creative writing – Page 10

Writing Paranoid Personality Disorder

Paranoid Personality Disorder (PPD) is a condition characterised by extreme distrust and suspicion of other people and their motives. Characters with PPD are well-suited to serving fictional roles as fiendish adversaries or challenging social obstacles. This article gives some useful tips for writing a believable and engaging character with Paranoid Personality Disorder.

People with PPD are generally very low on the agreeableness scale. Characteristic of the condition is an extreme suspicion of other people’s motives. To be paranoid is to be distrusting, and without a significant element of mutual trust it’s impossible to have any kind of social organisation.

A diagnosis of PPD comes when paranoia has led to a level of disruption that has caused significant disruption in the life of that person or others. It’s not hard to see how this can easily happen in the case of extreme paranoia, for the aforementioned social reasons. A person with PPD is unlikely to trust their employer or supplier to not be ripping them off, and nor are they likely to trust a professor or a doctor.

A protagonist with PPD might live in a world of perceived malevolence. They might see schemes, tricks and traps around every corner. No-one ever approaches them with good news, or with a good offer: all human contact represents merely just another attempt to cheat them. In this regard, the life of a character with PPD might be socially impoverished in a similar fashion to someone suffering from Schizoid Personality Disorder, only with distrust replacing indifference.

If the protagonist of your story encounters another character with PPD, chances are high that they won’t like them very much. It isn’t a pleasant experience to be spoken to as if one is a liar, especially when one had never considered actually lying. It also becomes quickly apparent that investing time and emotional energy in a friendship with a paranoid person is unlikely to be reciprocated, because their constant suspicion will quickly lead to them discounting the value of any favours or friendship offered.

This could make for an interesting story if the protagonist was tasked with winning the trust of a character with PPD. Such a story might mean that the protagonist has to find a way to tease out the few remaining trusting elements in that person and making sure that they get rewarded.

It might also mean that your protagonist ends up learning exactly how someone can end up with PPD in the first place. Perhaps the character they are interacting with did genuinely get cheated, on multiple occasions, by liars who they once trusted: parents, teachers, lovers, bosses. There could be a further twist, if the character with PPD brought all this upon themselves owing to their own malignant personality.

It’s common for individuals with PPD to have what appears to be a “fragile” personality. Ambiguous comments are frequently interpreted as personal attacks, and jokes are often taken in bad humour. Even worse, these reactions are often permanent, because individuals with PPD do not readily forgive slights and insults. For obvious reasons, such behaviour tends to attract enemies, which only serves to fuel the paranoia and mistrust.

A commonly related phenomenon to PPD is that of projection. People who are paranoid are often narcissistic in the sense that they think everything is about them. For this reason, they tend to project their own selfishness and malevolence onto other people. Many cases of paranoia are based on the fact that the paranoid person is themselves not worth trusting.

Some theorists have delineated a variety of subtypes of PPD. Some people with it are particularly stubborn, obsessed with order and regularity and consumed by a fear that someone is trying to cheat them out of something. Others are insular, and lead hermit-like lives far away from the crowds of crooks and criminals that make up society. A third type is malignant – their distrust of other people comes from from suspicion but from hatred.

It’s unlikely that a character in your story will see it as a good thing to encounter a person with PPD, but it is possible. After all, paranoia is an extremely useful aptitude in a variety of security and surveillance-related roles. So if you’re writing about a spy, for example, you might use touches of PPD to flesh out their personality. A character who was once an intelligence officer, but who was let go because they became too paranoid, would be a fitting example.

An interesting twist on a story featuring a character with PPD is if they were actually correct. What if the PPD character was correct in their suspicions of everyone else, and there was, in fact, a great conspiracy or scheme going on?

An important distinction to make is the one between PPD and paranoid schizophrenia (note that paranoid schizophrenia is not in the DSM-V). Paranoid people don’t hallucinate from paranoia alone, and the paranoia involved in PPD is not ludicrously delusional. In other words, a person with PPD may have a twisted conception of reality, but they will not have lost touch with it.

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.

