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He seemed as if he might be delirious. He blasted out bewildering tweets in all caps. Sick and infectious, he circled the perimeter of the hospital in an armored SUV, waving to supporters. He demanded the arrest of his opponents.

After doctors treated Donald Trump with a steroid last week, following his COVID-19 diagnosis, House Speaker Nancy Pelosi, other Trump critics, and national-security experts questioned whether the drug had warped his judgment. “Roid rage” started trending on Twitter. His condition revived talk about invoking the Twenty-Fifth Amendment. A Stanford University law professor who had taken the same drug tweeted that she couldn’t be “president of my cat” when under its influence.

Those suspicions miss the point: Trump is belligerent when sick, just as he’s hostile when well. He sees plots when he’s dosed with dexamethasone and conspiracies when he’s gulping Diet Coke behind the Resolute desk. Days have passed since he apparently stopped taking the drug, and he sounds every bit as unmoored.

What’s been driving him in the final stretch of the campaign isn’t a medication that messes with his mood. It’s dread, people who’ve worked with him throughout the years told me. There are less than three weeks to go in a campaign that appears to be heading the wrong way. “He’s down and he’s likely to lose,” a former White House official, speaking on the condition of anonymity to talk more freely, told me. “This is fear.”

It’s hard to gauge whether Trump’s thinking was impaired. One measure that doctors use to spot changes in a patient’s behavior is deviations from the baseline. But Trump’s ordinary conduct is, “let’s say, charitably, unusual,” Robert Wachter, the chairman of the department of medicine at UC San Francisco, told me. Or, in the nonclinical and wholly unscientific assessment of the ex–White House official: “There’s no way to put lipstick on this pig. The guy is nuts.”

In fundamental ways, Trump’s recent behavior isn’t all that different from his conduct in other moments of personal stress; the stakes are just massively higher. In his book Trumped, Jack O’Donnell, a former Trump hotel-casino executive, describes how his boss lashed out about the installation of a new VIP lounge at one of his hotels in Atlantic City, New Jersey, in the late 1980s. Trump liked high ceilings, but this one was set low to leave room for the pipes connected to hot tubs in the suites above. Inspecting the space one day, Trump swore, jumped up, and “punched his fist through the tile,” leaving one of his top executives feeling shaken and humiliated, O’Donnell writes.

Watching the news after Trump’s hospitalization, O’Donnell told me, he questioned the “people who supposedly know him who were acting like this behavior is a result of the steroids. While I think it’s ratcheted up a little bit, this is classic Donald Trump that you’re seeing.”

Michael Cohen, Trump’s former lawyer and fixer, was struck by a moment in 2009 when Trump berated his eldest son, Donald Jr. He describes the scene in his book, Disloyal. Donald Trump was about to appear at a World Wrestling Entertainment event in Green Bay, Wisconsin, when his namesake asked him if he was nervous. “I’m going in front of millions of people. What kind of stupid fucking question is that? Get out of here,” Trump snapped, according to Cohen. (The White House has assailed Cohen’s credibility, along with his book.)

Right now, the pressure Trump may be “feeling, knowing that he’s going to lose the election, is intensifying everything that we’re seeing and putting him in a hyper-agitated state,” Cohen told me.

After all, Trump has pumped out baseless attacks before, sent unfathomable tweets before, accused opponents of criminal acts before. Speaking to Fox Business yesterday morning, Trump sprayed attacks with all the precision of 52 playing cards flung into the wind. He slammed Pelosi (“she’s got a lot of mental problems”), Joe Biden (“he’s mentally shot”), New York Governor Andrew Cuomo (“incompetent”), antifa (“scum”), former FBI Director James Comey (“a corrupt person”), and the news media (“the enemy of our people”). Referring to Gretchen Whitmer not by name but by “she,” he said that the Democratic governor wants “to be a dictator in Michigan.”

“The people can’t stand her,” he added, just days after the FBI revealed that Whitmer was the target of an alleged kidnapping plot.

None of this behavior especially surprises those who’ve heard Oval Office rants dating back to the start of Trump’s presidency. “In terms of his current behavior, to me it looks like just another day at the office,” John Bolton, Trump’s former national security adviser, told me. “He doesn’t need steroids to behave this way.”

In Oval Office meetings, John Kelly, the president’s ex–chief of staff, would clear the room of lower-level aides when Trump grew irate. “His face would get contorted and red, and you could see spit flying out of his mouth because he would get so mad about something,” Miles Taylor, a former chief of staff at the Department of Homeland Security, told me. “Sometimes he’d get mad about something that wasn’t even the topic of the meeting.”

Taylor remembers an instance when Trump berated him for taking notes at a meeting. “What the fuck are you doing? Are you fucking taking notes?” Trump looked at him and said, Taylor recalled. “And then he waited and he just stopped, and I closed my notebook.”

“I don’t think the so-called roid rage was all that remarkable,” added Taylor, who’s become an outspoken Trump critic.

It might all get worse. As Election Day nears, Trump’s dread may only grow, and his outbursts may only become more desperate. He may step up attacks in hopes of staving off a loss that he’d see as an intolerable rebuke. For someone who craves adulation and can’t ever seem to get enough, defeat could leave a hole that no treatment can remedy.

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