Writing Autism Spectrum Disorder

Autism has gone from being a little-known condition to being a condition that everyone is accused of having, autistic or not. However, just because everyone is aware of autism doesn’t mean that everything they think they know about the condition is accurate. This article looks at how to write believable and realistic characters with autism.

The most characteristic feature of autism is a pronounced difficulty with social interaction, usually coupled with an obsession with certain repeated actions. This difficulty with social interaction is enough to cause immense difficulty in the lives of some autists and the people around them. This goes beyond mere awkwardness, to a point where fundamental communication becomes difficult.

From the perspective of a person with autism, much of the difficulty about living with the conditions comes from an inability to make the intuitive understandings about other people, and their behaviour, that is usually taken for granted. A person without autism (a “neurotypical”) seems to have an almost psychic understanding of how other people think and behave. Social interaction just seems so effortless for such people.

Your protagonist might have difficulty getting along with someone who has autism, on account of that the autistic character doesn’t seem to understand what the protagonist believes to be the rules of social interaction. The protagonist might make jokes that don’t get laughed at, and come to think that the autistic character doesn’t like them, when the problem is a low level of communication.

Then again, your protagonist might get along with an autistic character just fine. Autists can make a lot of sense, in their own way. Often, a person with autism will be capable of observing human interaction without all the pretense and brainwashing, and can arrive at objective, if odd and unconventional, conclusions. These can sometimes be valuable wisdom (and they can sometimes be juvenile truisms).

Viewed from the outside, an autistic character might appear as excessively orderly, to the point of dysfunction. Autists often like to ritualise certain behaviours (much like Obsessive-Compulsive Disorder), to the point where not being able to perform the ritual sometimes creates unbearable anxiety. Their speech can be likewise regimented and repetitive. It’s common for them to compulsively stack objects or line them up.

Moreover, autists often feel solidarity with other neurodiverse people, and vice-versa. Autism is entirely different to, say, schizophrenia, but much of the lived experience of autism is similar to other mental conditions. The social rejection and the anxiety about more rejection, the anxiety, the shame, the frustration, the despair: these are all emotions that mentally ill people tend to experience more than others. An autist might relate strongly to someone who also feel them, even if that person is not autistic.

If your protagonist has autism themselves, you will have to be very careful about how you render their internal dialogue, should you write about them in the first person. A lot of fiction is poorly written because the characters in it have an unrealistically high level of understanding the behaviour of other people. An autistic protagonist will frequently be baffled by the behaviour they encounter. Much of their behaviour will be a complete mystery.

One of the most dramatic things about autism is the emotional consequences of the social difficulties that arise from having the condition. The awkwardness of autism is often mistaken by other people for malice, psychopathy, pedophilia, terrorist intent and all manner of other things. This makes life extremely difficult and can make for a harrowing story (unless your protagonist turns out to be a pedophile or terrorist).

It ought to be easy to engender sympathy from your reader here, because most people are sympathetic to the sense of injustice that comes from undeserved social rejection. Despite that, the other characters might feel like they have good reasons to reject the autistic character. After all, it is hard to tell the difference between social clumsiness and malice sometimes.

Because autism is a spectrum, there are many subclinical versions of it. A character with a subclinical level of autism will be relatable for many – after all, there is no person who has perfectly smooth social interactions all day every day. For them, their autism might be something that just makes life more colourful or interesting.

Autism can increase in severity all the way up to the point where a character with it will just about live in their own world, divorced from the concerns of most of the others. Realistically, a character with severe autism will have a hard time being a major character in your story because their degree of communication impairment will be so severe that no-one else will understand them. More moderate forms could involve a degree of social impairment that can be more or less overcome.

There is reason to believe that small amounts of autism can be helpful in certain occupational fields, especially those that pertain to the imposition of order upon chaos. Therefore, an autist need not be presented as conspicuously mentally ill. They might have found a niche that suits them perfectly, in some job that requires order to be imposed upon chaos. Mechanics and computer engineers are favourites.

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This article is an excerpt from Writing With The DSM-V (Writing With Psychology Book 5), edited by Vince McLeod and due for release by VJM Publishing in the summer of 2018/19.

Writing Dissociative Identity Disorder

Once known as Multiple Personality Disorder, and known casually by some as “split personality”, Dissociative Identity Disorder (DID) is a condition characterised by more than one distinct personality in the same physical body. The disorder is one of the most misunderstood and mischararacterised of all psychiatric conditions. This article looks at how to write believable and non-cliched characters who have Dissociative Identity Disorder.

People who have DID don’t change personalities whimsically. It usually only happens in response to intense stress or emotional pressure. When it does, however, it can be frightening and confusing for the people who see it. A person who has “switched” personalities might indeed seem to be an entirely different person, with different facial expressions, a different gait, different body language and an entirely different way of talking. Their vibe might feel entirely different, and not just in the sense of a change of mood.

Like many of the conditions in this book, DID is believed to have origins in early childhood abuse. The currently prevailing theory is that particularly intense early childhood trauma can cause the mind to dissociate. If this is severe enough, this dissociation can lead to one part of the mind becoming almost quarantined from the others, as if to protect the whole.

