Young Writers Society

Does your character have a mental health disorder and you want to portray it accurately? Does your character go to therapy and you don't know what happens in therapy?

I got you! (probably :p)

This is like the character clinic, except for all of your character's mental health inquiries!

I am a licensed therapist and I've been practicing for over four years. I'm very passionate about accurate portrayals of mental health in fiction and I think we need more fiction that shows therapy as a good thing! Obviously #ownvoices narratives about mental health experiences are ideal (ownvoices meaning if you're writing about a character with schizophrenia, you also have schizophrenia), but I would love to help anyone who is trying to research some component of mental health for their story.

I am obviously not an expert at every single subject, and I will try to direct you as needed if I don't feel I can answer your question. And like the character clinic, this thread is for fun. This is for fictional problems and fictional characters, and nothing I say here should be taken as mental health advice. I cannot be your therapist, and if you have a personal mental health concern or question, please talk to your doctor or seek a mental health care provider in your area! <3

I am familiar with all of the disorders listed in the DSM and am familiar with a wide variety of treatment modalities and techniques. However, what I have the most experience with is:


While I can't tell you what it's like to have a particular diagnosis (other than social anxiety) what I can help with is:


Ask away! I'm happy to help or point you in the right direction if I don't feel I can

Frequently Asked Questions

*Please note that I live and work in the United States and some of this information may be different depending on what country you live and the specific laws in your state within the US.

What happens if a minor is suicidal/homicidal/self harming/a danger to themselves or others?


What's the difference between a therapist, counselor, psychologist, psychiatrist? How would my character become any of these things as a job?


What's the difference between therapeutic settings? Office-based, home-based, school-based, residential, intensive outpatient, partial hospitalization, acute inpatient??

Hey @Carlito, I’m happy to tag in if ever - I’m obviously not as experienced but I’m halfway through my Master’s in Counselling.

@Lavvie I thought about you as I was posting this! Feel free to chime in whenever

I'm curious about Dissociative Identity Disorder.

What are the key defining traits of it?
Do we know what the stages of development are?
How does it differ from other personality disorders?
Is there any neurological science currently available to explain it?

I'm not looking to use it in a project, but I do have characters with multiple identities in the same form (fantasy / supernatural setting) and I want to make sure I'm steering clear of an overlap between them.

@Tenyo

Great question! I think the first thing to know about Dissociative Identity Disorder (DID) is that it's a controversial diagnosis. There are clinicians who believe it exists and is a real thing, there are clinicians who don't. I'm in the camp that I believe it probably is a real thing, but I think there are a lot of people on Youtube who pretend to have DID for attention/views who don't actually have it.

DID forms as a result of significant early childhood trauma. Specifically trauma before the age of 8 or so when your personality is developing. The thought is that in these early stages of development, when significant trauma occurs, the mind will sometime split into multiple personalities in an effort to "protect" oneself from the trauma that is occurring. (This abuse isn't happening to me Suzie, it's happening to this alter Tom). The alters can be any gender, any age, and don't even have to be human.

What are the key defining traits?
In the DSM-5, it's classified as:
1. Disruption of identity characterized by two or more distinct personality states, which may be described in some cultures as an experience of possession. The disruption in identity involves marked discontinuity in sense of self and sense of agency, accompanied by related alterations in affect, behavior, consciousness, memory, perception, cognition, and sensory/motor functioning. These signs and symptoms may be observed by others or reported by the individual.
- So these personality states are not like oh sometimes I'm goofy and silly and girly and sometimes I'm serious and punch people. They are totally separate "people" that can be identified. They have their own manner of speech, their own handwriting, their own mannerisms, their own gait, their own memories, interests, hobbies, everything.
2. Recurrent gaps in the recall of everyday events, important personal information, and/or traumatic events that are inconsistent with ordinary forgetting.
- Because each personality state has their own memories, when a switch happens the new person in control will often have huge memory gaps and have no idea what happened over the last however many hours and how they got to where they are and what they're doing. Not all of the alters will remember the early childhood trauma. Some alters may not even be aware that some of the other alters exist.
3. - 5. The symptoms cause significant distress, cannot be explained by a religious or cultural practice, and cannot be explained by substance use.

