An anti-Trump political group organized a letter signed by more than 200 mental health professionals, warning that Donald Trump is dangerous because of “his symptoms of severe, untreatable personality disorder – malignant narcissism”, which makes him “grossly unfit for leadership”. Less than two weeks before the presidential election, the group bought a full-page ad styled as an open letter in the New York Times on Thursday, arguing that the Republican nominee for the White House is “an existential threat to democracy” in the US. The ad was funded by Anti-Psychopath Pac – a political action committee that has produced attack ads questioning Trump’s mental fitness for office. “Using the DSM V”, or the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, a bedrock text that helps mental health professionals define and treat mental disorders, “it is easy to see that Trump meets the behavioral criteria for antisocial personality disorder,” the open letter said. “Even a non-clinician can see that Trump shows a lifetime pattern of ‘failure to conform to social norms and laws,’ ‘repeated lying,’ ‘reckless disregard for the safety of others,’ ‘irritability,’ ‘impulsivity,’ ‘irresponsibility,’ and ‘lack of remorse,’” the letter said. The American Psychiatric Association considers it unethical to diagnose individuals whom a psychiatrist has not personally assessed, a prohibition known as the Goldwater Rule. The rule is named after Barry Goldwater, a former US senator and 1964 Republican presidential candidate who was called “psychotic”, “schizophrenic” and compared to the late leaders “Hitler, Castro, Stalin”, by psychiatrists who responded to a survey from Fact magazine. Goldwater successfully sued the magazine for libel. Fact was ordered to pay the former candidate $75,000. Anti-Psychopath Pac is led by George Conway, an attorney and activist best known for leading the Lincoln Project, a Republican group that was a thorn for Trump during his presidency but later imploded amid allegations of sexual misconduct against one of its co-founders. Conway is divorced from Kellyanne Conway, a senior Trump adviser from 2016 to 2020. Thursday’s letter addressed the Goldwater Rule directly by stating that since it was adopted in 1973, “the field has modernized the DSM diagnostic system, which relies exclusively on ‘observable behavioral criteria.’ For many years, we’ve all observed thousands of hours of Trump’s behavior, reinforced by the observations of dozens of individuals who have interacted with him personally.” The professionals argued that disorder they discern in Trump “makes him deceitful, destructive, deluded, and dangerous”. Trump’s rival for the White House, the Democratic nominee, Kamala Harris, earlier this month called the former president “increasingly unstable and unhinged” and, this week, a fascist. The letter also argued Trump exhibits signs of cognitive decline, and said he should be subject to “a full neurological work-up”. Signatories of the letter run the gamut from a Cornell University lecturer to a professionals such as a Maryland psychotherapist, a mental health nurse practitioner, a sex therapist and a social worker. Don’t miss important US election coverage. Get our free app and sign up for election alerts Since Joe Biden left the race amid concerns about his age and mental fitness for office, some of the same scrutiny has come to dog Trump, who would become the oldest US president ever, if elected, and 82 years old by the end of his second term. Recognizing his speeches are often rambling and even incoherent, Democrats have taken the unconventional step of encouraging voters to watch Trump’s speeches and rallies. “I’m going to actually do something really unusual and I’m going to invite you to attend one of Donald Trump’s rallies because it’s a really interesting thing to watch,” Harris said during their only presidential debate. “You will see during the course of his rallies he talks about fictional characters like Hannibal Lecter. He will talk about windmills cause cancer. And what you will also notice is that people start leaving his rallies early out of exhaustion and boredom,” she said. The ad from Anti-Psychopath Pac comes in the same week as another full-page New York Times ad signed by more than 200 survivors of sexual assault and gender violence. One of the signatories was an ex-girlfriend of the late sex offender Jeffrey Epstein and alleged in an interview with the Guardian that Trump had groped her in the past. The aim of the ad was to remind voters that Trump was found liable for sexual abuse in civil court, after a case brought by the New York writer E Jean Carroll.