The Psych Writer on Narcissistic Personality Disorder

Gilderoy Lockhart. Zaphod Beeblebrox. Scarlett O’Hara. What do these three characters have in common?

Well, if you read the title, then you could guess they’re all different portrayals of Narcissistic Personality Disorder (NPD). Even though I enjoyed reading those books, and find many parts of their characterizations to be spot-on accurate, your job as a writer is not to copy those characters. You need to make your own. Make them human. Because a person has a PD does not make them any less human, but they are extremes of the human condition.

The Psych Writer is here to help you with this. Remember, this is not a substitute for therapeutic advice. If you somehow manage to see yourself in these symptoms and it also somehow bothers you (or, you know, if your loved ones are ready to throw you out of the house because you have these signs and symptoms), then seek the advice of a professional health care provider.

Without further ado, here is the lowdown on NPD.

NPD is part of the Cluster B personality disorders. They used to be in the Axis II, but the DSM no longer uses that multiaxial diagnosis (much to their detriment, if I’m to be blunt). Cluster B is the cluster of dramatic, emotional, and erratic personality disorders. That means it’s in the same group as Borderline, Histrionic, and Antisocial personality disorders. (There are ten total, in three clusters.)

People who fit into Cluster B have difficulties with impulse control and regulating their emotions. Ever seen someone in line at the store who is just outrageously angry because the cashier won’t honor a coupon, and they start threatening to sue the store and the cashier personally, calling the employee every name in the book and demanding to speak to the president of the company? Yeah, like that. That’s a problem with regulating one’s emotions.

In order to receive a diagnosis of NPD, the person must have an enduring and persistent pattern of grandiose behavior and feelings, a continuous desire for admiration, and a lack of empathy for others.

NPD begins in early adulthood and is often lifelong (especially if untreated), and can be observed in a variety of contexts (home, work, school, social gatherings, public areas).

The disorder is only diagnosed if the person exhibits five or more of the following signs/symptoms (again, some have all nine, but this isn’t seen often):

  1. Has an exaggerated sense of self-importance that’s grandiose. In other words, they expect you to recognize them as your superior without proportionate credentials or achievements.
  2. They are preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love. (In some cases, they are so preoccupied with the fantasy that they don’t do the work to make those dreams a reality, such as putting in work for promotions or completing their coursework.
  3. They believe they are special and unique to the point where they can only be understood and appreciated by high-status people or institutions, or they may also believe that they should only associate with the above-mentioned.
  4. They require excessive admiration. (If they aren’t constantly complimented and admired, they often become depressed or use manipulative tactics to gather attention.)
  5. They have an enormous sense of entitlement, unreasonably expecting favorable treatment, or having their expectations met without resistance or delay. Think about the coupon explanation above as an example.
  6. They are interpersonally exploitative. That means they’ll take advantage of others to achieve their own ends.
  7. They lack empathy. They refuse to identify or recognize other people’s feelings or needs.
  8. Envy issues: they think people are envious of them, and/or are often envious of others.
  9. They display  and possess attitudes of arrogance and haughtiness.

Behavioral characteristics include what’s known as “narcissistic rages,” which are hellish for the people who have to endure them. Some threaten suicide, some threaten homicide. Some come close to going through with it, and some complete it. Mostly, though, these rages are part of the loss of emotional regulation and sometimes impulse control. Occasionally, they are done to manipulate the other person into the behavior that the person with NPD wants from them.

Are they like this all the time? Yes. The majority of the time they are like this. That’s what pervasive and consistent mean. Don’t forget that when you’re writing the character!

When you do write a character with NPD, remember, you don’t have to hit all of these points. Not everyone is a textbook case and not everyone has every single symptom (in fact, they rarely do have all of them). Infuse your characters with what makes them uniquely human.

Happy writing.


Anne Hogue-Boucher won’t go into a narcissistic rage if you don’t follow her on Twitter or Facebook, but why risk it? You can also buy her books, and that will enable her to eat a sandwich.

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The Psych Writer: Exploring Borderline Personality Disorder

I had an idea for introducing the personality disorders after I went through some of the others, but I also take requests, as I said in one of my previous posts. Via Facebook, a request came in for me to write about Borderline Personality Disorder. So I’ll be moving into the Personality Disorders a little earlier than I expected.

That having been said, personality disorders are what we consider “bigger” in therapy. Personality disorders are deeply ingrained into the personality of the client. They are invasive, pervasive, and ever-present.

I live in Georgia. Here in Georgia we have an invasive plant called kudzu. It’s everywhere. It grows all over the place and it can’t just be cut down or even burned (burning is illegal anyway because duh, we’re in a drought most of the time and the place would go up in flames faster than Michael Jackson’s hair in that Pepsi commercial). It has to be uprooted from the ground by its root crown.

