T3 - Schizoid Personality Disorder

Schizoid Personality Disorder is pretty uncommon even in clinical settings, but I'm convinced this disorder would make for an interesting villain, or perhaps a flawed hero, but that one might be harder to pull off. Just read and think about it.

There are seven diagnostic criteria for Schizoid, and the person would have to have 4 or more to qualify for this diagnosis. So without further ado, we'll just jump right in.

1) Lack a desire for intimacy and don't really derive much satisfaction from being part of a family or other social group. They basically seem indifferent to opportunities to develop close relationships, which, as my post yesterday confirms, isn't main stream remotely. Most of us are made to be relational. They date infrequently and often never marry.

2) Prefer to be alone rather than with other people. These are the quintessential "loners" that are socially isolated. The people who go to movies by themselves, eat by themselves and essentially need (or want) very little interaction with others. They chose solitary hobbies and activities to pursue that just don't include interaction, like computer games. Working a job that requires regular human interaction might be very difficult for them.

3) Have very little interest in having sexual experiences with another person. Hmm...not much else to say about this one.

4) Take pleasure in few, if any, activities. Things that make other people happy, like the sensory experience of walking on the beach or the interpersonal experience of enjoying a candlelight dinner with someone, or the bodily experience of intercourse, just don't make these people feel pleasure.

5) Have no close friends or confidants, except perhaps a first-degree relative. The reason being, of course, that it's difficult to be friends with someone who actually prefers NOT to hang around you. That doesn't exactly inspire close bonds.

6) Seem indifferent to the praise or criticism from others. These people just aren't bothered by what others may think about them, certainly lose no sleep over it. They seem oblivious to the normal day-to-day social cues, and often don't respond appropriately...coming across as socially inept, superficial or self-absorbed (even though that's really not the case). Quite honestly, they just lack social skills.

7) Show emotional coldness, blandness or detachment. A person with this disorder rarely reciprocates gestures or facial expressions like smiles or nods. They claim to hardly ever experience the emotions of anger or joy. Even in the face of direct provocation they won't get angry. They just seem very passive when they encounter what a normal person would consider adverse circumstances and they often can't response appropriately to important life events.

A clinician has to be careful before labeling anyone with any type of disorder. For example, a person who just moved from a very rural area to a highly congested city might react with an "emotional freezing" (kind of like shock) that could exhibit some of these characteristics. The clinician has to take into account the cultural experiences of the person.

In childhood, people who go on to develop this disorder often presented as under-acheivers in school, had poor peer relationships and were often solitary. Quite often they were teased by other children or adolescents. (This is actually a fairly common experience for people with early manifestations of personality disorders. This personality disorder is found most often in males and may cause more impairment for a man than a woman.

It may be more prevalent in relatives of individuals with schizophrenia or schizotypal personality disorder (which we'll cover next week....totally different disorders but share some common features). There is some indication that Schizoid Personality can be a precursor to Schizophrenia, especially since stress can cause Schizoids to have brief psychotic episodes.

That's it for Schizoid. Interesting to think about, huh?

Q4U: Ever known someone who might have fit this bill? What possibilities could it have for a villain? Or hero? Remember: You only have to have FOUR of the above characteristics...so you could pick and choose....

Treatment Tuesday - Meeting An Absent Father

This week’s assessment comes from Alexandra. I have to tell you…this is one great plot, with twists and turns that will be a page-turner! She's writing a contemporary women’s fiction with Ellie* as the 24-year-old heroine. Ellie grows up with her mom, living hand-to-mouth, with no knowledge about her father (who left her mother before Ellie was born because he thought he wasn’t good enough for her). Ellie becomes a single mom as well when her boyfriend turns abusive (causing her to miscarry twice) and she leaves him, taking her baby girl Kathryn* with her. Danny,* a really good guy at her church, loves her and wants to marry her, but Ellie’s not trusting men again. While her mother is dying of a terminal illness, she tells Ellie that her father is a best-selling crime thriller novelist. Ellie conceals her identity and goes to interview him so she can meet him. Her father offers her a job as his research assistant for his upcoming book, and Ellie takes it. She meets up with her abusive boyfriend later in the book because he’s the head of the publishing house that puts out her dad’s books.

* Names have been changed to protect the fictional.

Alexandra wants to know: What sort of emotions will Ellie go through as she interacts on a daily basis with her dad? What physiological problems would she be dealing with? How would she respond to Danny’s advances? What problems would need to be worked out in a relationship? How would Ellie respond to meeting her old boyfriend? When her identity comes to light, how would her father respond (who still loves her mother)?