For example, a child might receive such intense physical abuse that their personality splits into a regular child’s personality (or primary identity) and a second, much harder and meaner one, who comes about as an adaptation to the abuse. What this can lead to is a situation where the second personality comes out in stressful situations as if trying to “defend” the primary personality from further trauma and abuse. That second personality might be willing to make decisions and take measures that the first cannot countenance.

Characteristic of this condition is the inability for one persona to remember things that have been said to another persona. Because the various personas are complete personalities with their own set of memories, things that are understood by one persona are not necessarily understood by others. People with DID can also lose track of time very easily, on account of that time that passes for one personality doesn’t necessarily also pass for another.

If the protagonist of your story encounters a character with DID, their first clue might be observing signs of depression in that other character. People with DID commonly also have depression, partially on account of the difficulty of living with the condition, and partially as a result of early childhood trauma and abuse. Other conditions are commonly comorbid with DID, especially the other conditions that are believed to have origins in heavy childhood trauma, such as schizophrenia, borderline personality disorder, anorexia and bulimia.

Your protagonist might find it baffling how that the character with DID sometimes doesn’t remember what’s said to them. Even more baffling is that the character with DID will often react with anger if it is put to them that a certain subject had already been talked about. Your protagonist might conclude that the character with DID is on drugs of some kind, and they might feel like they have good reason to draw such a conclusion.

In other ways, your protagonist might have to tread carefully. The heavy childhood abuse that usually precedes the development of DID can make a character with the condition hard to deal with for reasons not directly related to it. For example, they might be paranoid, suspicious, vicious etc. before the effects of DID are accounted for. This might mean that your protagonist mistakes the separate personalities of a person with DID as them being dishonest. Your protagonist might feel that the character with DID is only pretending not to remember things.

If the protagonist of your story has DID themselves, then telling a story about them automatically becomes a challenge because it isn’t clear who is speaking in the first person and who is speaking in the third. Assuming that there’s a primary personality and a secondary one, the primary one might be the one that is written about in the first person. It’s possible to do both, but care has to be taken not to sound like you are retelling the story of Jekyll and Hyde.

Your protagonist’s encounters with other characters could become extremely difficult if the protagonist has this condition. They might find themselves confronted with repeated accusations of being two different people – an accusation which is, understandably, not simple to deal with. Neither are accusations of being on drugs, or being a bastard, or lying, or just being fucked-up – all things that a protagonist with DID might have to deal with from other characters.

DID is not schizophrenia, but it shares many things in common with schizophrenia. DID is believed to be the single most strongly correlated psychiatric condition with severe early childhood abuse and neglect, with schizophrenia closely behind. So a person with DID might have deep understanding of how schizophrenics think and operate, and may have gone through some parts of the schizophrenia spectrum themselves.

It’s worth noting here that attempting to get off a criminal charge by claiming that one has DID and that one’s alternate personality did the crime has virtually zero chance of success, and that even if it did succeed the consequences would probably entail involuntary psychiatric care every bit as unpleasant as going to prison. Juries and judges are wise to such simple tricks and it won’t succeed outside of an extraordinary setting.

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This article is an excerpt from Writing With The DSM-V (Writing With Psychology Book 5), edited by Vince McLeod and due for release by VJM Publishing in the summer of 2018/19.

Writing Dependent Personality Disorder

Dependent Personality Disorder (DPD) is a condition characterised by an extreme emotional dependence on other people. It’s usually a long=term condition that makes it much harder to live an ordinary life, and is slightly more common among women and young adults. This article looks at how to accurately write about characters with Dependent Personality Disorder.

People who have DPD have extreme difficulty making decisions on their own on account of their dependence on other people. They tend to lack the self-confidence to back their own instincts and their own decision making. They are rarely certain that they have made a good decision, unless someone else gives it their approval. This approval they constantly seek, and they constantly act to avoid disapproval.

DPD is a Cluster C Personality Disorder, which means that fear and anxiety are ever-present features of it. In this case, the fear and anxiety primarily relates to making wrong decisions. For whatever reason, people with DPD don’t learn that no-one on this planet really knows what they’re doing and that their decisions are usually as good as anyone else’s. Dependent personalities have a strong desire to have someone else give the “stamp of approval” to their behaviours and actions.

If the protagonist of your story encounters a character with DPD, they might perceive that second character as childish, even infantile. Many of their mannerisms will be the same as young children who are yet to learn the boundaries of social behaviour. A common example is when they make a joke but become afraid that it was a social error until someone else laughs, at which point they do too.

This can be frustrating if the protagonist has to get the character with DPD to take adult responsibilities and to be independent. The condition is especially challenging since the harder someone pressures a person with DPD to take responsibility, the more anxious they will become, and consequently the more dependent. The protagonist will have to know patience to succeed, and if they don’t know if they have to learn.

Your protagonist might be resented by a DPD character if that character feels the protagonist is not approving enough. It’s common for people to think disparagingly of someone with DPD because they see dependency as weak and craven. This timidity can breed resentment, so that a character with DPD might easily feel themselves slighted and wish to take revenge. Passive-aggressive behaviour is a common feature.

A protagonist who has DPD themselves probably lives a life of extreme anxiety. Because so many decisions are made in everyday life, a protagonist with DPD will almost certainly have a lot of difficulty living one. They will have great difficulty getting projects or activities started, because they are too dependent on what other people think to take the initiative themselves.