Beyond that, as the name suggests, people with DID are often dissociative and feel unreality, detachment, being an outside observer looking in, numbing, etc.
And I think it's also worth noting that I think it would be super rare for someone to just have DID (I know for your purposes it's not for a character with the actual diagnosis), but people will also likely display symptoms of PTSD or depression or anxiety, or a combo because of the significant trauma they have experienced.

Also, a person with DID cannot generally control the switching. A switch might occur when someone is under stress or experiences some kind of trigger (can be a positive or negative triggers) that brings another alter to the forefront. This is often distressing as the person may not be fully aware of what's going on and will often have memory gaps or be confused once the switch happens. And if the switch happened as a result of stress or a negative trigger, they may now find themselves in a state of anxiety or panic.

Do we know what the stages of development are?
It can first manifest itself at any age (childhood - adulthood) although there must be significant early childhood trauma.
I don't personally know how it progresses exactly. I know that someone who genuinely has DID will get a lot of other diagnoses before they get the DID diagnosis. It will probably look a lot like PTSD or bipolar disorder, or borderline personality disorder, or a psychotic disorder, or some other combo of disorders before they're actually given the DID diagnosis.
I would imagine in childhood, someone who will later develop DID would have a lot of PTSD-esque symptoms. I would also imagine that the first signs someone might notice would be frequent dissociating (but not necessarily having the distinct personality switches) and huge memory gaps.

How does it differ from other personality disorders?
In the DSM-5 it's no longer classified as a personality disorder but rather a dissociative disorder (which can be confusing because it used to be known as "multiple personality disorder" and it's characterized by personality switches).

The current listed personality disorders are: paranoid, schizoid, schizotypal, antisocial, borderline, histrionic, narcissistic, avoidant, dependent, and obsessive-compulsive (not to be confused with OCD :p).

The biggest difference between DID and the personality disorders, is with DID you have more than one distinct personality, and with personality disorders you only have one personality and it "deviates markedly from the expectations of the individual's culture".

Is there any neurological science currently available to explain it?
There is! There's a channel on Youtube called DissociaDID and she does a nice job of explaining some of the science behind DID, so many of these links are from things she's shared on Youtube.
I can't say I've read them all, but I did read the abstracts!


Let me know if you have any clarifying questions!

One of my character had an abusive parent, and ran away with his sister. What are all the possible ways this will affect him?

@LittleLee

Whenever someone experiences trauma (like an abusive parent) it can impact them in many different ways. They may suffer from PTSD, depression, anxiety, addiction, to name a few, or a combo. Also, it's important to note that just because someone has been through abuse or trauma, that doesn't guarantee they will go on to develop a mental health disorder (may do, but not all). For some people, with enough protective factors (like other supportive adults in their life, supports at school or church, being athletic or artistic or having some kind of outlet, etc) and natural resilience (the ability to bounce back from adversity), they can go through something horrible and not develop a mental health disorder. But also, you can have lots of supportive factors and some resilience and develop a mental health disorder. In my experience though, if someone experiences some form of abuse, they're most likely going to have PTSD, depression, anxiety, a substance use disorder, or a combo.

Beyond a possible diagnosis, running away can be super, super dangerous and also be traumatic in its own respect. I should add this to the list of things I have experience with, because I've actually worked with a lot of young people who are chronic runaways

A young person who runs away is much more likely (I can find exact statistics if you'd like) to end up in some pretty dangerous situations such as human trafficking (very high numbers!!), gangs, addiction, or further physical/sexual assault. Logistically speaking, there are not a lot of places a young runaway can go without being reported to the police or child protective services. If they go to any kind of shelter they're going to be reported. So that leaves other family members or friends, and again, you have to hope you're not going to be reported. Some young people can stay on the run without being caught for months and months, but again, this is traumatic and takes a huge toll on a young person. It's really hard to survive out there on your own and the longer you're out on the run the higher the chance is that you're going to be sucked into human trafficking, gangs, addiction, or another rough situation.