Writing Illness Anxiety Disorder (Hypochondria)

Lying awake at night worried that you have cancer, despite having no real sign of it, is symptomatic of Illness Anxiety Disorder

Illness Anxiety Disorder is more commonly known as hypochondria. Most people are familiar with the concept of someone who worries so much about imagined illnesses that they cause themselves actual ones, and everyone can relate to feeling fear when faced with uncertainty about a personal medical condition, but despite the familiarity it’s easy to get it wrong. This article looks at believable and realistic ways to portray a character with Illness Anxiety Disorder.

Hypochondria is one of the most common of psychiatric conditions, probably because humans have evolved to be concerned about their health. Getting alarmed about someone you know getting sick makes a lot of sense if you live in a small tribe of about 150 people, while contagious diseases can decimate society. Getting alarmed because you saw something about cancer on television doesn’t make sense, and if this gets bad enough it can become a real problem. .

The disorder is really a gross exaggeration of what would normally be a healthy level of anxiety over one’s physical condition. Instead of maintaining a moderate level of awareness about one’s body, ready to take appropriate measures when necessary, a person with Illness Anxiety Disorder will compulsively check and re-check spots and bumps and marks, and will intently track all rumblings and pains.

Hypochondriasis is believed to be ultimately caused by depression and anxiety, which manifests as an obsession with illness. As with many anxiety-based illnesses, dysregulated stress responsivity as a consequence of early childhood abuse is frequently a factor, although this also commonly arises from a single traumatic shock.

If the protagonist of your story has Illness Anxiety Disorder, this might manifest in ways that are similar to the other anxiety-based and obsessive conditions. They might go to considerable lengths to avoid triggering their condition, such as refusing to visit sick friends or family members. This can quickly cause conflict with the people closest to them, especially if those people think that the hypochondriac is shirking their duties.

A character with Illness Anxiety Disorder is likely to fixate on a particular set of symptoms that they have come to believe is indicative of a medical condition. In fact, they are likely to identify a condition and name it. As could be expected, the availability of Dr. Google to everyone’s home has been tempting for those inclined towards Illness Anxiety Disorder. Many hypochondriacs obsessively research their self-diagnosed condition online.

It’s easy for other characters to become frustrated with a protagonist who has Illness Anxiety Disorder, especially if the hypochondria starts to have an impact on their punctuality or ability to hold an ordinary conversation. It quickly becomes tiresome to listen to a litany of medical complaints every time you see a person, and once other characters start to dread such a thing then they are likely to leave the protagonist on their own.

A protagonist who encounters another character with Illness Anxiety Disorder might find it a great challenge to keep the conversation away from that character’s morbid pre-occupation with death and disease. They might have to make a great effort of will to keep their patience and not become angry. It might also be hard not to tell the hypochondriac to “harden up” or to “get over it”.

As with most of the other conditions in this book, Illness Anxiety Disorder has to cause significant disruption to the life of the character with it before it can qualify as a clinical condition. However, there is a wide range of subclinical forms of hypochondria, such as a preoccupation with various symptoms like everyday pains in the chest, stomach, head or gut. These might be symptomatic of a deeper problem.

Most of the disruption caused by this condition is a consequence of the heavy anxiety it is linked with. This anxiety makes hypochondriacs difficult to get along with, because they are always checking their body functions or fidgeting. The constant need for reassurance that hypochondriacs have is apt to drive their doctor up the wall, let along their partner or caregiver.

Usually, a character with hypochondria will not realise it, at least not initially. Most people are not aware of the extent of physical symptoms that can be produced by simple anxiety and depression, and it’s common to attribute these symptoms to a severe disease instead of psychological origins. It’s possible, then, to use physical symptoms – even if psychosomatic – to foreshadow a general decline in health .

At the end of the day, most of your readers will already know about hypochondria and will have met someone with the condition, even if it was at a subclinical level. It won’t take very many hints for them to realise that a particular character in your story is a hypochondriac. The real challenge, from the perspective of the writer, is to depict such a character realistically and not as a stereotype.

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.