Quite a long list to tackle! Let’s start with the biggest thing that happened to Ellie: an abusive boyfriend. Women often get sucked into relationships that are abusive, so it says a lot about Ellie’s strength to be able to walk away from this man (who is the father of her child…that’s even doubly courageous). Seeing him again definitely would bring up her memories of the abuse that led to the two miscarriages and probably countless other wounds. But since time has passed, she just might see parts of her daughter in him that have emerged during the time away from him. She’d probably hope for some evidence that he’s changed, that she might be able to safely include him in her daughter’s life (but maybe not…your call. This might depend on whether you intend for her to end up with Danny or Kathryn’s father.)

Her response to Danny’s advances could definitely be mistrustful. She hasn’t had any kind of good role model for how a relationship with a man should be. She likely wouldn’t be able to recognize or trust true love if she found it. So a key for Ellie’s relationship with Danny will be tried-and-true patience/endurance. He’ll come through for her where others have failed, stick with her when others would have bailed, stay with her when others would have tuck-tailed. (I’m such a poet…and didn’t know it!) Eventually there will have to be a scene where Danny throws down the gauntlet, though, giving Ellie a choice.

She’ll either have to come out of her scared shell to accept the love he is offering…and that’s a conscious choice...or she'll face living her life completely alone. (She might be more likely to make this decision after she realizes her dad really loves her mom…that would show her that true love does and can last forever.) Danny does NOT need to offer someone like Ellie any kind of choice where if she makes the “wrong” choice, he’ll give up on her and walk away. Ellie would perceive this as abandonment and it would only serve to reiterate her mantra that men can’t be trusted. Danny would probably get further with Ellie if he says he’ll be whatever she needs from him…if it’s a friend, than he’ll try to swallow his attraction, if it’s more than friends, he’ll be the happiest guy in the world…that sort of thing.

Next big thing to happen to her is the reemergence of a long-time absent father. This really is huge, even for a 24-year-old. Initially, she’d be shocked and outraged, probably, and I’m sure you have a great scene where her emotional reaction to this news is strong. But eventually her intellectual, secondary reaction will come to the fore. She’ll reason through her anger at how he treated her mom (considering she knows the particulars) and for leaving them to squeak out their existence while he shares none of his wealth.

Her anger might remain latent, though, and show up in passive-aggressive interactions with him while she’s his assistant. You know, a little witty remark here or there. I think you could have some tremendously tense scenes as they relate to one another with such similar “caustic, sarcastic personalities.” Great stuff.

Eventually, as she gets to actually know him as a person, she might be touched at how they share some mannerisms and quirks…and yes, “wowed” by her living, breathing, larger-than-life father. She’s a part of him….which will give her an additional sense of self….a more inclusive identity. (Not sure I’m getting my idea across…but I’m going with it. If you have questions…ask away in the comments.)

Last question was how her father would react when Ellie’s identity comes to light. That’s a harder one to nail, because all I know about her father is that he loves her mother still and is a successful novelist. If he had known about Ellie’s existence, he perhaps could have atoned for his “sins” and written a book that paralleled his own life a bit, complete with regrets and disappointments at how his life ended up. Maybe this book is so close to his heart he keeps it from his agent and editor…but agrees to publish it to win back Ellie’s love and trust (as well as her mother’s). This would be a poignant plot development for the reader.

But that still doesn’t answer the question. I think he’ll be thrilled. Deep down, men want to know their children just as much as women do. Fathers want to share themselves, pass part of themselves on. It’s natural. To finally meet her (or, if he had no idea of her existence, to finally know about her existence) would be surreal. A joyous occasion. He’d probably have some reservations about why Ellie’s mother didn’t tell him….and plenty of regrets at how different their lives could have been if he’d known…sadness over the years of her life he missed and the years of potential happiness he could have had with the love of his life, who’s now dying. But he'd probably grab at the chance to make amends, do right by them, pay her mother's medical bills (heck, marry her!), and use his sway to help Ellie in her career however he could.

So there are a few ideas to get your plot rolling smoothly along. Hopefully this helps some!

This service is for fictional characters only, so any resemblance to real life examples is entirely coincidental. Any other fictional character assessment questions can be directed to charactertherapist@hotmail.com.

The Bartered Bride Book Review and Giveaway!

