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Having read Mary Trump's book about the family..
plus other tidbits about the family and dump's history, it could be that he developed most of his symptoms at an early age, or was born with this condition. At the very least, it appears he has never been what most people would call normal.
I guess we should cite media, ineffective justice system, profiteering entertainment system and its many addicted customers, tons of disoriented and naive religious persons, greedy republicans, and foolish "news" viewers for overlooking his many symptoms and dreadful behavior.