Writing Generalised Anxiety Disorder

Everyone knows what it feels like to be anxious. The clammy hands, the tightness in the gut, the dizziness, the sudden need to urinate. Where anxiety becomes a psychiatric problem is when this anxiety gets out of control, causing suffering and an inability to get through everyday life. This article looks at how to write engaging and believable characters who suffer from Generalised Anxiety Disorder (GAD).

One cluster of problems that people with GAD tend to have relates to restlessness and irritability. They think too much about what might go wrong. A number of small problems can then have the tendency to build up and to provoke an outburst over something small. Often a person with GAD will hit their limit and explode, to the astonishment of others around them who didn’t appreciate the underlying anxiety.

Other characters might see the usual signs of anxiety, only writ large. They might notice the signs of despair in the face – tight lips or a pallid look. The character with GAD might tap their feet a lot, fidget or stammer. Other characters might be able to detect and increase in the tension level of the room when someone with GAD is present.

The author might prefer to be more subtle, however. A character with GAD might to prone to explosive anger or hysteria, but the other characters might not be able to perceive the anxiety that underlies the fractiousness. They might also be prone to mind blanks from the anxiety. The other characters might only perceive the surface expression of the GAD, leaving the reader to draw their own conclusion.

For instance, people with GAD tend to smoke a lot of tobacco. If the protagonist of your story has GAD, it might be that they’re reaching for the cigarette packet every time the telephone rings. If the protagonist of your story encounters someone with GAD, it may be that the constant presence of tobacco smoke or smell causes them them to realise that that character has an anxiety disorder.

Insomnia is another common sign. If the protagonist of your story is an insomniac because of GAD, this might be something close to a living hell; a nightly torment that they are forced to endure. Other characters will be able to pick it in their face as well – they will look tired, with puffy eyes and a downcast look. They will look every bit like someone for who life is difficult.

People with GAD, like many people with mental disorders, have a tendency to suffer low self-esteem. As with many other conditions, it’s not easy to tell where the border between the mental disorder and personal weakness is. A character with GAD might frequently be asking themselves if they’re a coward, or if they’re really cut out for the challenges of life. Naturally such an attitude will eat away at their self-confidence.

Intertwined with this is the reality that people with GAD will often not be treated too well by other people. For one thing, anxiety tends to be contagious. If another person is anxious it’s hard to properly relax around them because of the chance that they might blow their top any moment. For another thing, anxiety tends to make people selfish, because the focus is on the desires of the self and not the needs of others. This selfishness tends to be reciprocated.

GAD can cause some of the same thought-loops and obsessional thinking as other psychiatric conditions. With generalised anxiety it’s easy to become anxious about being anxious, especially once one has become conditioned by unpleasant physical side-effects of worry. A character with the condition might feel highly anxious every time they feel a slight gut disturbance or chest pain, fearing that death has finally come.

Although there’s a shared component of extreme anxiety, GAD is distinct from phobias. Phobias (as discussed at length here) are fears of specific things that are hard to escape. GAD is also distinct from social anxiety. People with social anxiety tend to only feel anxious in anticipation of the risk of social judgment, whereas people with GAD tend to be anxious all the time.

GAD is also distinct from Obsessive-Compulsive Disorder, but several patterns of thinking overlap between the two. In particular, people with GAD are prone to worrying about things like whether or not they left the stove on when they left the house. Because anxiety is always present in such people, and because the risk of burning down one’s house is (reasonably) something that many people are cautious of, people with GAD are frequently triggered into panic by such common concerns.

The best thing about GAD from an author’s point of view is that virtually all of the readership will be able to identify with it. Almost everyone knows what it’s like to feel unpleasantly high levels of anxiety, so GAD will also be reasonably easy to identify with. Probably they also are aware of how unpleasant it is to be around highly anxious people, so they can identify with that also.

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.

Writing Hallucinogen Persisting Perception Disorder

Hallucinogen Persisting Perception Disorder (HPPD) is an uncommon condition that arises as a consequence of permanent perceptual changes brought on by use of hallucinogens. There is almost no data on the prevalence of this condition, and some don’t even believe it exists. Nevertheless, this article will discuss how to believably portray characters with HPPD.