This is especially the case when a person with DPD has to be examined by an authority figure. If a protagonist with DPD has to, for example, sit a driver’s licence test, it’s common for them to work themselves into a state of panic beforehand, thinking about the possibility of making a mistake and earning the instructor’s disapproval. Passing through international customs is also a great trial. Both of these situations induce far more anxiety in someone with DPD than in a person without the condition.

If your protagonist has this condition, they might find it extremely difficult to ask for their rights if they are being taken advantage of. A character with DPD might be so afraid of disapproval from their boss that they don’t seek to enforce their rights, and standing up to one’s parents is out of the question (unless one is really pushed too far). They might also take measures to ensure that they are never alone, because this requires that one think for oneself.

People with this condition tend to be highly motivated to seek out and maintain relationships with people they consider protectors or caregivers. A protagonist who is acting along these lines might find that pledging their allegiance to a leader of some kind alleviates much of their anxiety about not making correct decisions, for good or for ill.

DPD patients usually have a perception of themselves as powerless or incapable of anything, which might betray a life story of having been treated in that manner by authority figures. Mirroring this is a perception of other people as all-powerful and infinitely capable. This is not simply the same as low self-esteem, because DPD doesn’t tend to come with the bitterness and resentment that characterises a poor self-image.

As with many of the conditions in this book, there is believed to be a considerable link between early childhood abuse or neglect and later development of DPD. In particular, it is thought that parenting styles with too much overprotectiveness or authoritarianism correlate with having the condition. Overprotective parents might prevent a child from exposing themselves to danger and therefore from learning that they are capable of overcoming it, whereas authoritarians might create a sense of learned helplessness.

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This article is an excerpt from Writing With The DSM-V (Writing With Psychology Book 5), edited by Vince McLeod and due for release by VJM Publishing in the summer of 2018/19.

Writing Schizotypal Personality Disorder

Frequently confused with schizophrenia, Schizotypal Personality Disorder (STPD) is a schizophrenia spectrum disorder that manifests as an extremely odd or eccentric personality type, with strong social anxiety and unpopular beliefs. The characteristic feature of it is an unwillingness or inability to engage in close social bonds such as friendships. This article looks at how to write engaging and believable characters with STPD.

The concept of a “schizophrenia spectrum” is relatively new and the precise boundaries between the various stages on this spectrum are not yet perfectly clear. One way of thinking of STPD is as a less debilitating and destructive form of schizophrenia. STPD is a Cluster A personality disorder, which means that people with the condition broadly come across as odd or eccentric, but not particularly dangerous or anxious.

Despite affecting around 3% of the population (and a higher percentage in males), so that almost everyone will have met someone with it, STPD is not a well-known condition. A character with STPD might be conspicuous on account of odd habits when it comes to speech or dress. They might mumble and speak vaguely and imprecisely, and they might wear highly unfashionable clothing or styles of clothing without thinking it amiss.

Some theories consider that there are two different forms of schizotypal personality disorder, one which is passive and one which is active. These are called insipid and timorous schizotypy.

If the protagonist of your story encounters an insipid schizotypal person, they might have difficulty with that person’s strange and absent way of being. Sometimes this sort of schizotypy can come across as vacant, as if the person inside was without emotion. If your protagonist is not a worldly type they might mistake a character with STPD for being on heavy drugs.

The protagonist of your story might want to make friends with a character who has a condition like this, only to be constantly frustrated. The other character might have decided as a general rule that other people don’t like them and so it’s not really worth trying to be friends with them, and so they are not interested in a friendship with your protagonist. Your protagonist might try several ways to overcome this social reticence, and may or may not succeed.

People who are timorous schizotypal are likely to create a different set of problems. This version of schizotypy is more active, which means that it is more likely to present as hostility and paranoia. Although a character with this condition is not likely to become aggressive, they are still likely to exhibit much of the suspicion, wariness and hostility that other people often mistake for aggression.

If the protagonist of your story has schizotypal personality disorder, they might find that other people can’t tell the difference between them and a schizophrenic. It is possible that a person with schizotypal personality disorder is not much different from the characters around them, but that this difference is still enough to cause their ostracisation.

As might be guessed from the above descriptions, people who have STPD often have related conditions, such as Paranoid Personality Disorder, Depression or Avoidant Personality Disorder. People with STPD are often genuinely afraid of other people and what those other people might think of them, and this can lead to them becoming paranoid about what other people are saying about them.

A person with STPD might then choose to just stay away from other people so as to not give them a reason to dislike them. A character developing this condition might find themselves discovering more and more reasons for avoiding social contact until they end up becoming a shut in.

Also very common are what are called delusions of reference. This is when a person encounters an event that they interpret as having special meaning just for them. For instance, a character with STPD might hear some advertisement on television and think it’s referring to them specifically, or they might meet a person twice on the same day by total coincidence, and mistake this for being stalked or similar.

Like many of the conditions in this book, schizotypal personality disorder is heavily correlated with early childhood abuse and neglect. There are some theories that suggest that the schizophrenia spectrum, rather than being simply a form of damage, is an adaptation, in which the person afflicted falls into chaos in the hope of reforming in a healthy way, instead of staying hard and risking becoming vicious.

