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Ask a therapist!



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Sun Jun 14, 2020 9:39 pm
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Liberty says...



@Carlito thanks so much!! <3 <3
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Mon Jun 15, 2020 5:48 am
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SirenCymbaline says...



@Carlito thank you very much! This helps a lot. And I'll let you know <3
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Sat Jun 20, 2020 9:00 am
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SirenCymbaline says...



@Carlito So I've got ideas for what sorts of situations might trigger PTSD reactions, but I'm less versed in what those shapes those reactions can take. I read a book on it years and years ago but I am ruuuusty.

I vaguely remember patients disassociating/freezing/being unresponsive but I'm sure there's more to it that I don't recall/didn't know.

Sorry for asking you simple stuff I could be asking wikipedia, I hope it's not too much of a bother.
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Sun Jun 21, 2020 7:12 pm
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Carlito says...



Hello again @SirenCymbaline! Not a bother at all!

It's going to vary somewhat based on the person and based on what their specific trauma is and how they were triggered :)

What you're talking about here is intrusion symptoms in PTSD. In the DSM-5, to be diagnosed with PTSD someone has to have at least one of the five intrusion symptoms:
1. Recurrent, involuntary, and intrusive distressing memories of the traumatic event(s)
- Think of this as having random memories that pop into the person's head related to the trauma, but different from a flashback which we'll get to in a second.

2. Recurrent distressing dreams in which the content and/or affect of the dream are related to the traumatic event(s)
- Pretty self explanatory. I've read that for people who tend to block distressing memories or thoughts about their trauma, it's more likely to come up in a dream because their body is trying to process it. But that doesn't mean someone who has distressing memories or flashbacks won't also have nightmares or distressing dreams.

3. Dissociative reactions (such as flashbacks) in which the individual feels or acts as if the traumatic event(s) were recurring.
- Flashbacks happen on a continuum of severity, but when they occur, the person is disconnected from present reality. They will see, hear, smell, feel, and/or taste things related to their trauma. To the person experiencing the flashback it's as if they are literally back in that moment experiencing it all over again. And again, this happens on a continuum. It's not always writhing on the ground screaming and crying (but it can be). I've also seen people having a flashback who are sitting very still and calm, eyes unfocused, tears rolling down their face, totally unaware of what's going on in the present around them.

4. Intense or prolonged psychological distress at exposure to internal or external cues that symbolize or resemble any aspect of the traumatic event(s)
- This is when someone hears/sees/smells/feels/tastes/etc something that reminds them of some part of their trauma and they have a corresponding psychological symptom. For example, it's really hot outside today and it was this same temperature the day my friend drowned in front of me so I'm super anxious because I'm reminded of this aspect of my trauma.

5. Marked physiological reactions to internal or external cues that symbolize or resemble an aspect of the traumatic event.
- Similar to #4 except it's a physical reaction. So for the same example with it being hot outside and it was hot the day my friend drowned in a pool, I'm profusely sweating because the temperature reminds me of my friend dying.

What I've personally seen when a client with PTSD has been triggered (and again I work with people 18 and under and their presentations are sometimes different than what we see in adults), anger and aggression (could be physical or verbal aggression), self harm like cutting/picking/scratching, screaming/crying/yelling, not moving, unfocused eyes, becoming very grand and exuberant, trying to distract or change the subject or avoid, becoming very quiet, using substances. It really varies and depends :)

I also recommend checking out first person accounts of people with PTSD who are able to describe what it actually feels like. Because while I can describe what I see when someone is triggered and while I can imagine what it feels like, I actually don't.
Tanja Windegger has C-PTSD (which stands for complex PTSD. This isn't technically in the DSM-5, but many clinicians and people have adopted this term for people who have experienced long-term, repeated trauma rather than a singular traumatic event). Windegger does a nice job explaining a little of what's happening in the brain when someone is triggered or having a flashback and what it feels like to her and what's helpful to her when she is triggered.
Buzzfeed interviewed several people with PTSD (trigger warning: some share the nature of their trauma, no details) and they shared what triggers them and how it makes them feel/how they responded and what's been helpful to them.
Post Traumatic Victory also describes what flashbacks feel like to her in this video and what it feels like for her when she's triggered (which for her happens very frequently throughout a day).
Special Books by Special Kids has interviewed three people (that I'm aware of) with PTSD or CPTSD, Luna, Betty, and Matt

Let me know if you have any clarifying questions or if you'd like to know anything else! :)
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Thu Feb 25, 2021 12:53 am
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Ignorance says...



@Carlito

Hello there! So, my character in a roleplay I’m doing wouldn’t really have any mental health issues (well, he does have a bit of trauma, but I believe you’ve already covered that), but he is indeed a therapist. For a bit of context of his personality, he is very energetic and kind hearted. He is also neurodivergent-coded, the friend who I’m doing this roleplay with and I still haven’t decided which disorder yet, though. Could you please give me some advice on how to write a therapist/neurodivergent character? I feel like I’ve been doing decently so far, but some advice might be nice.
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Fri Feb 26, 2021 4:04 am
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Carlito says...



