Part VIII. Delusional Disorder: Diagnostic Criteria for Evaluating the Mental Health of Donald Trump--You Make the Call

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Since becoming president, Donald Trump has made increasingly staggering and frequent statements contradicted by irrefutable evidence to the contrary (videos, photos, tweets) leading us to consider whether his psychological disturbance is far more severe than what has widely been proposed as merely narcissistic or antisocial personality disorder, or merely pathological liar.

The exceedingly rare diagnosis of Delusional Disorder may help us understand why DT makes such jaw-dropping statements. I am intending, not to diagnose, but to educate the general public regarding the straightforward, specific, easily understood criteria from the Diagnostic and Statistical Manual-5 so that you yourselves can make an informed assessment. I will then examine the final five of a fifteen minute videotaped speech to the CIA the morning after his inauguration to see if the diagnosis can provide a lens with which to fathom three egregious, separate, and startling statements contained in a mere five minutes.

Delusional Disorder is coded as 297.1, (F22) for the purpose of insurance coverage for treatment. But the simple fact is that those with Delusional Disorder scoff at the notion that there is a problem in the first place. This “stealth” disorder is exceptionally beguiling because such individuals can seem perfectly normal, logical, high-functioning, and even charming so long as the delusion itself is not challenged. Delusional Disorder is described as “one of the less common psychotic disorders in which patients have delusions but not the other classical symptoms of schizophrenia” including bizarre behavior, hallucinations, overtly disordered thinking, etc. Psychosis is defined as “a condition in which there is profound loss of contact with external reality.” Whereas in schizophrenia, the disconnection tends to be highly visible and all-encompassing, the less serious Delusional Disorder is neither bizarre nor readily apparent to the outside observer:

-- Delusions are beliefs that exist despite indisputable, factual evidence to the contrary.

--Delusions are held with absolute certainty, despite their falsity and impossibility.

--Delusions can have a variety of themes including grandeur and persecution.

--Delusions are not of the bizarre variety (“I am being vivisected by aliens”), but rather seem like an ordinary figure of speech except that each word is meant literally: e.g., “I alone am the chosen one, invincible, extraordinary beyond words, the very best of the best in every way.”

--Delusional people tend to be oversensitive and humorless, especially regarding the delusions.

--Delusions are central to the person’s existence and questioning them elicits an inappropriate and strong emotional reaction.

--Delusional Disorder is chronic, even lifelong.

--Words and actions are consistent and logical if the basic premise of the delusion is accepted as reality: “If I am superior to all, it follows that I would never apologize because I am never wrong.”

--General logical reasoning and behavior is unaffected unless it is very specifically related to the delusion.

--The person has a heightened sense of self-reference and trivial events assume out-sized importance through connection to the delusional belief, making such trivial events hard to let go and move past.

Delusional Disorder may help us to make sense of the the last five minutes of his CIA address which contain three staggering statements that lead us to think, “He can’t possible mean that.” In the tenth minute, DT declares he is “1000% behind” the CIA, accusing the Fake Media, “some of the most dishonest people on the planet…of making it sound like I had a feud” with the intelligence community, when the truth is the “exact opposite.” Anyone in the audience instantly could have googled DT’s numerous tweets about the incompetence and dishonesty of the “so-called” intelligence community, a position he has since reverted to. Did he actually believe that the truth was defined by his words and not hard facts to the contrary? Or was he merely lying despite knowing that each and every person in attendance knew there was not an iota of truth to the claim? His stunning falsehood lacks the shrewdness of the typical pathological lie.

A minute later, he described his disappointment as he began his inaugural address that it was raining, but then claimed, with a finger to the sky, “God looked down and said, ‘We’re not going to let it rain on your speech,’” that it stopped immediately and became “really sunny” before it “poured right after I left.” Again, anyone from the audience could immediately have seen the video from a cell phone demonstrating clearly that the rain started the moment he began to speak. It never got sunny. It never subsequently poured.

The third statement, of course, was his insistence that the grounds were packed “all the way to Washington Monument.” Despite his badgering the Park Service to come up with photos that might suggest a larger crowd, the aerial shots clearly showed that DT’s audience was many hundreds of thousands less than Obama’s in 2009. Again, DT claimed this was another example of Fake News because the photos did not accord with his certainty of his personal reality.

These three incidents of demonstrably false statements made in the space of five minutes exemplify scores of other completely false claims: he knows more than all the generals, he has the best temperament of anyone ever to be president; he still bellows that the 1989 wrongly convicted Central Park Five are guilty of raping and brutally beating a woman despite the actual rapist confessing after nine years, knowing intimate details of the scene, and having matching DNA with a sample from the crime site; he insists he saw on TV thousands of Muslims in NJ celebrating the collapse of the World Trade towers; he insists that he was the very best high school baseball pro prospect in NY; he brags that “in a movement like the world has never seen,” he won by the greatest electoral landslide since Reagan despite trailing five of the previous seven electoral totals, etc., etc., etc.

Though the term “solipsism” comes from philosophy, not psychology, it appears relevant to this discussion: “Solipsism is the belief that the person holding the belief is the only real thing in the universe. All other persons and things are merely ornaments or impediments to his happiness.”

DT lies regularly and reflexively, telling the truth only when it suits his purposes. But pathological lying does not nearly seem to account for the staggering, self-aggrandizing statements I have referred to. Does he actually believe what he is saying based upon underlying delusions of grandeur? Had he been hooked up to a lie detector test during his CIA speech, would he would have passed with flying colors?

You make the call.