Debut author Erica Vetsch nailed her first book, people. Nailed it. I really enjoyed reading this one....so much so, we're going to have a giveaway! (Just leave a comment in the comment section with your email address to be entered.)

First, a bit about the book from the back cover:

Jonathan Kennabrae is furious when his grandfather informs him that his future has been decided. He will marry Melissa Brooke or lose his inheritance. Jonathan has invested years of his life in Kennabrae Shipping, but heaven help him if Grandfather decides to take it all away for this.

Melissa, too, is devastated when her parents make their announcement. As little more than a bargaining chip in her father's business maneuvers, she feels her secure world slipping away. Engaged to marry a man she has never met--someone "considerably older" than herself? What have her parents done?

Can Jonathan and Melissa find a way out of this loveless marriage, or must they find a way forward together?

You have to love the immediate conflict and high tension from a premise like this. What a great title to capture that conflict. But that's not all that's great. Erica's writing is succinct and tight, with every scene moves the plot forward....very little fluff. But there are some lighthearted moments that make you smile....and the first kiss is so swoon-worthy it certainly won't disappoint. Hel-lo Jonathan! Big *sigh* for all you romantics out there. :)

One thing Erica did particularly well was her use of metaphor. Often she drew from nautical terms for scenes with Jonathan, whose life was immersed in shipping. She always found verbiage to fit the mood of the scene so well.

Donning the therapist cap for a moment...Erica's book covers some intense topics like women's suffrage and arranged marriages and parental expectations. During a time where women were expected to be seen, not heard....certainly not to make a fuss about a marriage or about the right to vote. I think Erica captured young Melissa's plight very well...getting us into her head and heart and how she feels.

Her main characters face the problem of staying true to themselves while trying to be obedient to their parental authority. The pang of disappointment many of us have as adults when we realize our parents aren't perfect...but are, in fact, flawed (sometimes severely so). Because of this, I think just about anyone reading this book could relate to the predicament the characters find themselves in. (Maybe not about an arranged marriage....but we all have received pressures to do things we don't want to do in various forms.) There does come a critical juncture where you have to do what you know is right, to follow your beliefs and live out your faith. Jonathan and Melissa both face to this to a degree. (But you'll have to read it to find out how it all works out for them!)

It's a page-turner...one for the book shelf. So don't forget to leave a comment to be entered in the drawing!

Click over to Erica's blog, On the Write Path, for some great posts about writing. Definitely want to follow her if you aren't already.

Blessings!

T3 - Avoidant Personality Disorder

Week 6 in the Personality Disorder Parade has us studying Avoidant Personality Disorder. (There are only four more PDs to go!) People with Avoidant PD are characterized by social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation.

There are 7 diagnostic criteria for Avoidant PD, of which a person only has to have 4 to have a diagnosis. Without much ado, here they are:

1) Avoid work or school activities that involve significant interpersonal contact because of fears of criticism, disapproval or rejection. These people might even decline a new job promotion just because the additional/new responsibilities could put them under the microscope for criticism. They are anxious about reacting to criticism with blushing or crying.

2) Avoid making new friends unless they are certain they will be liked and accepted without criticism. For a person to be deemed friend-worthy, they have to pass stringent tests to prove they uncritically accept the person with Avoidant PD. These individuals won't join in group activities without repeated and generous offers of support and nurturance. Interpersonal intimacy is only established after the other person is put through the ringer to prove their acceptance. These individuals don't have a large social support network to help them through crises.

3) Shows restraint within intimate relationships for fear of being exposed, ridiculed, or shamed. So even once they decide to enter into a relationship with someone, these individuals still withhold intimate feelings or have trouble talking about themselves with a partner.

4) Preoccupied with being criticized or rejected in social situations. They will feel extremely hurt if someone is only mildly critical. These people are the proverbial wallflowers, but they like it that way. The less attention on them, the better, because the less likelihood of them being degraded ot rejected. So these individuals tend to be shy, quiet, and inhibited. They don't speak out much for fear others would say they're wrong. They react strongly to veiled or even suggestive mockery or sarcasm, taking it extremely personally. Sadly, these individuals long to be active participants in social life, but fear placing their welfare in the hands of others.

5) Inhibited in new interpersonal situations because they feel inadequate. Situations involving strangers are particularly difficult.

6) Views self as socially inept, personally unappealing, or inferior to others. Individuals with Avoidant PD have extremely low self-esteem. This starts at an early age. In childhood, these individuals would be shy and isolated, with a fear of strangers and new situations. While part of that is common in all children, in those who grow up to have Avoidant PD, the shyness actually increases in the adolescent years where social relationships are of the utmost importance.