For this reason, the schizotypal personality, like the schizophrenic, often feels hard done by and misunderstood. They might be aware that the usual course of action for a person who has been damaged as badly as them is to become cruel, perhaps vicious, and that their condition has in some sense prevented this. A profound sense of injustice can arise from the reality that their condition will afford a low social status.

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This article is an excerpt from Writing With The DSM-V (Writing With Psychology Book 5), edited by Vince McLeod and due for release by VJM Publishing in the summer of 2018/19.

Writing Bulimia Nervosa

Bulimia nervosa (usually known as bulimia) is a psychiatric condition characterised by intense bouts of over-eating, followed by a “purge” of some kind. The condition is about nine times more common in women than in men, and is believed to affect 1% of young women at any given time. This article looks at how to write engaging and believable characters with bulimia.

The classic example of bulimic behaviour is to consume an abnormally large amount of food, and then go to the toilet to vomit it all up. It’s worth noting that simply throwing up a lot, even after eating, is not sufficient for a bulimia diagnosis. The throwing up is not the main factor, as the condition is psychological and not physical.

It’s also worth noting that bulimia is very different to anorexia, despite that both conditions are eating disorders caused by a nervous complaint. Bulimics and anorexics share many symptoms, in particular the obsession with food and body image, but there are major differences. Bulimics are often at or near a healthy weight (despite the unhealthiness of much of their activity), and anorexics do not binge eat as a general rule.

If the protagonist of your story encounters another character with bulimia, it might be a matter of slowly coming to the realisation. The character with bulimia might show signs of having thrown up a lot or recently, such as bloodshot, puffy eyes or burst blood vessels in the face. Other physical tell-tale signs are low energy and evidence of self-harm.

Another character might give away signs that they are falling into a pattern of bulimia. An obsession with dietary rules is a common early sign. A character developing bulimia might also develop a set of strict dietary rules that they expect themselves to abide by. These rules might seem obsessional to a second character, but the bulimic character is unlikely to appreciate this sentiment.

These rules are key to understanding the condition. Because consuming fewer calories than one needs to survive is not sustainable in the long-term, the strict dietary rules will inevitably be broken. This doesn’t come with a sense of relief but a sense of horror and shame – feelings so intense that they have to be purged. In this state, vomiting often brings the desired relief.

If the protagonist of your story has bulimia, they are likely to live a very difficult life with a considerable amount of confusion. Thoughts of suicide are common, a symptom of both the condition itself and the difficult life circumstances caused by the condition. Also common are depressive and obsessive-compulsive thoughts, especially self-recrimination and rituals relating to food.

A protagonist with bulimia will probably experience a great deal of anxiety in their everyday life. This is not just because of the condition itself, with the neverending worry and guilt relating to food and body shape. It is also because of the social anxiety that comes with trying to keep their condition a secret. Your protagonist might find themselves telling lies to keep other characters from realising they are bulimic.

A character who develops bulimia may do so on account of exposure to media images that create an idea about what a human body ought to look like. It’s common for teenage girls – especially those who have never previously thought about their bodies as things that sexually attract men – to develop an obsession with what their bodies ought to look like. Bodily self-hate is an inevitable consequence of this for some people.

Some societies that have not yet been exposed to sophisticated and manipulative Western advertising culture find it a shock when they finally are. Many people have been unaware of the possibility of hating their own body on account of it being the “wrong shape”. Some cultures are naive when it comes to lies and lying, and are more easily affected by them. These cultures can see sudden spikes of bulimia rates when this advertising does come.

Like many other psychiatric conditions, bulimia carries an increased risk of depression, anxiety and self-harm. Thoughts like this form an unpleasant positive feedback loop, where the low self-regard puts a person at risk for bulimia and the bulimia causes low self-regard. A character with the condition may not realise that their thoughts are circular. On the other hand, they might be all too aware, and start losing sanity.

Also like other psychiatric conditions, there is a body of literature that suggests a strong correlation between having bulimia and early childhood abuse, in this case sexual. It’s possible that the trauma of sexual abuse leads to some difficulty in handling thoughts and feelings related to one’s own sexual attractiveness.

Bulimia is, along with anorexia and schizophrenia, one of the psychiatric conditions most likely to end in suicide. It is easily possible that such a fate will await a bulimic character in your story – after all, the average woman can no easier look like a photomodel than the average man can look like Schwarzenegger. However, like most mental illnesses, the majority of people with bulimia find some way to accommodate it in their lives.

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This article is an excerpt from Writing With The DSM-V (Writing With Psychology Book 5), edited by Vince McLeod and due for release by VJM Publishing in the summer of 2018/19.

Writing Bipolar Disorder

Bipolar Disorder is an extremely taxing mental disorder that is believed to affect about 1% of the population at any given time. Most commonly affecting people in their mid to late 20s, the condition affects men and women in roughly equal numbers. This article looks at how to write believable and realistic characters with Bipolar Disorder.

