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[oscarkelfbom]

STOP TAKING PENALTIES

[jannwrites]

SCHIZOPHRENIA & OTHER PSYCHOTIC DISORDERS: A GUIDE FOR WRITERS.

hey me again, local mental health therapist and writer on tumblr dot com, coming at you with yet another “how to write mental health” post! because my friend asked me about it today, we’re talking about SCHIZOPHRENIA AND OTHER PSYCHOTIC DISORDERS. psychotic disorders are easily the most misunderstood and misrepresented diagnoses i see in writing. if i see you misrepresenting psychotic disorders after this post, i'm coming for your tasty little fingers.

there’s been a lot of changes to the language around schizophrenia and psychotic disorders, which isn’t Super Important tbh but the point is this post is going to get a little long. bear with me.

*a quick note before we get started: prior to the dsm-5, schizophrenia was broken up into five "types," including paranoid schizophrenia, which is the language i most commonly see folks referring to schizophrenia as. the other "types" were disorganized, catatonic, undifferentiated, and residual. for the purpose of this post, i'm going to be referring to dsm-5 terms. the language itself isn't all that important in my opinion, if that's how you understand schizophrenia that's cool and good.

so, let's start with talking about the symptoms seen across ALL psychotic disorders, including schizophrenia. depending on the disorder, one or all of these symptoms may be present:

DELUSIONS. delusions are "beliefs that are not amenable to change in light of conflicting evidence." the most common types of delusions you will see are:

persecutory. the person believes they are going to be or are being harmed, harassed, and so forth by an individual, organization, or other group. these are the most common types of delusions.

referential. the person believes that certain gestures, comments, environmental cues, and so forth are directed at oneself. these are the second most common types of delusions.

grandiose. the person believes that they have exceptional abilities, wealth, or fame.

erotomanic. the person falsely believes someone is in love / interested in them.

nihilistic. the person falsely believes a major catastrophy is going to occur.

somatic. the person is obsessed with and/or very preoccupied with their health and organ function.

HALLUCINATIONS. these are "perception-like experiences that occur without an external stimulus. they are vivid and clear, with the full force and impact of normal perceptions, and not under voluntary control." auditory hallucinations are the most common type of hallucination ( hearing an external voice or noise that does not exist ) but folks can experience hallucinations within multiple or all of their senses ( e.g. the sensation and sight of insects crawling up their arms ).

hallucinations generally, but not always, go hand in hand with the delusions the person is experiencing. for example, i work in court ordered substance abuse treatment, so a lot of my clients with psychotic disorders have delusions about being gang stalked and have hallucinations of external voices telling them they are not safe, someone is following them, that person over there is looking at them funny, etc.

DISORGANIZED THINKING. this is mostly going to come across in the way the person speaks. the person may switch very rapidly between subjects or respond to a prompt with something that is wildly off topic. there are times where the person is so disorganized their speech is completely incomprehensible.

GROSSLY DISORGANIZED OR CATATONIC BEHAVIOR. the person may behave with childlike "silliness" or they may be incredibly agitated. they have disorganized habits that interfere with their personal life, like preoccupations with certain actions or hoarding behaviors. repeated movements, staring, mutism, or echoing speech are also examples of disorganized behavior.

catatonia refers to decreased reactivity to the environment. e.g. you can scream in the person's face or they can pour boiling water on their skin and there will be no reaction.

NEGATIVE SYMPTOMS. these are mostly present in folks with schizophrenia specifically but they are known to make appearances in other psychotic disorders. negative symptoms refer to a lack of something. here are the most common negative symptoms:

diminished emotional expression. this refers to "reductions in the expression of emotions in the face, eye contact, intonation of speech, and movements of the hand, head, and face that normally give an emotional emphasis to speech."

avolition. this refers to "a decrease in motivated self-initiated purposeful activities. the individual may sit for long periods of time and show little interest in participating in work or social activities."

alogia. this is a decreased use of speech. the person may speak very little or not at all.

anhedonia. this is the decreased ability to experience pleasure or to recollect pleasureful experiences. anhedonia is very common in many other mental health disorders, particularly any disorder that includes depressive episodes.

asociality. this is a lack of interest in social interactions. kinda goes hand in hand with avolition but the dsm-5 makes a point to specify it so here you go.

keeping these in mind, here are the schizophrenic spectrum and other psychotic disorders outlined by the dsm-5:

DELUSIONAL DISORDER. the person experiences DELUSIONS ONLY for one month or longer.