7) Reluctant to take personal risks or to engage in any new activities because they may prove embarrassing. They live a restricted lifestyle because they need certainty and security. They may exaggerate the potential dangers of ordinary situations

Only about .5-1% of the general population have this personality disorder.

Treatment Tuesday - Childhood Trauma

Today’s assessment comes from Cathy over at Word Vessel. She’s writing a contemporary romance that includes a 6-7 year-old boy who witnesses his father's injury from a horse kick to the head. The father dies a month later from the injury. The boy’s disobedience caused the accident. Her story is going to start 6-8 months after this accident.

Cathy wants to know: What are some possible behaviors that he would take on as a result of this? What steps would a counselor take to help him through the trauma? How long would the process take?

I love questions like this, Cathy, mainly because there are some general predictors of human behavior, but nothing is set in stone. This boy witnessed a horrific sight. Not only that, but he had a personal connection to. A young child is going to feel tremendous guilt, but because of his developmental level, he won’t be able to convey this any other way except by anger.

It’s important to remember that children have the capacity to feel the same things adults do, but they lack the ability to communicate those emotions. Very typically, children will begin to “act out,” as this is the only way they have of expressing themselves. Unfortunately, adults all too often misread the acting out and think the child is doing bad things just to be annoying and that they can control it better. Maybe they can, but just as an adult might utter a curse quickly after enduring pain or blow up at a spouse for belittling them in public, children have reactions, too. But they might not be able to immediately express what they felt. It may take months or even years.

So my first suggestion to you is to consider some way in which this child could act out…and school is the primary place this would happen. Children spend more time at school than anywhere else, so this makes sense. Some typical behaviors you might give him would be hitting, kicking, biting, spiting, choking (most of which would occur on the playground or in the cafeteria when the day’s activities aren’t as structured…these behaviors are less likely in the classroom); defiance, disobedience, inattention, self-isolation, daydreaming, not getting work done on time or at all (all of which could happen at any time). Many of these could also happen at home or with other authority figures at church, baseball practice, what-have-you.

You mentioned a fear of horses as a possibility. Definitely. As an adult, if I had witnessed an accident like that, I’d be scared to be around horses for a while. So a specific phobia (or crippling fear) of horses is more than feasible for a child. What would be interesting is to have the child go see a therapist who specializes using therapeutic animals in their practice. (You find these type therapists out in the country on ranches, mainly, which sounds like it would fit your book.) I don’t know much about this personally, but I found an interesting article here and here about Pet Therapy. Just a suggestion to consider.

The other things you mentioned (sucking his thumb, bed-wetting, not letting his mother out of his sight) are all possibilities. Those behaviors would be considered “regressive” in a child his age. But sometimes children regress to former behaviors because they find comfort in them. You can see my post here about enuresis, also known as bedwetting.

Now to a bit about the process. Every therapist goes about this a bit differently, so I can only tell you how I would approach this young boy. The most important thing would be for the child to feel safe and comfortable around me. This is during the rapport-building stage, which could take months all by itself. But a good therapist can achieve a relatively good rapport within 3-4 sessions. During this time, I do non-threatening activities, like free play (where they can play with whatever’s in the room and I join them), art, games (many of mine are therapeutic, which reveal things about the child unbeknownst to them) or outside sporty stuff (if the space allows).

Once the child is comfortable with me, then I start to do more directive play where I choose activities that are more pointed toward what the child is dealing with. I’ll give you two examples that you are free to use in your novel.

With a child having gone through trauma like this, I like to use a book called Brave Bart, which is called bibliotherapy (using books with therapeutic messages). You can find info and an excerpt about this book here. This book is great because it’s generic and applicable to ANY kind of trauma. The questions at the end of the book are designed for the child to project what happened to them on to the cat Bart, giving the therapist an idea of how to better help the child.

Another popular activity with children I use is a mini-trash can I bought. With the help of one young client, we named it Mr. Trashy, but you can insert your own name. Mr. Trashy “eats” pictures of things that make the child sad, angry, scared, etc. It’s an age-appropriate variation of what’s called ritual. The child gets their emotion out on the paper, but the trash can “eats” it so they child doesn’t have to deal with it. There’s also the ritual of worry dolls (read about them here) where the child whispers their worries (or what causes nightmares, etc) to the dolls and put them under their pillow, which relieves their minds and enables them to go to sleep. Adults do this type ritual at Christian camps everywhere when they write down their sins and nail them to the cross or throw them in a bonfire.

