Should Political Anxiety Disorder Be a Diagnosis?

There is a long history of using mental health diagnoses to act out political agendas. This storied history includes diagnosing women who complained of sexual assault as mentally ill (Bourke, 2012); using patients with intellectual disabilities as part of inhumane experiments (Iacono & Carling-Jenkins, 2012); and using conversion therapy to alter the orientation of homosexual patients (Haldeman, 1994). In the United States, in the current political climate, terms signifying mental illness as well as intellectual disabilities are bandied about as weapons in partisan warfare. It is perilous to characterize people with different political beliefs as somehow dumb, evil, or mentally ill.

“Trump derangement syndrome” has been coined as a way of labeling people who are frightened by the agendas of this president as irrational (Goldberg, 2015). “Derangement” implies that the individuals who hold these fears do so with little basis in reality, suggesting that their fears are irrational. After Donald Trump’s loss in the 2020 election, the same term, “Trump derangement syndrome,” was used to label Trump's followers for their inability to accept his election loss (Avlon, 2020). The term has now returned to its original use as a pejorative term for people who are afraid of President Trump.

Concepts from Cognitive Behavioral Therapy (CBT) may be useful in combating the depressogenic feelings that follow from political anxiety. Early in my career as a psychologist, I was taught the three questions one should ask to help patients work on changing their thinking to accurately appraise and manage fears. I am applying them to some of the fears expressed by people who are struggling with fears and depressive feelings regarding the current political situation:

• Is this something that I should worry about? (“Will policies be enacted that are dangerous for me?”)
• How serious is it? (“Will these policies affect my day to day life or the functioning of the world? How much?”)
• What coping skills do I have to deal with it? (This depends on the specific worry and coping set of the individual involved. Some examples include, “If tariffs make things cost more, do I have money to pay for what I need?” or “What can I do if I encounter a person different than myself?”)

Of course, the question of distortion may depend on the person’s actual circumstances. The level of true threat can be different depending on the person. Concerns may vary depending on the state in which one lives as well as the demographics of the person who is anxious. The individual situation will have to be taken into account when considering whether thoughts are rational or not.

Some Features Associated With Political Anxiety

When a new diagnosis is identified, people often feel relief in having a name for what they experience and often embrace it in a “that’s it!” kind of way. In the case of “Trump derangement syndrome,” this “diagnosis” is only used for the sake of mockery, and is not endorsed by those seen as having it.

“Political anxiety disorder” may feel more genuine to some people. In addition to fears, whether distorted or realistic, there are other characteristics of this condition, making it worth coining as a diagnosis. It has features that I have not seen before in my more than 30-year career as a licensed psychologist, and entire life as an American, including the following:

1. Patients often insist that they need to know the political leaning of their psychotherapist as they would be unable to trust someone who believes differently than they do.
2. Patients are coping via schadenfreude, the enjoyment of the pain experienced by others. I had never seen this used as a strategy by any patients before now. To explain “schadenfreude” with a simple anecdote, I will recount the time I had directly experienced schadenfreude as a child through an interaction with my brother. When I was eight, my brother asked me to touch the family refrigerator. I was wise enough to know that if he wanted me to, there must be a good reason not to do it. He continued to cajole. I finally demanded that he touch the refrigerator first which he did with seemingly no observable ill effects. To silence his begging, I touched the refrigerator and received a fairly unpleasant shock. I looked at him as he smiled with pleasure at my pain and asked, “Didn’t it hurt you too?” He replied with his 11-year-old crooked smile, “Yeah, but it was worth it!” I learned on that day that sometimes people enjoy the suffering of others. The enjoyment of “owning the libs”(Coppins, 2018) is schadenfreude as is the “FAFO,” standing for “F around and find out” (Vargas, 2024), where the enjoyment is seeing Trump supporters receive consequences from their vote such as deportation, racism, loss of reproductive rights, loss of healthcare, illness from lack of vaccines, or money hits from tariffs.
3. Patients have shifted their view of what is emblematic of evil. None of my patients previously ever asked “Will my child (with mental health concerns) grow up to be like Reagan, either Bush, Clinton, Obama, or Biden?” Parents used to ask questions related to their child’s prognosis citing different villains, “Will he or she grow up to be like Hitler (or Dahmer)?” These were the two most commonly invoked supervillains parents asked about in my clinical practice. Now a current political figure is cited in such questions.

What Can be Helpful?

If there is political anxiety, what can be done about it? Does it fall in the purview of other anxiety disorders or does it deserve its own unique category? What is the treatment?

1. The CBT exercise above may be useful. Reminding people that policies take time to take effect may ameliorate some of the panic symptoms that can ensue about immediate threats. If the fears are realistic, identifying, planning, and carrying out a response may be helpful.
2. Behavioral activation is often helpful when anxiety and depression are on scene. Helping patients shift from passive docility to active choices can improve mood and reduce anxiety. Whether it has to do with politics or not, being active in the world, especially working in positive ways in the community, can help. Help the people with whom you work consider whether there is anything they can do to make the world a better place. Regardless of their political beliefs, most people believe they are in favor of a better world.
3. Continue with daily health-promoting behaviors. Even in the context of significant stress, eating well, sleeping well, exercising, and relaxation, when possible, can give people the strength to face one more day.
4. Encourage individuals with political anxiety disorder to find community. Finding like-minded people can be enormously helpful, as can finding respectful ways to interact with people who think differently.
5. Encourage patients to take news and social media breaks when they can.
6. Remind parents that they have the power to intervene with their children before they become independent adults. Every day is an opportunity to help their children develop skills to manage their impulses and avoid a villainous future.
7. Encourage those patients, especially those with anxiety about the current political context, to enjoy what life brings every day. Remind them of their own power to think for themselves and vote when there is an election, as well as to fight for what they believe in every day.

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With the amount of ambient anxiety in our current world, helping patients and their families manage and cope, despite societal threats, is essential. I am certain that mental health providers need to be a force in helping people handle the political worries of our time so that everyone remains an effective member of our community.