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Keter

[GUIDE] Roleplaying Mental Illness

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Keter    1
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Roleplaying Mental Illness

A guide on how to convey mental illness realistically in your roleplay character.

 

 

What will this guide cover?

 

This guide will attempt to cover various symptoms, reactions and actions of a character afflicted by different types of mental illness. I will attempt to cover common disorders that a psychiatrist or doctor would typically diagnose a patient after one (or two) meetings with them and discussion of their symptoms. This guide will not cover developmental disorders such as Autism and Asperger's Syndrome as neither of these are a mental illness.

 

Terminology Guide

 

Mania: An emotional state where an elevated, expansive or usually irritable mood exists.

DSM-5: "The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) is the 2013 update to the Diagnostic and Statistical Manual of Mental Disorders, the taxonomic and diagnostic tool published by the American Psychiatric Association (APA). In the United States, the DSM serves as the principal authority for psychiatric diagnoses." - Wikipedia on "DSM-5"

 

 

Depression

 

What is it?

 

Depression, otherwise known as major depressive disorder or clinical depression, is a common and serious mood disorder. A person who suffers from depression experiences persistent feelings of sadness and hopelessness and loss in interest of activities they once enjoyed. Depression may also cause physical symptoms such as chronic pain or digestive issues. To be diagnosed with depression, the symptoms must persist for at least two weeks.

 

Depression is associated with high mortality, which is most accounted for by suicide. A person may express suicidal idealization through verbal expression (examples of this could be "I wish I could sleep and never wake up." or "I could just disappear and no one would notice.") or through physical actions such as alcohol and drug addiction and harming oneself (examples of self harm could be burning, cutting, substance abuse and subjecting to violence that would result in harm to oneself).

 

Depression vs. Sadness

 

Given that a primary symptom for depression is sadness, it can be hard to make a distinction between two psychological states. The important thing to note is that depression is more than sadness. The difference doesn't lie in the extent a person feels down, but rather a combination of factors relating to the duration of the negative feelings, other symptoms, bodily impact, and the effect on the person's ability to function in daily life.

 

Sadness is a normal emotion everyone experiences at some point in their life. When it comes to depression, however, no trigger is necessary. A person suffering from depression feels sad and hopeless about everything. They may have every reason in the world to feel happy and yet they lose the ability to experience joy or pleasure. It's important to keep in mind that sadness is temporary. Within a few days your sadness will have passed and even during the time you may be able to enjoy your favorite TV show, food, or spending time with friends. With depression, these activities are no longer enjoyable or cause pleasure.

 

In sadness, you may feel remorse or regret for something you said or did, but it's likely you won't experience a permanent sense of worthlessness or guilt as you might with depression. With depression, it's important to recognize that one of its features is a kind of self-diminishing, negative thought pattern that lingers constantly or for extremely long periods of time.

 

Finally, self harm and suicidal inclinations don't arise with non-depressive sadness. Those struggling with depression may have thoughts of hurting themselves, dying, suicide or have a suicide plan. Although there is a clear distinction between sadness and depression, it's possible for major depression to exist in addition to sadness resulting significant loss such as a family or friend's death, financial ruin or serious medical illness.

 

Symptoms

 

The DSM-5 outlines the following criteria to make a diagnosis of depression. The individual must be experiencing five or more symptoms during the same two-week period and at least one of the symptoms should be depressed mood or loss of pleasure.

 

  • Depressed mood most days or nearly every day
  • Significant diminished interest or pleasure in all, or almost all, activities most days or nearly every day
  • Significant weight loss or gain or decrease in appetite most days or nearly every day
  • A reduction of physical movement that is observable by others and a slowing of thought
  • Fatigue or loss of energy nearly every day
  • Feelings of worthlessness or excessive or inappropriate guilt nearly every day
  • Diminished ability to think or concentrate, or indecisiveness nearly every day
  • Recurring thoughts of death, recurrent suicidal ideation without a specific plan or a suicide attempt with a specific plan for committing suicide

 

The latest edition of the DSM-5 recently added two specifiers to further classify diagnoses:

 

  • With Mixed Features - This specifier allows the presence of manic symptoms as part of the depression diagnosis for individuals who do not meet the full criteria for a manic episode.
  • With Anxious Distress - This specifier allows the addition of anxiety as part of the depression diagnosis. Anxiety may affect the individual's response to treatment.