The idea is that by talking and processing through what happened, the child’s behavior improves. And this works. It just does. The child feels heard and understood, and as a result, no longer has the compulsion to act out (which really is just a cry for help). I’ve spent anywhere from 6-8 weeks with a child up to 2 years. Time frame depends on a lot of things (like willingness of the parents to allow the child to come, insurance, etc).

So hopefully this has given you quite a lot to go on for your WIP. I enjoyed sharing some of my therapist tools with everyone. Feel free to leave additional questions in the comments.

This service is for fictional characters only, so any resemblance to real life examples is entirely coincidental. Any other fictional character assessment questions can be directed to charactertherapist@hotmail.com.

T3 - Borderline Personality Disorder

I would be remiss not to discuss Borderline Personality Disorder (BPD), even though I discussed it briefly here months ago for someone's character assessment.

Borderline falls into Cluster B personality disorders and keeps company with Histrionic, Antisocial, and Narcissistic PDs, all of which are marked by drama, emotion, and erratic behavior.

Borderlines, as individuals with this disorder can be called by those in the industry, have historically been considered to be on the border between psychosis and neurosis. Psychosis is a loss of contact with reality. (Literally, from the Greek words "psyche" for mind and "-osis" for abnormal condition--an abnormal condition of the mind.) These people experience an alter reality where hallucinations and delusions and bizarre behavior are common-place. Neurosis has become sort of a pop-psychology term to describe a way of existing that's distressful, but not outside societal norms. (For example, someone with a phobia or with obsessive-compulsive disorder or anxiety would be considered neurotic, but not actively psychotic.)

If that gives you any indication how life is for a Borderline, then you should understand this is no walk in the park. The essential feature of BPD is a pervasive pattern of instability in personal relationships, self-image, and affects, and marked impulsivity that begins in early adulthood and is present in a variety of contexts. There are 9 diagnostic criteria, of which a person has to have 5 or more of the following:

1) Makes frantic efforts to avoid real of imagined abandonment. Borderlines are sensitive to environmental circumstances, and nothing escapes their attention. Even if the separation is time-limited (just a week) or unavoidable (workshop for work calls you to travel away or you're late meeting them because there was a traffic accident), they will experience intense fear of abandonment and inappropriate anger.

2) Has a pattern of unstable and intense relationships. They put friends/lovers on pedestals and idealize them, wanting to spend as much time together as possible and giving too much out too much intimate information in relation to how long they have known them. However, they can quickly switch to devaluing them, feeling the other person isn't there for them enough or doesn't care or give enough.

3) Identity disturbance characterized by markedly and persistently unstable self-image or sense of self. Goals, values, aspirations, career plans--anything and everything is up for change. They might put come off as needy one day and then seeking revenge the next with a strong personality. People who know them really feel that they don't know them.

4) Display impulsivity in at least two areas that are potentially self-damaging. There are a number of areas that can meet this requirement, such as; gambling, spending money irresponsibly, binge eating, abusing substances, practicing unsafe sex, driving recklessly.

5) Recurrent suicidal behavior, gestures, or threats; self-mutilating behaviors. This is often the reason for Borderlines to seek help in the first place and is considered a hallmark trait. The completed suicide rate is high amongst this population (usually 8-10%). Self-mutilation, which includes cutting or burning, are very common. (Cutters usually favor the inside of the forearm or the tops of the thighs, but wounds can exist anywhere.) These acts are usually caused by a threat of separation/rejection or expectations from their partner that the Borderline assume more responsibility in the relationship. Cutting and burning (can be with flame or even pencil erasers rubbed extremely fast over the skin) may happen when the person is dissociative (not fully themselves) and often brings about a relief for the individual because the pain is preferable to the emotion. (I've had a few clients say that they feel so numb, and that cutting allows them to feel something, which is reassuring. Others say cutting themselves is a way for atoning for their being an evil/bad person.)

6) Affective instability due to a marked reactivity of mood. Borderlines have one basic mood: dysphoria. When a person feels dysphoric, they feel a state of unease and generalized dissatisfaction of life. But a Borderline's dysphoria can be disrupted by periods of intense anger, panic or despair that can last a few hours...rarely more than a few days.

7) Chronic feelings of emptiness. They may be easily bored and so therefore constantly seeking something to do.