HPPD usually causes a problem because of visual disturbances that are akin to those that accompany a hallucinogenic experience. It’s common to see glowing halos around various objects, or visual trails that linger behind moving objects. It’s also possible to perceive objects as being much larger than they actually are, or much smaller. Some people even see a kind of “visual snow” between objects, like the static on a television set. Auditory hallucinations are also possible.

A character who has HPPD might appear kind of ‘spaced out’ to the other characters. Those other characters might suspect that the one with HPPD is, or has been, on a heavy drug of some kind. Because their perceptions are so vivid, a character with HPPD might be too distracted to pay proper attention to what’s going on around them. This could create a number of social difficulties for that character.

The author might decide that writing a character with HPPD is not very interesting if focus is placed solely on visual and perhaps auditory disturbances. It might be possible to tell a far richer and more engaging story by showing the reader some of the other lingering psychological effects of psychedelics, especially the deeper emotional and spiritual ones.

The problem with this approach is that one soon steps outside the bounds of the clinical – which is perfectly fine for the sake of literature, but it has to be kept in mind that the strictures of the DSM are distantly removed from what follows here.

Many psychedelic drugs have the capacity to break down a person’s existing perception of reality and replace it with something entirely different. This means that some of the persisting perceptions that arise from hallucinogenic drugs use are not so much sensual, but intuitive.

A common persisting perception from using hallucinogens is a belief that the material world isn’t real. Our culture is materialist; we take for granted that the material world is real and that the human brain generates consciousness. For the vast majority of us, it seems intuitively true that the material world genuinely exists and that the brain gives rise to consciousness, and this perception is so common that it’s taken for granted by most.

People who have HPPD might no longer believe in materialism. They may feel that, in the course of a hallucinogenic trip, they were granted a particular insight into the way the cosmos truly functions. Maybe they now believe that the world is a dream in the mind of God. A character who has had a change in perceptions relating to cosmic attitudes might find themselves coming into conflict with some of the other characters around them. Theirs could be a story of how easy it is to get ostracised from a community for having unique beliefs.

In practice, it doesn’t actually matter whether materialism is correct or not; a character who becomes a non-materialist as a result of a hallucinogenic experience will have extreme difficulty fitting into society in any case. They will frequently be rejected and mocking for being mentally ill. In particular, it will be impossible for them to convince a psychiatrist that their new belief is anything other than a mental illness. A character who thinks like this will therefore likely be an outsider to some degree.

Another common change in perception relates to the presence of a light at the end of the tunnel. Dovetailing with materialism is atheism – the two seem to follow each other closely. The vast majority of people who were raised atheist do not believe in the presence of a benevolent force that watches over their life with a desire to end their suffering. The cosmos is indifferent to human suffering and misery.

A person who has a strong experience with a hallucinogen can easily come to change their opinion on this subject. It might be that your protagonist has suddenly decided to believe in God – not the God of Abraham, but the benevolent, all-pervading force that gives rise and motion to the world. This might not be received well by the other characters in your story, especially if they are materialists, or if they believe in a dead God such as the Abrahamic one. They will probably think your protagonist is mad or evil.

This can make for an interesting story because of the contrast between the good feelings that arise naturally inside a person who has spiritual satisfaction, and the bad feelings that comes from the outside world as a consequence. Their social life might become much more difficult than before, on account of pressure to go back to the socially-approved way of thinking. This could push them into the arms of a new group of people, such as those who have also seen beyond.

These persisting changes in perception are much more subtle than the visual and auditory ones, but they might have just as large an impact on a person’s ability to live a normal life, primarily because of the social disruption just mentioned. In extreme cases, these changes in perception might make employment also impossible, leading to radical life changes that could lead anywhere.

Writing a character with HPPD is no easy task, because it is likely that most of the readers are not intimately familiar with the effects of hallucinogens and so will have difficulty relating to the often bizarre and surreal perceptual changes that accompany the condition. However, if executed skillfully, a tale with a character who has HPPD could be highly entertaining, insightful or even edifying.

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.