 

Edited by Keter
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Keter    1
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Generalized Anxiety Disorder (GAD)

 

What is it?

 

Generalized Anxiety Disorder (GAD) is a mental disorder characterized by excessive anxiety and worry. People with this condition often recognize they are "over-worrying" but have no ability to control the worry and associated anxiety. It is constant and can interfere with an individual's sleep or ability to relax and can cause the individual to startle easily.

 

During mild episodes of this disorder, one is more likely to be able to hold down a job and not have it interfere in their social life. When it flares up, a person may experience difficulty with daily life situations and may find even simple tasks unbearable. Generalized Anxiety Disorder can also be coupled with agoraphobia as many people with this disorder attempt to avoid places and situations that flare up their symptoms.

 

There is no clear cut answer to what causes this disorder but it's speculated to likely be caused by a combination of genetic, behavioral and developmental factors. If one has a family member that suffers from Generalized Anxiety Disorder, the individuals chances of suffering it as well are increased, especially in the presence of a life stressor.

 

Long term substance abuse also increases your chances of Generalized Anxiety Disorder as the use of benzodiazepines can worsen your anxiety levels as can excessive alcohol use. Tobacco use and caffeine are also associated with increased levels of anxiety.

 

Normal vs. Excessive Anxiety

 

So how does one know if their anxiety is "normal" or "excessive"? It's normal to be anxious about an upcoming test or how you're going to cope financially when you suddenly find out that your car needs more repairs or part replacements than expected. If an individual is suffering from Generalized Anxiety Disorder, they may see or hear the news of a health scare and lie awake at night worrying if they or their friends will be affected even though the risks are minimal at best. The individual will likely spend days or weeks in a constant state of worry for the well being of their friends and family and experience anxiety that debilitating, excessive, intrusive and persistent.

 

Symptoms

 

To be classified with Generalized Anxiety Disorder you must be experiencing a constant state of worry about a variety of everyday situations for at least six months. In addition you must be experiencing at least three of the following six symptoms:

 

  • Irritability
  • Muscle tension
  • Difficulty concentrating or mind going blank
  • Sleep disturbance (difficulty falling asleep or staying asleep, or restless, unsatisfying sleep)
  • Being easily fatigued
  • Restlessness or feeling on edge

 

Other symptoms may include:

 

  • Stomach upsets - including nausea and diarrhea
  • Avoidance of stressful situations
  • No tolerance for uncertainty - needing to know what's going to happen and how it will happen
  • Constant feelings of dread or apprehension
  • Feelings of overwhelm and avoiding things or situations as a result
  • Feelings of being unable to control one's emotions and constant worry
  • Heart palpitations
  • Trembles or shakes
  • Sweating and dry mouth
  • Difficulty breathing
  • Lightheaded feelings or dizziness
  • Cold chills or hot flashes
  • Numbness or tingling sensations

 

 

 

Bipolar Disorder

 

What is it?

 

Bipolar Disorder, also known as Manic Depression or Bipolar Affective Disorder, is a mood disorder that causes individuals suffering from it to cycle through extreme mood swings that interrupt daily life. If an individual is living with bipolar disorder they may feel abnormally happy, energetic and make impulsive decisions during states of mania. Another kind of manic state is hypomania, which is a less severe form of mania in which the person generally feels good but is aware of their well-being and productivity. During depressive states, a person may feel the overwhelming urge to cry, experience feelings of hopelessness and have a negative outlook on life.

 

These extreme mood swings occur more frequently, such as every week, or more sporadically - maybe just twice a year. There is no defined pattern to the mood swings and one doesn't always occur before the other. The length of time a person may be in one state varies as well. 