8) Express inappropriate, intense anger or have difficulty controlling their anger. This could manifest as extreme sarcasm, verbal outbursts, or physical fights. The anger results from when the Borderline feels than someone is neglectful, witholding, uncaring, or abandoning. After expressing themselves, they often feel guilt and shame while furthering their opinion that they are evil.

9) Brief periods of paranoid ideation or dissociative symptoms may occur during times of extreme stress (but generally not enough to warrant another diagnosis). By brief, I mean minutes to hours. Usually, this is also as a result to real or imagined abandonment. They may feel that they are briefly outside their body, a condition called depersonalization.

The thing to remember about Borderlines is that they can lie and manipulate extremely well. Unlike Antisocials, who use power to get what they want, Borderlines appear to use their weaknesses to manipulate. Dr. C. George Boeree commented on his website, "They pull you towards them, then push you away, then pull you back. They pit one friend against another. They dramatize situations to their own ends. They move, chameleon-like, from one "personality" to another." This description reminded me of a book I had to read in school. The title, I Hate You--don't leave me, is indicative of the nature of a Borderline.

Borderlines are hard to treat. Very hard. Therapists are not immune from the idealization/devaluation that Borderlines do, and this makes for talk therapy difficulties. When I slipped from the pedestal for one Borderline client, regaining ground was hard. She thought I was uncaring, but in reality, it was only because I cared that I told her what I had noticed about the patterns in her behavior, trying to help her be self-aware. They also have a typical pattern of regressing just as therapy is going well, to avoid the perceived abandonment of terminating therapy. So you can see the inherent difficulties in just being friends with someone like this, much less treating them.

As for what type of childhood these individuals had, some common backgrounds from Borderlines across the country are physical and sexual abuse, neglect, hostile conflict and early parental loss or separation. Medications and therapy (and patience) are the best modes of treatment. Borderlines can be found in about 2% of the general population, 10% in outpatient mental health clinic populations and about 20% in psychiatric inpatients. The young adult years are the hardest, but Borderlines in their 30s and 40s generally gain greater stability in their relationships and have less likelihood of suicide.

It's a long post, I know, but there's a lot going on with this disorder. Hopefully you'll find what you need if you're seeking info on BPD.

Q4U: Discuss any experience you've had with a Borderline. Did they seem to straddle the fence between sanity and insanity?

Treatment Tuesday - Death of a Parent

Today’s assessment is from Robyn. She’s writing about Miller,* a high school senior.

Eight months before Miller is scheduled to graduate as valedictorian from high school with plans to become a physician, Michael's pregnant mother dies of a drug overdose—only she has never used drugs. It becomes established that she was murdered, and very soon afterward, Miller becomes unsettled and starts doing things that are out of character for him. He doesn't study, skips school, and has some anger issues. He wants to help in the search for the killer, which is a big reason why he skips school. His stepfather and aunt (mom’s identical twin sister) try to help him.

* Names have been changed to protect the fictional.

Robyn wants to know: Does this sound like something a person in his shoes would do? Is it part of grieving? And would he want to stay away from the mother's twin since they look identical?

Wow, Robyn. Sounds like such an interesting premise for a book. Let’s see if I can help.

Miller is obviously a very smart guy. And he’s got aspirations of being a doctor, so he has medical inclinations. Both of these would contribute to his more-than-average interest in his mother’s unusual death. So I think you’ve set him up well to really give him a motivation for his behaviors.

As for the specific behaviors you mentioned, these are very typical reactions for a high school teenager to have when faced with grief or trauma. Even extremely put-together teens have reactions out of character for them. What I think really has potential in your book is the angst Miller will have to go through, as he eventually has to make a decision: find the killer or make the grade.

If you have written him as a very driven, goal-oriented person (which it sounds like he is) and medical school is the end goal, then the stakes are so much higher for him to make that decision. Even more so if his motivation for being a physician is tied to his mother…or possibly father, but since you didn’t mention the father, I’d stick with the mother.

So when her death brings all sorts of questions that Miller wants to help answer, then his goal of becoming a physician for his mother is divided by his desire to find the mother’s killer. Both goals involve his mother and doing something for her, but he can only choose one. These are the type books that keep readers turning. What will he decide? Make sure to include plenty of pressure from the school system administrators and teachers, threatening to take away his valedictorian status, which will in turn prevent him from getting into a good college, which won’t help him get into a good med school….see the angst?