As the name suggests, bipolar disorder refers to two distinct poles, one corresponding to ‘up’, the other ‘down’. These relate to mood and behaviour; Bipolar Disorder was once known as “manic depression”. The stereotypical course of Bipolar Disorder is for someone to feel extremely low and depressed, and then suddenly feel high-energy and manic, only to fall back into depression, in a cycle that never ends (important to note here that the cycle is not predictable, like a pendulum, but chaotic).

Although the idea of mania can sound appealing to those with no experience of the condition, and although it is generally much less unpleasant than depression, Bipolar Disorder causes problems at either pole. It contrasts with healthy, natural changes in mood in the sense that people with the condition are seldom in an average, moderate state inbetween the two poles, as mentally healthy people are.

When a person in this condition is in a depressed phase, they are at risk for all of the suicidal behaviours that accompany Major Depressive Disorder. Self-harm is common among people with Bipolar Disorder, a function of the deep self-hatred that occurs in depressive phases. However, when a person is in a manic phase, they are also at risk of harming themselves.

Manic periods have to last for at least a week to really count, as an elevated mood could occur for any number of reasons. The manic phase of Bipolar Disorder can, at its most extreme, present much like a methamphetamine bender. A character undergoing one will tend to talk fast, sometimes stammering, and will have difficulty following a conversation, being easily distracted. Also like a methamphetamine bender, manic episodes tend to result in very little sleep. At worst, they can cause a person to become psychotic.

The combination of these factors can result in some extremely risky behaviour, which could be dynamite for your creative fiction. Hypersexuality, gambling, drug-taking and speeding in motor vehicles are all common behaviours for a person with Bipolar Disorder while they are in their manic phase. Someone behaving like this might seem like they’ve been given a week to live and want to make the most of it.

A character with Bipolar Disorder might not be easy for other characters to deal with. The erratic moods of bipolar sufferers means that other characters seldom feel comfortable around them. People with bipolar can be unpredictable. They are also very high suicide risks, because of the combination of impulsiveness arising from the mania and the self-hatred arising from the depression.

Sometimes a character with Bipolar Disorder will come across as full of energy and life and enthusiasm, making them seem very charismatic to another character. Other times they were be low in energy and miserable, which makes them seem very different. Someone who meets a Bipolar character while they are at one pole, and then meets them again while they are at the other, might have difficulty believing they’re the same person.

If the protagonist of your story has Bipolar Disorder, they might find themselves facing a considerable degree of social stigma. As mentioned above, their condition might make other characters feel uncomfortable. The protagonist might find themselves getting overlooked for parties and for social occasions on account of that other characters are afraid they will be in too crazy of a mood.

If the protagonist encounters another character with Bipolar Disorder, things might not be much easier. It’s common to meet a person with Bipolar Disorder during one of their manic phases, because this tends to cause them to become more extraverted. During this time, they might strike others as dynamic, engaging and enthusiastic. However, if a friendship is formed, it may not survive the depressive phase.

There are two kinds of Bipolar Disorder, known as Bipolar I and Bipolar II. The essential difference lies in the severity of the manic symptoms. The more powerful the manic symptoms, the more likely the sufferer will get a diagnosis of Bipolar I. This is not to downplay the difficulty of living with Bipolar II, but some of the hypomanic episodes in the latter case can actually be useful for getting things done.

Bipolar Disorder is distinct from Borderline Personality Disorder, although the behaviour of people with the condition can appear similar. For instance, people with either condition are capable of changing their attitude towards another person very quickly, but the Bipolar sufferer tends to have more self-awareness than the Borderline and maybe aware that their change in perception is not fully rational.

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This article is an excerpt from Writing With The DSM-V (Writing With Psychology Book 5), edited by Vince McLeod and due for release by VJM Publishing in the summer of 2018/19.

Writing Panic Disorder

Panic Disorder (PD) is a kind of anxiety disorder that is characterised by reoccurring, sudden attacks of intense fear without any obvious cause. These attacks, called panic attacks, involve a number of unpleasant psychological and physical sensations, including shortness of breath, dizziness, heart palpitations and sweaty hands. This article looks at how to believably portray Panic Disorder in your creative fiction.

A panic attack usually lasts for about ten minutes. The first sign is usually a wave of adrenaline and noradrenaline that surges through the bloodstream in preparation for the fight or flight response. It’s common for sufferers to feel a panic attack even in their bowels. Despite the absence of an obvious threat, the panic can be equally as intense as if one was confronted with a terrorist mass shooter.

One unpleasant feature of these attacks is that they can stir many different kinds of fears. Some panic attacks make the victim afraid of dying, whereas others make them afraid that they will lose control and become a screaming mess (even though this is extremely rare). In some ways the experience is like a tour de force of terror.

Perhaps the most difficult thing about this condition is that panic attacks are so unpleasant that they can be traumatising, and this creates fear of future panic attacks, which is often enough to itself cause a panic attack. So a person with the condition can end up learning to fear situations which may cause panic, and this can lead to social isolation in a similar fashion to agoraphobia.

If the protagonist of your story has panic disorder, it is likely that they have to live a life somewhat on the outside. Panic Disorder makes it difficult to socialise, especially when a person starts to become afraid of future panic attacks. This can lead to an everyday experience of constant misery, as the protagonist starts to twist themselves up in knots of over-thinking and anxiety.