Behind the scenes and logistically with police and child protective services (CPS) what happens (at least in my state), the parent needs to report their child as missing. Failure to do this would be neglect on the parent's part and if someone reports the child as missing (like the school) and the parent never does, that could lead to trouble with child protective services. When a parent calls in their child as a runaway, there will be a police report and a CPS report. It's pretty rare that police or anyone is going to be actively looking for a runaway. There are just too many runaways and unless the child is a missing person or thought to be in extreme danger, they're probably not going to be actively looking for them. Now, if the parent didn't report the child missing, the school probably will. Once the kids have been missing from school for enough days and they try to follow up with the parent or do some kind of well check and find out the kids ran away, the school is then mandated to make a report with CPS.

Now what happens once the kids are found, turned it, return on their own? In my experience it'll be one of three things. One, the young person could go to juvenile detention. This might depend on where you live and what the laws are, but where I live minors can go to juvenile detention for running away. I wouldn't expect this to happen on a first offense, and would be more likely to happen with chronic runners. Second, child protective services might get involved. I'll probably do a whole FAQ post on what happens when CPS gets involved, but basically they may do an investigation and then close the case. They may also do an investigation and decide the children are in need of services and open a case (which is a whole long topic in and of itself!). Third, nothing might happen. No juvenile detention, no CPS investigation, the kid comes home and that's that. This might happen if the parent never notifies the police or CPS that the kid returned or if the kid runs again before CPS can finish their investigation.

Let me know if you have any clarifying questions or if you'd like to know anything else!

Hey Carlito! In my book, my main character survived a plane crash and her and the other characters are stranded on a random island. Would there be any PTSD or things that would develop instantly (within 2-3 days)? Also, what would be the result of watching someone that you are OK friends with die from what seems to be a heart attack (but is actually poison)? What if you watched someone die from being shot/stabbed?

Sorry if I worded this weirdly and that the questions are a bit specific!

Hey @LZPianoGirl!

Would PTSD symptoms or anything else develop within the first few days after a plane crash and being stranded on an island?
Possibly! Obviously the plane crash itself is a super stressful event, and then added on to that is the high stress of being stranded on an island! In Bessel Van der Kolk's book The Body Keeps the Score (highly, highly recommend!!), he talks about the impacts of trauma and trauma responses. He actually has interviewed and treated six people who have survived plane crashes and talks about this briefly in the book. He described those six people having one of the following three responses (and this is consistent across other forms of trauma too): collapse, panic, and calm. All may go on to develop PTSD.

If someone is collapsed, think of them as in shock or numb. They feel nothing, they may not remember what happened, they may not be fully aware of what's going on around them, they may not talk very much, they are mentally collapsed within themselves. If someone is panicked, think of them as highly anxious or agitated. They may be jumpy, on high alert, highly sensitive, or have a hard time sleeping. If someone is calm, on the outside they may appear to be weathering the storm and relatively okay. This might be the person who is organizing the group, helping people get to safety, finding shelter or food.

I would expect your character to have one of those three reactions in the first few days after the plane crash. Beyond that, I would expect them to have some problems sleeping, maybe nightmares, maybe some reaction to certain stimuli that remind them of the accident. And even in response to omg we're stranded on an island, your character would either be collapsed (all is lost, the situation is hopeless, feeling nothing at all, in total shock), panicked (WHAT ARE WE GOING TO DO WE'RE STUCK ON AN ISLAND), or calm (the one organizing and leading) in those first few days.