Now about the twin sister. That could swing either way. He might be comforted by her appearance, knowing that twins share a special bond and that his aunt has so much in common with his deceased mother. On the other hand, just looking at her might be too much to bear for such a teen with volatile emotions. He might do a push-pull with her, wanting and needing to be loved and hugged and possibly imagining her as his mother while she performs these nurturing actions….but then angry at himself for his weakness or angry at her for trying to step in and take his mom’s place…it’s really your call.

What would fit best for your story? If this aunt's going to be around a lot…tension could really be amped up in your book if you have Miller despise her. But you don’t want Miller dangling around in a spiral of negativism with no positive influence for him. His aunt might just be the channel he’ll need to process through.

So the short answer to your questions are yes, these actions sound feasible for a grieving teen. I’d just consider ways to ramp up tension and conflict for him internally, and I’ve given a few suggestions. Hopefully this was helpful! Thanks for writing in.

This service is for fictional characters only, so any resemblance to real life examples is entirely coincidental. Any other fictional character assessment questions can be directed to charactertherapist@hotmail.com.

T3 - Paranoid Personality Disorder

We've made it to Week Four of the Personality Disorder Parade. We've already covered Antisocial PD (sociopaths), Narcissistic PD, and Histrionic PD, so be sure to take a look at those if you missed them. This week, we'll look at Paranoid Personality Disorder. As before, the criteria for the disorder are in bold black.

Distrust and suspiciousness so define individuals with this disorder that they interpret the motives of others as malevolent. They automatically assume that other people will exploit, harm or deceive them, even if they have zero evidence to support their assumptions. They might feel that a next door neighbor is plotting against them, or that a coworker might just attack them suddenly for no reason at any time.

Even the people they have befriended aren't free from this. People with Paranoid PD are preoccupied with doubts about their friends' and associates' loyalty or trustworthiness. Many times, they simply perceive a deviation from trust from an innocuous act and this underlies their self-schema that no one can be trusted. When a friend actually passes muster and shows loyalty, the person with the disorder can't believe it.

It's hard for these individuals to share information about themselves with anyone, even close friends. They have a fear that anything they confide will be used against them. Any type of interrogation (like a job interview or applying for a loan) would probably be viewed as prying, which might limit their ability to function in life. (FYI: By definition, a personality disorder has to lead to distress of impairment.) They might even refuse to answer innocent questions, claiming it's no one's business but theirs.

People with this disorder often read into innocent remarks or events, and perceive that they are being demeaned or threatened in some way. For example, if the window clerk at McDonald's made an honest mistake and shortchanged them, they would consider it deliberate. A casual joke can be perceived as a full-on character attack. Even compliments given to them will often be misinterpreted. For example, if the person just bought a new-to-them car and a friend commented on how they liked it, the individual might misconstrue the compliment as calling them selfish underhandedly. An offer to help them might be misinterpreted as a criticism that they aren't going well enough on their own.

These individuals have huge chips on their shoulders too. They persistently bear grudges and are often unwilling to forgive the insults, injuries, or slights that they think they have received. Their reaction is often out of proportion to the perceived slight. A minor slight will arouse major anger that lasts for a long time. They are quick to counterattack and react with anger to perceived insults.

They may be pathologically jealous, suspecting their spouse or significant other as being unfaithful without adequate justification. They want to maintain complete control in their romantic relationships to avoid betrayal, so they may pepper their significant other with questions about their whereabouts or intentions. They may gather circumstantial "evidence" of an illicit affair (i.e., their spouse went to the grocery store and didn't leave a note--or did leave a note and they still don't believe the spouse).

Theodore Millon identified five variations of Paranoid PD in 2004.
1) Fanatic Paranoid - includes narcissistic features
2) Malignant Paranoid - includes sadistic features
3) Objurate Paranoid - includes compulsive features
4) Querulous Paranoid - includes passive-aggressive features
5) Insular Paranoid - includes avoidant features

As with most personality disorders, these individuals are generally difficult to get a long with. Close relationships are a challenge to both parties. Their quickness to retaliate against perceived threats might make them more involved in litigation and legal disputes as they seek reparation. In response to stress, these individuals can have brief psychotic episodes (minutes to hours) where they either hallucinate, have delusions, have grossly disorganized speech patterns or behavior.

So. How does this happen? Once again--sorry for those people who need nailed-down answers--no one really knows. There seems to be both genetic and environmental factors than could contribute to the onset. If a child grew up with caregivers in-and-out, or perhaps around a lot of drug activity where they witnessed manipulation, coercion, and other negative events, then that could contribute to hypersensitivity to mistrust as an adult. Children prone to being solitary, having poor peer relationships, social anxiety, underachievement in school, hypersensitivity, peculiar thoughts/language are susceptible to developing this disorder. These children will be the odd ducks, attracting teasing.