Hey @Ignorance!
Sounds cool! I think some of it will depend on what specifically you want the character to have to make them neurodivergent. A bit of trauma won't necessarily mean he will have PTSD. He could have any number of diagnoses, and even a diagnosis that's unrelated to trauma at all!

Overall, therapists are just like everyone else :) We don't have any special super powers other than being great listeners and being highly empathetic people. A good therapist isn't there to give advice, but rather is there to help a client find answers and explore. (and there are a ton of different modalities and theories to therapy about how one does that with someone!) It's important for therapists to be very intentional with boundaries and self care because otherwise we carry the stories and experiences of the people we see each day, and that's not healthy. Therapists can easily burn out or experience something called "compassion fatigue" if they are not practicing effective self care.

Depending on what makes the character neurodivergent, that will likely impact how they do their job, and that's okay! It's pretty common for therapists to have gone through trauma of their own or have their own mental health diagnoses. A lot of therapists are intrinsically motivated (or unconsciously motivated) to either be the thing that helped them when they were struggling, or be the thing they wished they had when they were struggling. But I think how to show it will depend on the specific diagnoses you go with.

Are there any diagnoses you're thinking about or trying to choose between? Any other specific questions about what you've done so far and if you're on the right track? Or any other questions in general? :)
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Sat May 14, 2022 4:53 pm
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Moonglade says...



Hey Carlito

I've been writing from the viewpoint of a 14-year-old boy who has started experiencing hallucinations... these rapidly get worse throughout the book. He has recently been forced to move and soon will figure out his father is abusive. Do you find it believable that he may worry more for his Mom at first? Or do you think he would become depressed rather?

Also, how do you think he would release his feelings if he had run away and was lost in a forest?

Are there any other symptoms other than hallucinations that are vital?

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Fri May 27, 2022 2:09 am
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Carlito says...



Hey @Moonglade!

I'm not an expert in hallucinations, but I can hopefully point you in the right direction :)
When people think hallucinations, I would imagine most people think of schizophrenia but there are actually quite a few disorders that could create hallucinations - brief psychotic disorder, schizophreniform, schizoaffective, and schizophrenia. Average age of onset for psychotic disorders are late teens/early twenties, which doesn't mean it's impossible for symptoms to being earlier than that, but it's not common.

Dr. Todd Grande is a clinical psychologist who makes YouTube videos about a variety of mental health related topics. He has a few videos on psychotic disorders that you might find helpful:
What are the symptoms of schizophrenia
Nine myths about schizophrenia
The difference between schizophrenia and schizoaffective disorder
The main difference between brief psychotic disorder, schizophreniform, and schizophrenia is duration of symptoms. Someone could have one psychotic episode lasting less than a month and that would be a brief psychotic disorder. Schizophreniform is an episode lasting 1-6 months, and schizophrenia lasts more than 6 months. There's a lot more that go into each of those diagnoses, but I wanted to point out that it's not always schizophrenia. If you're going for the beginnings of a psychotic disorder for this character, that should also point you in the right direction of other things he may be experiencing.

I also always recommend learning from people who experience hallucinations. I love Special Books by Special Kids -- a former special education teacher travels around the US and interviews people with physical disabilities and mental disorders. He's done several interviews with people who have schizophrenia: Cecilia 1st interview, Cecilia 2nd interview, Abelle, Isaac
And several people with schizoaffective: Daniel 1st interview, Daniel 2nd interview, John, Brandon

It's also worth noting that at 14, he will probably have very little awareness about what's going on with the hallucinations. This is touched on in some of the interviews I linked to (I remember Cecilia and Abelle specifically talk about this). Hallucinations can utilize any of the five senses (Cecilia talks about this, I can't remember if it's the SBSK interviews or other interviews she's done). It's not just seeing things. You might hear things, feel things, smell things, etc that aren't there. He may not understand that the hallucinations are not real, or he might be really scared of them because he may not understand what's happening.

As for the other questions, those hit more with trauma responses and I have a lot of experience with trauma responses!

Forced moving and finding out dad is abusive is a trauma and how he reacts to that is going to depend on him. I think both worrying for mom and feeling depression would be common reactions. When I think worrying about mom, it makes me think that mom is still in the home with the abusive dad and maybe the forced move was to make him go live with a relative or something? I think if that's the case and he's no longer in the home and mom is, it would be natural for him to worry more about his mom than himself -- he's now safe and she's not. Even if both he and mom have left the abusive dad and are safe together, it could still be realistic that he worries more about her than himself. Sometimes it's easier to put your focus on another person and make sure someone else is okay rather than looking at yourself. I see this all the time with teenagers.