Your other two questions will have similar answers. Initially: collapse, panic, or calm. For the sort of friends person who dies of a heart attack (but actually poison). The character would likely still have this reaction because it's traumatic to watch anyone die no matter how close you are to the person. Also, if the character later finds out that this person actually died from poison and not a heart attack, that would just compound the trauma (add on to their collapse or panic or calm). In that case collapse might look like nothing, no emotion, just utter hopelessness that this whole situation is a lost cause and we're all going to die and there's nothing I can do about it, totally numb. Panic might look like SOMEONE WAS MURDERED AND I MIGHT BE MURDERED and highly anxious, frantic, disorganized thinking and actions. Calm might look like, let's figure out how this happened and keep it from happening again.

Same with watching someone being shot or stabbed. Highly traumatic, and if there's fear that this is going to happen to them, highly highly traumatic. Collapse, panic, or calm initially. Now, it's also worth noting, that let's say immediately after the crash the character is collapsed and totally numbed out. They might have that same reaction to the other traumatic events that happen, or it may change. Someone could begin collapsed and turn panicked or start panicked and turn collapsed, or whatever combo.

Regardless, I would be surprised if this poor character didn't develop PTSD. The full range of symptoms may not develop until after the character gets to safety (assuming they do!) because while all of these events are happening they're purely in flight/fight/freeze mode and trying to survive. All of these events are going to be wrecking havoc on their body and mind. I would imagine they'll have a lot of sleep issues (going to sleep, staying asleep, nightmares) and probably a lot of somatic issues (stomach aches or GI issues, headaches, muscle aches, body pain, etc.)

Let me know if you have any clarifying questions!!

Thanks!

Hey @Carlito!

I'm writing a story about a princess who's father (the king, obviously) has fallen into a pretty deep pit of depression. His citizens used to love him a lot and some even came to his weekly meetings to ask important, citizenly questions. But when King made a serious promise about the farmlands and how he would make sure to keep the gryffins out of there, he couldn't successfully keep up with his promise because of some difficulties. One day the gryffins attacked and killed two families from the farmlands. And the citizens are pretty angry. So King is pretty darn depressed about that. What sort of feelings would he have? What would his behavior be?

And then Princess. Her story is that she's really loved her father, and suddenly seeing him in this horrible situation, what would she feel like? What her behavior be towards everything? (Oh and side note: she actually thinks that her step-mother got into a fight with her father and that's what made him be like that. Though her step-mother is actually very kind, Princess thinks that all step-mothers are evil. *cough* Snow White *cough cough*)

Hope I make sense!

Edit: Also please tell me if this seems realistic. xD

Hey @Liberty! Sorry for my delayed response!

What would the king's feelings/behavior be when he's depressed?
To be diagnosed with major depressive disorder, you have to have at least five of the following during the same two week period. (There is more to the diagnosis than just these symptoms, but these are the main criteria points).
1. Depressed mood most of the day nearly every day -- this could be feelings of sadness, emptiness, hopelessness, irritable, tearful, etc.
2. Diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day -- things that once were enjoyable may no longer be enjoyable, not having the energy or desire to do much of anything, etc.
3. Significant weight loss or weight gain, or increase or decrease in appetite nearly every day -- the key here is this is unintentional and uncontrolled
4. Insomnia or hypersomnia nearly every day -- difficulty falling asleep or staying asleep most nights, or the opposite and sleeping way too much
5. Psychomotor agitation or retardation -- think of this as nervous restlessness (agitation) or the opposite with sluggish movements or thoughts (retardation)
6. Fatigue or loss of energy nearly every day -- pretty self explanatory, but can go along with the insomnia or hypersomnia mentioned above
7. Feelings of worthlessness or excessive/inappropriate guilt -- I'm no good, I'm a burden, I can't do anything right, No one cares about me, People would be better off without me, etc.
8. Difficulty thinking or concentrating or indecisiveness -- not like ADHD difficulty concentrating, more like you're feeling so low you can't think through or make a decision
9. Recurrent thoughts of death, recurrent suicidal ideation, or a suicide attempt -- so anything from passing thoughts about wanting to die or wishing to be dead all the way up to an attempt

You have to have at least five of those to qualify for major depressive disorder, and the total number will correspond to the severity (mild, moderate, severe). It's possible to have all nine symptoms, but most people will not.