An interesting story can be told about a normal life that starts to break down because of Panic Disorder. It’s common for a sufferer of the condition, at least in the initial stages, to be unaware that they are suffering from a recognised psychiatric condition. The panic attacks can be embarrassing, on account of that they have no obvious cause, and it’s easy for a person who suffers them to consider themselves mentally weak rather than sick. They can seem to come out of the blue.

People with Panic Disorder tend to develop a fear of the places in which they have had panic attacks, by way of association. This is one of things that makes the condition so disruptive. Even something as simple as going shopping can become an ordeal if a person is afraid that the experience will trigger a panic attack. Because much of the suffering of the condition is caused by fear of the next attack, certain places can themselves become intimidating.

If a character in your story encounters another character with Panic Disorder, how the first character reacts will tell the reader a great deal about their level of compassion. Because panic attacks can be set off without any obvious cause, the suffering is in the mind. This means that people who need help and reassurance from others can usually only get it from especially empathetic people. A character who helps out another one suffering a panic attack might demonstrate their nature to the reader.

A character with Panic Disorder might have a very complicated relationship with drugs. Many people with the condition have found that alcohol, cannabis, tobacco etc. has a short-term, immediate effect of quelling the panic, but have also found that using these substances makes a panic attack more likely once they have worn off. A character taking drugs to treat their anxiety might not have figured the second point out yet.

In contrast with Generalised Anxiety Disorder (GAD), Panic Disorder tends to come in sharp spikes or groups of attacks. GAD is an ever-present background hum of anxiety, whereas people with Panic Disorder can often live entirely normal lives until the panic kicks in. When people with Panic Disorder are anxious, it is usually because of a particular fear of another panic attack rather than anything general.

Mass Panic Disorder is not a condition in the DSM, but the author might still like to use the phenomenon in their creative fiction. A contagious panic attack might be the event that leads to mass destruction of part of your story world, leading to the disruption of the life of one of your characters. An explosion might cause a mob reaction that a character gets caught up in.

Writing Borderline Personality Disorder

Borderline Personality Disorder (BPD) is a condition characterised by extreme emotional instability and sensitivity to criticism. This means that characters with the condition are naturally well suited to dramatic fiction. This article looks at how to write interesting and believable characters with Borderline Personality Disorder.

Originally named because it was the label given to those on the border between diagnoses (in particular psychosis and neurosis), BPD has taken on a somewhat different meaning in recent editions of the DSM. Indeed, some believe the name is no longer accurate, and the condition ought to be renamed as something like “Emotional Disregulation Disorder”.

People with BPD tend to have extremely strong reactions to criticism. This is believed to stem ultimately from a weak sense of self, which makes them prone to being heavily impacted by what other people say about them. It’s as if they don’t have the same defences that most people have when it comes to accepting criticism and resisting bullying.

They also tend to have problems when it comes to interpersonal empathy. A character with BPD might seem a bit narcissistic or psychopathic to other characters because of their apparent refusal to take other people’s feelings into account when making decisions. Alternatively, they might perceive someone to be angry at them when they really are not.

If the protagonist of your story has BPD, it might be that they experience even mild criticism as brutal, sharp and denigrating. This could make them seem extremely sensitive, or even narcissistic, to other characters. The difference between BPD and narcissism in this sense is that a person with BPD can be reassured that the criticism was not intended to be wounding, whereas a narcissist would likely bear a grudge.

People with BPD also tend to have a very strong fear of abandonment. It is uncommon for them to feel secure in romantic relationships. A protagonist with this condition will probably experience a lot of thoughts of jealousy and suspicion going through their minds. They will frequently perceive their partner as flirting with others when they really aren’t.

A protagonist that gets involved in a romantic relationship with another character who has BPD is probably in for a rocky time. People with BPD tend to treat their lovers like a demigod one minute and dogshit the next. This is often very difficult for those lovers, who then don’t really know where they stand. The line between this kind of behaviour and narcissistic abuse is not obvious.

On the other hand, a character with BPD might be more than memorable in bed. The combination of emotional intensity, need for reassurance, and lack of inhibition can make for an incredible sexual experience – perhaps even enough to make up for all the insanity otherwise endured. A psychologist can tell you that this kind of treatment is liable to become addictive, which makes for a tumultuous time.

Realistically, an experience with BPD is more likely to be deeply unpleasant than it is to result in legendary erotic achievements. Self harm is common among people with the condition, and could be considered characteristic of it. If the protagonist of your story encounters someone with scars on their forearms, this could foreshadow some intensely emotional scenes.

If your protagonist encounters a character with BPD, they might realise something is amiss on account of that that character has dysfunctional life goals. The borderline character might seem to drift from one meaningless activity to another, with little awareness paid to the fact that they’re getting older and that time is passing them by. This might manifest as a nihilistic streak.

A character with BPD might be disliked by other characters, sometimes intensely, if they don’t have sympathy for the condition. Because people with it tend to be deeply wounded by criticism, they can develop a tendency to lash out hard at minor insults. This can make them antagonistic and grudge-keeping. Other characters might get the perception that they have to walk on eggshells around the borderline or else run the risk of being attacked.