As for treatment, it's difficult (as it is with most personality disorders). Because of the inherent mistrust these individuals have, any one session could be seen as incredibly prying. They might wonder what the information was being used for and be incredibly resistant to opening up. But if the individual wanted help, then a combination of therapy and medications could definitely help.

So hopefully this will give you writers out there some ideas for your stories in progress!

Q4U: How would you handle being in a relationship with someone who was constantly perceiving everything you said and did in a way other than what you intended?

Treatment Tuesday - Torture 101

Today’s assessment comes from Matt. He’s writing about Molly,* whose mother disappeared when she was younger with no explanation, who was then sent away to school a year later where she was betrayed heavily by her ex-boyfriend. When she returned from school, she found her father bleeding to death in the entrance hall. So Molly’s background is pretty traumatic, and gets even more so when she and two companions are captured by the “bad guys” and are being transported to be tortured.

What Matt wants to know is this: With Molly’s latent anger issues from her mom’s disappearance and her ex-bf’s betrayal, and her inherent internal strength from not degrading into a depressive spiral from both, what level of physical/psychological torture could she be expected to endure and recover reasonably well from?

* Names have been changed to protect the fictional.

Which leads us to Torture 101. Thanks, Matt.

As Matt indicated, a person can be tortured physically or psychologically. Both can leave lasting mental afflictions on those tortured. But torture is far more than acts committed against a person or group of people by others. It’s more complex. To quote Wikipedia: “Torture…depends on complicated interpersonal relationships between those who torture, those tortured, bystanders and others. Torture also involves deeply personal processes in those tortured, in those who torture and in others.”

So the first thing I’d ask you is what is Molly’s relationship to these “bad guys?” Are they related to the person who killed her father? To her ex? Her mom? The more relation she has to the torturers, I’d hazard a guess to say the less torture she’d be able to endure from them. (But this is just an educated guess based on what I’ve read and know about human behavior. There is no formula to give you to determine how much she could endure, but we can create one of sorts with simple deductions.)

Then I’d ask what her relationship to her companions is. Are these random people she is forced to be with (a good example would be Shia LeBeouf and Michele Monaghan in Eagle Eye--an excellent use of mind games and psychological torture, actually)? Or does she have some former relationship with them? Are the torturers mostly interested in Molly—and are using the companions to get more info out of her? Or are the bad guys interested in all three of them equally? Based on your answer to these questions, then Molly may or may not be able to endure more or less. (Helpful, huh?) Let’s break it down: If she has a solid relationship with these companions, and the bad guys are using them as leverage to get info out of her, I’d say she’s be able to endure more torture out of her love and relationship for the companions. If not, I’d say the reverse.

I’d think Molly could endure more psychological torture than physical, but you may disagree, depending on what kind of physical condition she is in. The reason behind my opinion is that she has already endured so much psychological trauma…and you’re right. She didn’t spiral into a depression. So Molly is strong mentally. The flip side of this is that maybe she has already endured so much, that the torture could start to crack her.

Here’s a plot twist to consider to make the book riveting and realistic as far as how much torture she’d endure. If you’ve set Molly up to have had a great love relationship with her mother, and somehow during the torture, Molly realizes she could get some sort of information about her mother’s disappearance…I’d say Molly would be able to endure immense torture to gather this info. Make sense? It’s just something to think about, but the relationship between a parent and child is powerful—one of the most powerful out there. Even parents who are awful parents still have unconditional love from their children, even if we don’t understand why. The children still want to be with these parents who treat them terribly. Ask any foster child taken away for abuse or neglect. So even though Molly might have latent anger issues directed toward her mother for leaving, psychologically, the need to know WHY would be so great if Molly thought she could find out. So consider this during your torture scenes. How could you connect the torturers to the mother?

So here is a “formula” for writers to consider when dealing with torture:*

Increased relationship with torturer
+
Increased relationship with companions
+
Increased connection with past
=
Increased amounts of torture endured

* Note: This is strictly in my therapeutic opinion.

Hopes this gives you something to think about, Matt. Thanks for writing in!

This service is for fictional characters only, so any resemblance to real life examples is entirely coincidental. Any other fictional character assessment questions can be directed to charactertherapist@hotmail.com.

Q4U: Have any of you written some torture scenes in WIP? Is so, how did you decide when enough was enough?