Stress responses typically fall into four categories - fight, flight, freeze, and fawn. This is our bodies natural response to any kind of danger and when we're exposed to a real or imagined threat our bodies will do one of the four.
Fight: anger, aggression, controlling
Flight: anxiety, perfectionism, panic, difficulty being still
Freeze: can't make decisions, dissociating, numb, isolating
Fawn: people pleasing, codependent, no boundaries
Depression symptoms can definitely increase as a result of an abusive parent and a forced move. The stress responses would likely be the first things you'd see (so shortly after the forced move or shortly after finding out about the abusive dad) and then depression could develop over time.

Releasing feelings after running away and being lost in the forest -- being lost is a stressful event and I would imagine that he's running away from something that was a stressful event. His body's stress response is going to be super activated!!
Fight: could look like screaming, punching/kicking a tree
Flight: could look like crying, pacing, wringing the hands, biting nails, racing thoughts
Freeze: could look like trying to squash all emotions down to feel nothing, blindly walking
Fawn: could look like giving up, accepting the dismal reality

It's also worth noting that whatever his stress response is after finding about about the abusive dad and the forced move, it's likely that he will have a similar stress response when lost in the woods. So for example, if he's in "flight" after finding out about the dad, it's likely he'll be in "flight" again after he's lost in the woods. But, it's also possible for it to be different because it's a different situation and his body is reacting differently.

Let me know if you have any clarifying questions or if you'd like to know anything else! :)
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Fri May 27, 2022 3:13 am
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Moonglade says...



Thank you so much Carlito

This helped so much!

I just had one or two more questions to ask. Could his trauma be a factor for an earlier onset age? How long can hallucinations last, can they last full days? And can he experience several things at once, like say stupidly just not to be too grim that he found a pineapple that’s actually hallucination. Could more than one of his senses be affected by that?
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Sat May 28, 2022 2:20 pm
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Carlito says...



@Moonglade

You're so welcome! :)

Could trauma be a factor in early onset? -- Potentially? Psychotic disorders (like schizophrenia) have a pretty large genetic component, meaning that if immediate family members like parents/siblings have schizophrenia there's a higher chance that the child/sibling will also develop schizophrenia. It's not an exact science and there is also a strong environmental component. So for example, if someone is genetically predisposed to develop schizophrenia (or another psychotic disorder) and they experience early childhood trauma, they may be more likely to actually develop schizophrenia. Drug use can have a similar effect. If someone is genetically predisposed to develop schizophrenia and they use drugs, they may be more likely to actually develop schizophrenia. Now, someone genetically predisposed to schizophrenia who is has no early childhood trauma and never uses drugs could still develop schizophrenia too. I'm not sure on all the exact statistics and which scenarios are most likely, but that could maybe point you in the right direction for more research :)

Another thing that you could consider is flashbacks can look a lot like hallucinations Flashbacks are not part of schizophrenia or psychotic disorders and are a component of post traumatic stress disorder (PTSD). Someone can develop PTSD at any age due to any number of traumatic events (including abusive parents or exposure to domestic violence). Flashbacks, like hallucinations can feel incredibly real because they also incorporate any of the five senses. So for example, if someone had PTSD because of a house fire they experienced, if they had a flashback about that they might not only see the flames, but hear the crackling, smell the smoke, feel the heat, and taste the soot. (Not all five senses will be activated with every flashback, it could be any combo). The main difference between a flashback and a hallucination is that a flashback is directly related to a trauma the person has experienced whereas a hallucination is something the brain and subconscious has created on its own.

How long can hallucinations last? -- From what I remember of her interviews, I'm pretty sure Cecilia (linked above) talks about this. I think it varies and can last anywhere from minutes to days. She's talked about a clown that she sees almost constantly and has learned to live with.

Can they experience more than one sense at a time? -- I'm pretty sure Cecilia has talked about this interviews, too. I believe so! Like in your pineapple example, it would be possible for someone to not only see the pineapple, but be able to smell it too. I think it's more common for only one or two senses to be activated at any given time, but it's possible for all of them to be activated. Cecilia has also done a TED talk and I think some other interviews, too. She's awesome and has a ton of good info about schizophrenia :)

Let me know if you have any clarifying questions or want to know anything else!! :)
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Sat May 28, 2022 3:31 pm
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Moonglade says...



Thank you so much, Carlito (Again...)

You've helped me a lot! I was really interested when you spoke about flashbacks, it could be an exciting tool to use.

I am in the middle of exams so I haven't had time to watch the videos but you have really piqued my interest because I have been trying to work with an almost constant presence or something that is always or seems to always be near but it is hard to fantasize.

(My ideas are partly based on The Shining and some reading up I have done about voices and basic working knowledge of hallucinations. That knowledge has improved with your help.)

Thank you
Moonglade
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