BPD is around three times more common in women than it is in men (this is likely one of the main reasons why women are often seen as less emotionally stable than men). This can add to the difficulty of having the condition. If you’re writing a female character with BPD, that character might discover that other people don’t take their condition seriously, because their prejudice leads them to put it down to being a woman etc.

In the eyes of a protagonist who is encountering a character with BPD, the borderline character might just seem like a loose cannon, akin to certain other conditions like Schizophrenia and Histrionic Personality Disorder. Much as with those conditions, the risk of self-harm and suicide is often present with BPD. This is partially a result of the disinhibition that comes with the disorder but it is also the result of the fact that people with BPD tend to have difficult lives.

All in all, a character with Borderline Personality Disorder is a good choice if your dramatic fiction needs some more drama. Things are unlikely to remain stable for long with such a character around. However, care will have to be taken to portray such a character with compassion, and not make them seem like an arsehole.

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This article is an excerpt from Writing With The DSM-V (Writing With Psychology Book 5), edited by Vince McLeod and due for release by VJM Publishing in the summer of 2018/19.

Writing Post Traumatic Stress Disorder

Post Traumatic Stress Disorder (PTSD) is an unusual condition in that almost everyone has it to a greater or lesser degree, but few realise the impact that it has had on their lives. As the name implies, the condition describes when a person’s stress levels or reactions don’t go back to normal after a major traumatic experience. This article looks at how to write believable characters and situations involving PTSD.

PTSD is caused by exposure to a traumatic event, usually one in which a person thinks they are going to die. The classic examples are exposure to warfare, traffic accidents, sexual assault or physical assault. Experiences like these cause the brain to flood with fear, which can form long-term associations with the other stimuli present. This means that future exposure to those stimuli can trigger that deep fear again.

The classic symptom of PTSD is becoming full of adrenaline and going into combat mode when exposed to a loud noise or a touch to the head. In the former case, the loud noise might remind a character of the explosions of grenades and shellfire in combat; in the latter case, the touch to the head might remind of early childhood abuse at the hands of a parent. In either case, powerful memories of immense fear can quickly come flooding back.

The effects of PTSD are what could be expected from a close brush with gruesome physical death: adrenaline and cortisol prime the character for either combat or running. A character with the condition might easily become stirred into fight-or-flight mode as a response to the trauma. Here it can be seen that PTSD has considerable overlap with other psychiatric disorders, in particular Panic Disorder, Avoidant Personality Disorder and Generalised Anxiety Disorder.

Other effects are an increased propensity for self-harm. After all, one of the natural consequences of having a massively traumatic experience is that a person comes to realise that the world is much nastier or more dangerous than they thought it was. Some people with PTSD might decide that this world is actually pretty shit and not worth living in, given the horrors it contains.

In the case of violent crime or rape, a person might also come to lose all trust in a major societal demographic, which entails everyday difficulties. If a woman comes to distrust all men or a robbery victim comes to distrust all blacks, their life might become a lot harder and quickly, for no real fault of their own. Like children who have had bad experiences with dogs, a person with PTSD might come to dislike anything associated with their initial trauma.

Because PTSD is frequently portrayed in dramatic fiction, care must be taken not to write in cliches. The example of a nightmare leading to someone waking up in the middle of the night screaming, only to realise that the object of their terror is no longer present, is a striking one but also very heavily used. So too is the man staring into the distance, reliving a traumatic experience, not hearing someone calling to them.

A protagonist who suffers from PTSD might be aware of their condition or unaware.

If they are aware that they have PTSD, they might be a deep and sensitive character. They could be directly aware that a particular early life event has damaged them irreparably. This might be the reason for their unusual levels of compassion – the character knows what it feels like to be scared to death and commiserates with others who also do.

A story featuring such a character might be one about how they overcame their psychic damage and managed to find a way to engage joyfully with life. Often this involves healing oneself, the shamanic path. An extremely wise character may have attained their insight through having overcome an equally extreme trauma earlier in their life. Perhaps this experience caused them to understand what another character is going through.

It’s common to have PTSD and to be unaware of it. This is especially plausible on account of that people who incur severe psychological trauma might not show signs of it until many years later. A person might grow into early adulthood with a particularly surly or nasty character because of some heavy trauma incurred while a child. They might also show other signs of being strongly emotional, reckless or impulsive.

Just because a character with PTSD is not aware that they have PTSD, doesn’t mean that other characters will not be aware. In some cases it will be very obvious, because they will observe the first character go into kill mode for what seems like an insufficiently grave provocation. The character with PTSD might soon find that their condition is part of their reputation – they seem “damaged” in the eyes of others.

A combination of the two can also tell a story, such as the case of a protagonist who gradually becomes aware that they have PTSD or something like it. Perhaps they are perceptive enough to realise that a prior event has damaged their psyche – for example, they observe that they feel intense anxiety when presented with a stimulus that reminds them of a particular traumatic event.

If your protagonist encounters a character with PTSD, how that protagonist behaves might depend on their naivety and openness. A naive character might think that simply by being nice to someone with PTSD they can get them to behave normally. Although this is sometimes true up to a point, the reality is that PTSD often carries with it sinister undertones of bitterness and resentment.