BRIEF PSYCHOTIC DISORDER. the person experiences ANY OF THE FIRST FOUR SYMPTOMS for at least one day and no longer than one month.

SCHIZOPHRENIFORM DISORDER. the person experiences TWO OR MORE OF THE FIVE SYMPTOMS, WITH AT LEAST ONE OF THEM BEING ONE OF THE FIRST THREE SYMPTOMS LISTED, for a significant time during a one month period but no longer than a 6 month period.

SCHIZOPHRENIA. the person experiences TWO OR MORE OF THE FIVE SYMPTOMS, WITH AT LEAST ONE OF THEM BEING ONE OF THE FIRST THREE SYMPTOMS LISTED, for a significant time during a one month period. the difference between schizophrenia and schizophreniform is the longevity of the presence of symptoms. if it was less than 6 months, schizophreniform. if it's longer than 6 months, schizophrenia.

SCHIZOAFFECTIVE DISORDER. this is going to be someone who doesn't quite meet the criteria for schizophrenia but experiences some symptoms of schizophrenia, AND doesn't meet the criteria for bipolar OR despressive disorders, but experiences some symptoms of bipolar or depressive disorders.

SUBSTANCE OR MEDICATION INDUCED PSYCHOSIS. THIS IS IMPORTANT. all the previously mentioned disorders are NOT TRIGGERED BY SUBSTANCE USE OR MEDICATIONS, though substance use and medications may exacerbate the symptoms of a psychotic disorder. if your character doesn't experience psychosis ( hallucinations and delusions ) when they're sober and have fully withdrawaled, they have substance or medication induced psychosis. if they do have psychosis after they're fully withdrawaled, they likely have a psychotic disorder.

PSYCHOTIC DISORDER DUE TO ANOTHER MEDICAL CONDITION. basically the person is experiencing psychosis due to a health issue. this is very common in folks with dementia.

all right, you still with me? good! here are some additional things to keep in mind:

SCHIZOPHRENIA AND PSYCHOTIC DISORDERS ARE OFTEN TRIGGERED BY STRESS AND/OR TRAUMA. eleanor longden has an excellent ted talk on how the stress of moving out, going to college, and all the expectations from family and academia triggered her schizophrenia. i highly recommend watching her video.

because this is often the case, consider WHY DID MY CHARACTER DEVELOP SCHIZOPHRENIA OR ANOTHER PSYCHOTIC DISORDER? what happened in their life to trigger this? did they experience severe trauma in their life, or did something seemingly mundane like moving out of their parents house or starting their first job after college stress them out?

PEOPLE WITH SCHIZOPHRENIA AND PSYCHOTIC DISORDERS ARE NOT INHERENTLY VIOLENT. in fact, people with schizophrenia and psychotic disorders are more likely to be the VICTIMS of violence. unless the person already has a history of violence prior to developing schizophrenia, they are very unlikely to suddenly develop violent tendencies. stay away from this trope. it's infuriating.

in that same vein, PEOPLE WITH SCHIZOPHRENIA AND PSYCHOTIC DISORDERS ARE NOT INHERENTLY BAD OR EVIL. see the above point. i'll bite your fingers off.

i already spoke about this briefly, but do keep in mind SCHIZOPHRENIA AND PSYCHOSIS ARE NOT NECESSARILY TRIGGERED BY SUBSTANCE, ALCOHOL, OR MEDICATION USE. all of the above absolutely CAN cause psychosis that may persist for a while, depending on how heavily the person was using substances, alcohol, or medications for, and all of the above can exacerbate symptoms, but it is not the sole reason people develop schizophrenia or other psychotic disorders. i guess that's a common misconception. don't fall for it.

that's it for now! if you've made it through this post, you're probably entitled to kicking my ass once, free of charge. i may edit this later but in the meantime cheers, and happy writing.

[ask-ong-scout]

pSA

(ETHAN IS A FUCKIN BOYYYYY) (JUST BECAUSE HE HAS LONG ASS HAIR! OR LOOKS FEMININE IT DOESN'T MEAN HES A GIRL!!!!!!!!) / @asktheplantsdork