I'd recommend checking out some primary sources about what it's like to live with depression as well for a more personal view of what it feels like to have depression. I myself had a bought of mild depression in college, but I don't think of myself as an authority on what depression feels like.

I've always loved this spoken word poetry from Sabrina Benaim explaining how depression feels to her. I also highly recommend interviews from Special Books by Special Kids (Trigger warning: suicide attempt), and this is Elisa's account of what depression feels like to her and her experience with depression. There are also a lot of great Ted Talks (Trigger warning: suicidal ideation) related to people's experiences with depression, and this is Jake Tyler's account. There is also a great resource here on YWS, where people shared their own experiences about what depression feels like to them.

I mostly work with people 18 and under (and their parents). Since you're thinking specifically about an adult, I can say that I've seen adults with pretty severe depression who truly cannot get out of bed, who are in almost a fog like they're going through the motions of their life but they're not emotionally present, or are very flat and generally cut off from most of their emotions. I think it's also worth noting that some people with depression (not all!!) will self-medicate with alcohol, marijuana, or other substances.

How would the princess feel in response to her father's depression?
That's really going to depend on the princess's personality
I've had several close friends go through pretty serious depressive episodes and as their friend I obviously care and worry and want the best for them. For me it was also a helpless and scary feeling at times because I wanted to support them but didn't always know how to help. When there are no easy answers and no easy "fixes" for your loved one, that can be a really powerless feeling.

But it depends on the person. Someone might feel frustration seeing their loved one in a depressive episode. They might not fully understand what's happening and why and they might be angry or frustrated that their loved one suddenly has no energy, doesn't want to do anything, and is gloomy all the time.

For someone else it may trigger their own depressive episode or it may trigger anxiety. Someone might go into "savior mode" and try to fix it for them and make it all better (even though it's usually not that simple). Someone might be a positive support and just a listening ear and present for the person. Someone might view the person with depression as someone who is "weak" or deficient in some way (which is not true!). It will wildly depend on the person.

Let me know if you have any clarifying questions or if you'd like to know anything else!

Hey so this is a Harry Potter oc but that doesn't matter too much. I have a plot in mind but I don't know if it's feasible or not so I wanna run it by you first.

Basically he's a 17 year old student who has been studying with the intent of becoming a doctor, then the whole war in the final book happens and he ends up helping the school nurse with the wounded in the final battle. Seeing your classmates die around you, that prolly leaves a mark on someone.

In my current plan, when he tries working as a trainee in ER a few years later it ends up being a bit triggering, just enough for him to reconsider career options.

Is it at all feasible that he could have it together enough to be useful at the time, but not quite enough to do it on a regular basis?

If it isn't realistic, what might be a better route to go with it?

Thank you for reading

Hey @SirenCymbaline!

I think your scenario makes perfect sense. In that moment of helping out during the war, he's in total survival mode. It's do or die. Help people or they die. Stay safe or die. Think about military doctors and nurses. They have to work in some pretty extreme conditions and still do their job. I think the same could be true for this character.

In terms of him struggling later on when he goes to work in the ER. I think that also makes total sense. Trauma effects everyone a little differently and it's possible to have something called delayed onset PTSD, meaning at least six months have passed since the traumatic event and then symptoms start to show up. It's not uncommon for people to dissociate, block memories, or avoid memories of a trauma for a long time (years and years even!) before something brings those memories back to the surface.

I think especially if this is the first time he's doing that type of medical work since the war, it would make total sense for him to have some trouble. Especially if he sees any injuries that remind him of the war, a person that reminds him of someone he treated during the war, sounds, smells, anything could trigger a memory.

Let me know if you'd like to know anything else!