It’s common for people who have PTSD for similar reasons to bond strongly over the fact. This is especially true in the case of soldiers, emergency personnel and survivors of abusive relationships. For one thing, misery loves company, but for another, severe trauma is often the kind of experience that deeply shapes a person and their conception of life and reality, so people who share the trauma often share an entire worldview that’s based on it.

C-PTSD (Complex Post Traumatic Stress Disorder) isn’t actually in the DSM-V, but it’s worth covering here for the sake of completeness. Essentially it’s a similar condition, only brought about by repeated exposure to a traumatic person or stimulus, as opposed to one single, horrifying event as is usually the case with regular PTSD.

The major difference with C-PTSD is the loss of a sense of self. One’s boundaries are violated with such consistency that it becomes hard to say where one ends and the outside world begins. This can be related to Depersonalisation Disorder and frequently coincides with a deep sense of distrust about other people.

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This article is an excerpt from Writing With The DSM-V (Writing With Psychology Book 5), edited by Vince McLeod and due for release by VJM Publishing in the summer of 2018/19.

Writing Narcolepsy

Best known as the condition that causes Grandpa Simpson to fall asleep at a moment’s notice, narcolepsy is an uncommon disorder linked to sleep patterns. This article looks at how to write believable characters with narcolepsy.

Narcolepsy is a decreased ability to regulate sleep-wake cycles. The overwhelming problem with narcolepsy, and its most characteristic feature, is that people with it can feel extremely tired during the day. The most notable symptom is recurring bouts of extreme daytime sleepiness, which can result in falling asleep in unexpected and inappropriate places.

Because being properly awake during the day is virtually a necessity for normal life function, narcolepsy can be a crippling condition for those afflicted. If it’s bad enough, driving a car will be impossible because of the risk of crashing (similar to epileptics). Taking public transport might not be possible either, which means that the life of the a narcoleptic character in your story might have to be a restricted one.

The author should pay close heed to what’s known as the “tetrad of narcolepsy”: cataplexy, sleep paralysis, hypnagogic hallucinations and being extremely tired during the day.

Cataplexy is a strange condition that involves the sudden weakening of large muscle groups. A bout of cataplexy can involve a weakening at the knees, or in the neck and head (similar to nodding off to sleep). This is one symptom that can truly wreck the life of a narcoleptic. It isn’t just that the physical debilitation is a problem, it’s that the narcolepsy sufferer learns to fear the social occasions that pose a risk of provoking one.

Sleep paralysis is the experience, often terrifying, of not being able to move one’s body when awakening or falling asleep. The experience of a character undergoing sleep paralysis might be similar to one undergoing night terrors. They may feel as if they have died.

Hypnagogic hallucinations are felt by narcoleptics when falling asleep. These are intense, vivid and dreamlike experiences that usually manifest as sights and sounds. These experiences can feel much like salvia divinorum experiences in that they are surreal and cause one to feel like one is present in another world. These hypnagogic experiences are sometimes disturbing enough to cause a person to get out of bed again.

The excessive daytime sleepiness is probably the most striking and obvious symptom. This manifests as powerful “sleepiness attacks” that overcome the narcoleptic, no matter how much sleep they have had the previous night. These attacks may be irresistible, so much so that the narcoleptic can literally fall on the ground asleep.

Narcolepsy might be more useful as a plot device than as something to afflict a character with. It could be that someone’s narcolepsy in the past led to a car accident, which then had far-reaching consequences for the protagonist of your story. Or it could be that, as a small minority of narcoleptics are “supertasters” with heightened olfactory awareness, your protagonist has a special use in forensic science or perfumery.

It might even be that a character’s narcolepsy has led to them waking up and rearranging their environment during the night. This could be combined with more interesting sleep disorders, like somnambulism.

Another curious point about narcolepsy is that it’s easy to confuse with an addiction to heroin or some other drugs. After all, it need not be immediately obvious to a close observer if a given person nodding off is doing so because of narcolepsy or heroin, drunkenness or something else. A character with narcolepsy might then feel that they are hard done by on account of being treated like something they’re not.

Unlike most of the other psychiatric conditions in this book, narcolepsy is not caused by early childhood abuse or neglect. So a character with it is unlikely to demonstrate signs of being damaged. Possibly they are an entirely normal person by most apparent measures apart from the narcolepsy.

Many stories about mental illnesses are tragedies because of the exposure to violence, neglect or abuse that caused the trauma underlying the illness. In this sense, a story about narcolepsy is probably different. The trauma might be ongoing, on account of that the coming of narcolepsy can ruin the life of an otherwise entirely normal person who had previously given no indication that they might be mentally unusual.

Alternatively, the narcoleptic could be a good choice of character to place at the centre of a comedy. A problem with suddenly falling asleep all the time could make it very hard to get things done. If a band of characters had to achieve some set goal, and one of their number was a narcoleptic, that character might constantly be letting the others down by falling asleep at inopportune times.

Likewise, a narcoleptic guard, surgeon or helicopter pilot might be considered inherently funny, on account of that their condition makes them exceptionally unsuited for that particular job, in a fish out of water sense. The author will have to take care to find the right balance between comic and ridiculous here.

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This article is an excerpt from Writing With The DSM (Writing With Psychology Book 5), edited by Vince McLeod and due for release by VJM Publishing in the summer of 2018/19.