 

There are many types of Bipolar Disorder. Three of the most common include Bipolar I Disorder, Bipolar II Disorder and Cyclothymic Disorder. Bipolar I Disorder is characterized by the occurrence of at least one manic episode preceded or followed by a hypomanic or a major depressive episode. Manic episodes may be so severe they significantly disrupts a person's daily functioning and may trigger a break from reality. Bipolar II Disorder is characterized by the the occurrence of at least one major depressive episode lasting two weeks or more and at least one hypomanic episode lasting at least four days. Cyclothymic Disorder is characterized by at least two years of multiple occurrences of hypomanic and major depressive episodes. During this time, symptoms present themselves at least half the time and are constant for at least two months.

 

Mood Swings vs. Bipolar Disorder

 

How do you tell the difference between a mood swing and whether a person has Bipolar Disorder? Well, mood swings are a part of the disorder itself. The difference between a normal mood swing and someone experiencing a mood swing who has Bipolar Disorder is that bipolar mood swings affect an individuals daily life severely. In a regular mood swing, one can be a bit down or a bit up and still go to work or get out of bed. With Bipolar Disorder, a person can feel so depressed they don't want to get out of bed or begin to make a plan for suicide. They can be so manic they impulsively spend all their money on cars. They can be so manic they start fights with others and get arrested.

 

Symptoms

 

Manic Symptoms

 

  • Abnormally upbeat, jumpy or wired
  • Increased energy, activity or irritation
  • Exaggerated sense of self and well-being (euphoria)
  • Decreased need for sleep
  • Distractability
  • Racing thoughts
  • Poor decision-making

 

Depressive Symptoms

 

  • Depressed mood
  • Diminished interest or pleasure in all, or almost all, activities
  • Fatigue or loss of energy
  • Feelings of worthlessness or excessive or inappropriate guilt
  • Recurring thoughts of death, recurrent suicidal ideation without a specific plan or a suicide attempt with a specific plan
  • Significant weight loss or gain or decrease in appetite
  • Fatigue or loss of energy
  • A reduction of physical movement that is observable by others and a slowing of thought 
Edited by Keter

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Keter    1
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Post Traumatic Stress Disorder (PTSD)

 

What is it?

 

Post Traumatic Stress Disorder (PTSD) is a mental disorder that some people develop after experiencing or witnessing a terrifying event. It can severely interrupt a person's daily functions and social interactions. You may find yourself wondering what types of trauma can cause these changes to an individual's physical and mental responses. Any unexpected violation to one's physical or mental well-being can be considered trauma.

 

Not everyone who experiences a traumatic event will suffer PTSD. It's normal to have nightmares, be fearful and find difficulty forgetting what happened. When a person gets stuck in a state of fear and shock and these symptoms worsen or don't improve is when post traumatic stress disorder is likely settling in.

 

Individuals with PTSD are more likely to have problems with substance abuse and are likely to have another mental disorder such as depression and anxiety as well as post traumatic stress disorder.

 

What causes it?

 

One is more likely to experience post traumatic stress disorder if the traumatic event they endure is life-threatening or severely traumatic to their own personal safety. Additionally, the more exposure to the event or prolonged exposure is more likely to increase one's chances of developing PTSD. Other risk factors include:

 

  • Family history of PTSD or depression
  • History of physical, emotional or sexual abuse
  • High levels of stress in one's daily life
  • Lack of coping skills
  • Inability to get help or support after a traumatic event
  • History of depression, anxiety or other mental illness
  • History of substance abuse
  • Careers that expose an individual to traumatic experiences
  • Experiencing previous traumatic events, especially early in one's life
  • The extent that the traumatic event was uncontrollable, inescapable or unexpected
  • Type of traumatic event - intentional, human-afflicted harm is more likely to result in PTSD than a natural disaster

 

Symptoms

 

PTSD symptoms are often grouped into types. These types include: avoidance, intrusive memories, changes in emotional reactions, and negative changes in thinking and mood. The most common symptoms of post traumatic stress disorder include flashbacks, jumpiness and emotional detachment. These symptoms can come and go in severity.

