Now that Donald Trump is improbably close to becoming president, several frightened commentators are suggesting he receive psychiatric evaluation to ensure he is not mentally ill. The amateur diagnoses most often floated for Trump are Narcissistic Personality Disorder or Borderline Personality Disorder.
I know something about Personality Disorders, having written the final versions in DSM III, DSM 1V, and DSM 5 and also having been Founding Editor of the Journal Of Personality Disorders. I find this careless, and politically motivated, use of Personality Disorder Diagnoses inappropriate, inaccurate, and troubling.
Trump obviously does have an outsize, obnoxious personality, but most certainly does not have a Personality Disorder (and there is no evidence that he has now, or ever has had, any other mental disorder). Personality Disorder requires that the individual's personality characteristics cause clinically significant distress or impairment. Trump's behavior causes a great deal of significant distress and impairment in others, but he seems singularly undistressed and his obnoxiousness has been richly rewarded, not a source of impairment.
This does not make Trump fit to be president, not by any means. He must be by far the least suitable person ever to run for high office in the US -- completely disqualified by habitual dishonesty, bullying bravado, bloviating ignorance, blustery braggadocio, angry vengefulness, petty pique, impulsive unpredictability, tyrannical temper, fiscal irresponsibility, imperial ambitions, constitutional indifference, racism, sexism, minority hatred, divisiveness etc. We could go on a lot longer, but you get the idea.
None of these horrid personality features constitutes anything approaching a mental disorder. And mislabeling them mental disorder has two seriously harmful unintended consequences.
First, and most serious, attributing Trump's behavior to mental disorder unfairly stigmatizes the mentally ill. Most people with mental illness are nice, polite, well mannered, well meaning, decent people. They suffer, but don't cause suffering. They should not be stigmatized by association with Trump's bad behavior.
Secondly, we must get out of the facile habit of medicalizing all human behaviors that are troubling or distasteful. Trivializing the concept of mental disorder, by so loosely applying it, leads to our current rampant over-diagnosis and over-treatment of many people who are just different, not diseased (think the many who are mislabeled with Autism, ADHD, Posttraumatic Stress Disorder).
People who dislike Trump's outrageous behavior should call him on it, but need not and should not, add to their critique a gratuitous and inaccurate diagnosis of mental disorder.
Allen Frances is a professor emeritus at Duke University and was the chairman of the DSM-IV task force.
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