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In the full clinical sense, he is pathilogical. Realistically, at his age, he will never change which would require professional help. He will lie even when its to his benefit to tell the truth, that is one significant reason why the whole Russian BS has become a cover up. Not only does he refuse to tell the truth, but he adds more and more lies rather than simply remain silent.
What Trump does most of the time is mix lies with the truth so it become nearly impossible to sort out what is true, and what is fictional. He has 70+ years to become a highly skilled liar, so we have a professional liar as president; he is not just some lazy uncle who sits on the front porch spinning yarns about killing 1000s of men with his bare hands during The War.
If Trump as was great as claims\lies, he would have taken his company public decades ago. To his credit, he was smart enough not to go public because he would have been fired from his company for mismanagement and\or unethical conduct. Remaining private, he answer to no one, and like an alcoholic, he is free to lie as much as he wants. No ethical company would ever hire him, or if they did, he would be fired very quickly for lying to board of directors, investors, etc, etc.