 

Avoidance

 

  • Avoidance in talking or thinking about the traumatic event
  • Avoidance in going to certain places, doing certain activities, or seeing / talking to people who remind the individual of the traumatic event

 

Intrusive Memories

 

  • Experiencing nightmares about the traumatic  or the people, things or places associated with the traumatic event
  • Flashbacks - reliving the event as if it were happening again
  • Recurrent memories about the traumatic event - even when the individual is not actively thinking about it
  • Experiencing severe emotional distress or physical reactions to things, people or places that remind you of the event

 

Negative Changes in Beliefs and Feelings

 

  • Feelings of overwhelming guilt or shame
  • Being easily startled or frightened
  • Sleep disturbances - having a hard time falling or staying asleep
  • Difficulty concentrating
  • Hyper vigilance
  • Irritation
  • Aggressive behavior
  • Angry outbursts
  • Self-destructive behavior (Self-harm, substance abuse, reckless driving)

 

Negative Changes in Thinking and Mood

 

  • Experiencing negative feelings about one's self or others
  • Diminished interest or pleasure in all, or almost all, activities
  • Difficulty maintaining relationships with others
  • Memory problems - not being able to remember parts or any of the traumatic event
  • Feelings of hopelessness for the future
  • Emotional detachment
  • Inability to experience positive emotions
Edited by Keter

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Keter    1
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Obsessive Compulsive Disorder (OCD)

 

What is it?

 

Obsessive Compulsive Disorder (OCD) is a common, chronic and long-lasting anxiety disorder in which a person has uncontrollable, reoccurring thoughts, ideas, wants or sensations (obsessions) that make them feel driven to do something repetitively (compulsions). The repetitive behaviors can significantly interfere with a person's daily activities, well-being and social interactions.

 

A diagnosis of OCD requires the presence of an obsession and/or compulsions that are time-consuming (more than one hour a day), cause major distress, and impair work, social or other important functions.

 

Other conditions sharing some features of OCD occur more frequently in family members of OCD patients. These include:

 

  • Body Dysmorphic Disorder
  • Hoarding Disorder
  • Trichotillomania (Hair Pulling Disorder)
  • Excoriation (Skin Picking Disorder)

 

What are Obsessions and Compulsions?

 

Obsessions

 

Obsessions are repeated thoughts, urges or images that cause distressing emotions such as anxiety or disgust. Many people with OCD recognize that the thoughts, urges or images are products of their mind and are excessive or unreasonable. Most people with OCD try to suppress or ignore such obsessions or offset them with some other thought or action.

 

  • Unwanted or taboo thoughts involving religion, sex and harm
  • Fear of germs or contamination
  • Aggressive thoughts towards others or one's self
  • Having things in perfect order or symmetrical

 

Compulsions

 

Compulsions are repetitive behaviors or mental acts that a person feels driven to do in response to an obsession. These behaviors are aimed at preventing or reducing distress and anxiety. In most severe cases, compulsions can take up the entire day, making a normal routine impossible. Although the compulsion may bring some relief to the worry, the obsession returns and the cycle repeats over and over.

 

Some examples of compulsions:

 

  • Cleaning to reduce the fear of germs or contamination of or on one's self or their surroundings. Individuals may spend many hours washing themselves until their skin is raw and damaged or cleaning their surroundings.
  • Repeating to dispel anxiety. Some people will repeat a word or phrase, others may repeat a certain behavior over and over, some people count from 1 to 10 and over again. They know these repetitions won't actually guard against injury but fear harm will occur if these repetitions aren't done.
  • Checking to reduce fear of harming one's self or others by, for example, forgetting to lock the door or turn off the stove, some people develop checking rituals. Some people repeatedly take the same route home or retrace driving routes to make sure they haven't hit anyone.
  • Ordering and arranging to reduce discomfort. Some people like to put object or books in a certain order, or arrange household items in a certain way or in a symmetric fashion.
  • Mental compulsions to respond to obsessive thoughts, some people silently pray or say phrases to reduce anxiety or prevent a dreaded future event
Edited by Keter

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