). Transference Focused Psychotherapy and Mentalization Based Treatment are what are known as psychodynamic therapies, while Dialectical Behavioural Therapy and Schema Focused Therapy are forms of cognitive behavioural therapy.
Having received a diagnosis from a specialist psychiatrist, the easiest way to make sure that you receive your psychotherapy from an experienced therapist who is formally trained and accredited in the treatment they are offering is to ask the psychiatrist to make a referral for you to someone they can recommend.
So does Donald Trump have a personality disorder?
As a psychiatrist it is not good practice for me to make a diagnosis on someone who I haven't clinically examined. So while I won't commit to a diagnosis in this article let me leave you with the following;
Criteria for considering if a diagnosis of Personality Disorder is present include:
Does the individual's way of thinking, experiencing emotions, ability to control impulses, need for gratification and way of relating to others, manifest in a wide range of personal and social situations?
Criteria for considering the specific diagnosis of Narcissistic Personality Disorder
A pervasive pattern of grandiosity (in fantasy or behaviour), need for admiration, and lack of empathy, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:
1. Has a grandiose sense of self-importance (e.g. exaggerates achievements and talents, expects to be recognized as superior without commensurate achievements).
2. Is preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love.
3. Believes that he or she is "special" and unique and can only be understood by, or should
associate with, other special or high-status people (or institutions).
4. Requires excessive admiration.
5. Has a sense of entitlement, i.e. unreasonable expectations of especially favorable treatment or automatic compliance with his or her expectations.
6. Is interpersonally exploitative, i.e. takes advantage of others to achieve his or her own ends.
7. Lacks empathy: is unwilling to recognize or identify with the feelings and needs of others.
8. Is often envious of others or believes that others are envious of him or her.
9. Shows arrogant, haughty behaviours or attitudes.
So, does Donald Trump have a personality disorder? I leave the answer to you - what do you think?
*The article is based on: "Stormy Lives, A Journey Through Borderline Personality Disorder". by Dr T. Lee , published by Muswell Hill Press, London, New York. 2016. "Stormy Lives" unpacks key questions in Personality Disorder and its treatment. The book tracks the life of a young woman, Nina, who is diagnosed with Borderline Personality Disorder. Its primary aim is to provide both individuals and the clinicians who treat them with practical know how for a condition which frequently generates a sense of helplessness.
Dr Tennyson C Lee (BA, BSc, MBChB, FFCH, MRCPsych) has dual specialist training in psychiatry and psychotherapy and is a Consultant in General Adult Psychiatry and Medical Psychotherapy. Dr Lee has additional training in evidence based treatments for Personality Disorder, including Mentalization Based Treatment and Transference Focused Psychotherapy, in which he is accredited by the International Society of Transference Focused Psychotherapy. He is Clinical Lead in a Foundation NHS Trust within a specialist Personality Disorder Service and a partner in Psychiatry-UK, the UK's only CQC registered online psychiatry service.
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (Fifth ed.). Arlington, VA: American Psychiatric Publishing, 2013.