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President Donald Trump referred to adult film actress Stephanie Clifford as “Horseface” in a tweet on Tuesday, adding her to a long list of women he has attacked by demeaning their looks, mocking their bodily functions or comparing them to animals.

Trump’s verbal assault came as he gloated about a federal judge’s decision to dismiss a defamation suit filed by Clifford, who is known professionally as Stormy Daniels. Clifford’s lawyer responded by calling the president “a disgusting misogynist.” Daniels, who was paid US$130,000 through Trump’s former lawyer to buy her silence about sex she said she had with Trump, replied on Twitter by using the nickname “Tiny” for the president.

Trump’s tweet landed in the final days of a congressional election cycle in which Republican candidates are already struggling to woo female voters. The president’s language is unlikely to be helpful to them.

Although the president’s comment was striking about Clifford, who has graphically described Trump’s genitals in a recent memoir, it was hardly unique.

Trump has accused women of having “fat, ugly” faces and of repelling voters because of their looks. He called one woman a “crazed, crying lowlife” and said another was a “dog” who had the “face of a pig.” He said Hillary Clinton’s bathroom break during a 2015 presidential debate was “too disgusting” to talk about. He has repeatedly mocked women for being overweight.

“This rhetoric is the kind of thing that has turned off college-educated Republican women who voted for Trump in 2016, but have fallen away,” said Debbie Walsh, the director of the Center for American Women and Politics at Rutgers University. Calling the president’s comment “adolescent,” Walsh said “you cannot continue to be a party in power if the voters that you are appealing to are white men over the age of 60.”

Trump’s turn toward juvenile mockery illustrates why even those Republicans who were buoyed by the bounce they received in the aftermath of Justice Brett Kavanaugh’s nomination were still cautious in their midterm forecasts: One can never guess when this president will veer off message, as he did Tuesday with Clifford.

“To say this is unbecoming of any man, let alone the POTUS, is a vast understatement,” tweeted Rep. Ryan A. Costello, R-Pa., who is retiring from Congress, referring to the president. “And to say this enables teenage boys to feel they have a license to refer to girls w such names is obvious. It’s all very embarrassing.”

Some of Trump’s comments came before he was elected. Voters learned just weeks before Election Day that he had bragged that he could “grab ‘em by the pussy.” He has continued to make crude comments about women’s bodies since taking office, repeatedly testing the limits of the public’s acceptance of a president’s locker-room vocabulary.

A White House spokeswoman declined to comment for this article.

Here are some of the president’s most remarkable attacks on women over the years:

When he attacks women, as he did with Clifford in his tweet Tuesday, Trump often goes after their faces.

As he battled his rivals for the 2016 Republican presidential nomination, Trump made fun of Carly Fiorina’s face on television, saying that people wouldn’t vote for the former chief executive of Hewlett-Packard because of her looks.

“Can you imagine that, the face of our next president?” Trump said during an interview with Rolling Stone magazine. “I mean, she’s a woman, and I’m not supposed to say bad things, but really, folks, come on. Are we serious?”

Trump later denied that he was talking about Fiorina’s appearance and told CNN that he was referring to her “persona.” But similar remarks about other women have been a regular part of his repertoire.

During his long-running feud with television star Rosie O’Donnell, Trump described her as having “a fat, ugly face.” In 2016, he retweeted an unflattering photo of Heidi Cruz, the wife of Sen. Ted Cruz, R-Texas, who was one of his primary campaign rivals. The caption on the picture: “Images are worth a thousand words.”

In a 1992 issue of New York magazine, Trump was quoted as saying that Katarina Witt, a German Olympic figure skater, would be considered attractive only “if you like a woman with a bad complexion who is built like a linebacker.”

The president often expresses his ire by comparing women to animals, an effort to dehumanize his opponents that he also uses against men.

After his former aide Omarosa Manigault Newman published her tell-all book Unhinged, Trump responded by calling her “that dog” and a “crazed, crying lowlife.”

It was not unlike language Trump used in the early 1990s, when he sent Gail Collins, then a columnist for New York Newsday, a copy of a column she had written. Collins, now an opinion columnist for The New York Times, recalled that he scrawled several insults on the column, branding her “a dog and a liar” and writing that she had “the face of a pig.”

At a campaign rally in December 2015, Trump called attention to Clinton’s bathroom break during an earlier Democratic presidential debate, eliciting cheers from his supporters.

“I know where she went. It’s disgusting. I don’t want to talk about it,” Trump said. “No, it’s too disgusting. Don’t say it, it’s disgusting.”

Trump also suggested in August 2015 that Megyn Kelly, a Fox News journalist at the time, was tough on him when she was moderating a Republican debate because she was menstruating. The night after the debate, Trump said, “You could see there was blood coming out of her eyes, blood coming out of her wherever.”

And after becoming president and moving into the White House, Trump mocked MSNBC’s Mika Brzezinski in 2017, saying that she had a “low IQ” and that she had been “bleeding badly from a face-lift” during a social gathering at his resort in Florida around New Year’s Eve.

On Monday, Trump invited a disturbing image when he told reporters that he would keep his pledge to donate US$1-million to a charity only if he could “personally” test Sen. Elizabeth Warren’s DNA. “That will not be something that I enjoy doing,” he added.

Perhaps most common is Trump’s fixation on the overall appearance of women. He often uses their looks as a way of diminishing their abilities, their intelligence or their effectiveness — sometimes all three. Attacking a woman’s looks has become his standard response to female critics and rivals.

After Jessica Leeds said in 2016 that Trump groped her on an airplane in the 1980s, he said “believe me, she would not be my first choice.” Of Natasha Stoynoff, a former People magazine writer who said Trump accosted her during an interview, Trump denied it and said, “Check out her Facebook page, you’ll understand.”

In March 2012, Trump attacked Cher, the singer and actress, over her criticism of Republican candidates running for office, saying on Twitter that she should “stop with the bad plastic surgery and nasty statements.”

That same year, Trump lashed out against Arianna Huffington, the founder of HuffPost, saying she was “unattractive both inside and out.” In 2014, he reiterated that she was “ugly both inside and out!” In 2015, he again tweeted about “the extremely unattractive (both inside and out) Arianna Huffington.”

Trump derided Heidi Klum, the German supermodel and entrepreneur, in a 2015 interview with The Times, saying: “Heidi Klum. Sadly, she’s no longer a 10.” She responded by tweeting a photo of herself wearing a “10” label on her T-shirt.

In 2012, Trump dismissed actress Bette Midler as “an extremely unattractive woman,” adding that “I refuse to say that because I always insist on being politically correct.” And as he watched the 2014 Oscars, Trump attacked actress Kim Novak, writing on Twitter: “The last song was terrible! Kim should sue her plastic surgeon!” He later walked the criticism back by saying she was “a wonderful actress.”

Scott Reed, a veteran Republican strategist who oversees the U.S. Chamber of Commerce’s political affairs, pleaded with the president on Tuesday not to get distracted by lashing out at women the way he has in the past.

“We need a strong dose of message discipline out of the White House for the next 20 days,” Reed said. “If not, this midterm election becomes a crapshoot.”

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