That’s exactly what personality disorders are–they’re the kudzu of our personalities. They strangle the existing plant and take over completely. They become the plant itself.

So when we’re dealing with a personality disorder, it takes a long time to get to that root crown and eliminate it so that the person can be less miserable and learn to function better so that the people around them can have improved relationships with them. With several of the personality disorders, close relatives and friends grow weary of the “antics.” It makes it difficult to sustain and maintain relationships.

Personality disorders can also interfere with work relationships and productivity, as well as the general day-to-day functioning of the patient. While the same can be said for any disorder in the DSM-5, with a personality disorder, it is much  more treatment resistant, prone to severe relapse, and is lifelong.

A patient has a personality disorder for life. They are never cured. But they can manage it, find relief, improve their relationships, and even help themselves hold down steady employment. They can work towards stability if they work hard enough. It takes a demanding amount of work.

Borderline Personality Disorder (BPD) falls into “cluster B” of the personality disorders. If you don’t count Personality Change due to Another Medical Condition or Other Specified Personalty Disorder and Unspecified Personality Disorder (which we don’t), you have ten personality disorders in three clusters:

  • Cluster A: This is know as the odd or eccentric cluster. It includes Paranoid Personality Disorder, Schizoid Personalty Disorder, and Schizotypal Personality Disorder.
  • Cluster B: This is the dramatic, emotional, erratic cluster. It includes Antisocial Personality Disorder, Borderline Personality Disorder, Histrionic Personality Disorder, and Narcissistic Personality Disorder.
  • Cluster C: This is the anxious and fearful cluster. It includes Avoidant Personality Disorder, Dependent Personality Disorder, and Obsessive-Compulsive Personality Disorder (which is not the same as OCD).

Borderline is considered to be in the dramatic, emotional, erratic cluster. It is characterized by a lifelong pattern of of instability in interpersonal relationships, self-image and affects, and marked impulse control issues (DSM-5, p. 645).

So what the hell does that mean? That means the patient has little to no stability in their relationships with others (professional and personal), erratic behavior and lack of self-control to the point where self or others are harmed.

According to the DSM-5, the signs and symptoms of BPD are a pervasive pattern (as stated above)–but what makes up these patterns? The DSM-5 reports that for a person to be diagnosed with BPD, they must have five (or more) of the following (which I will give in plain English):

  • Frantic efforts to keep from being abandoned, whether that threat of abandonment is real or imaginary. This does not include suicidal behavior or self-mutilation as that is a separate criterion.
  • Repeated unstable and intense relationships that alternate between extremes of idealization and devaluation. Going from “you’re perfect” to “you’re the scum of the earth.”
  • Unstable sense of self. This instability is marked and persistent and goes to extremes. Not only does the love-hate relationship apply to other people, it applies to themselves and their self-image.
  • Recklessness/lack of impulse control in at least two areas of life that will cause them harm, such as unprotected sex with strangers that could result in STIs, overspending, substance abuse, reckless driving, binge eating, etc.). This still doesn’t include suicidal behavior or self-harm.
  • Recurrent suicide attempts, threats, gestures and behavior, or self-mutilation.
  • ‘Affective instability due to a marked reactivity of mood.’ This one’s a bit hard to explain. Imagine the worst overreacting you’ve ever seen. Now imagine it could happen at any time for any reason. You run out of cotton balls and the person has a massive anxiety attack and the anxiety affect lasts for a few hours. It’s a bit like that.
  • Chronic feelings of emptiness. (Exact words from the DSM. Self-explanatory.)
  • Difficulty controlling anger. Intense anger fits. Inappropriate anger to the stimulus. Imagine telling the person you’re out of donuts and they smash a table in response, demand to see your manager, threaten to sue, and threaten to kill you. While that might be funny and unbelievable, yes, it is that extreme.
  • Stress-related paranoia or severe dissociative symptoms that are transient. In other words, it doesn’t last, but the person will abruptly become paranoid, or they’ll dissociate (the world isn’t real, people are inhuman or automatons, etc.).

Now, writing a character with BPD is actually a challenge. Sure, you can go through all nine of the criteria, but I could almost guarantee you that you’ll create a caricature instead of a character. Even with black-and-white perceptions that many people with BPD have, they are still human beings. Avoid making a cookie cutter. You’ll want to add lines of sympathy to that character. He or she didn’t get there on their own. In many cases of BPD, there is not just a genetic component–there is often a history of abuse–sexual, physical, etc.

The person with BPD does not mean to do these things. They cannot help it. That’s why Dialectical Behavior Therapy helps so much. Patients learn from a system of mindfulness and awareness. DBT was developed by Marsha M. Linehan, who has successfully managed the disorder herself. Bear in mind that if you are writing someone with BPD, remember, they cannot help themselves when they do these things. Yes, some of the behaviors are purposefully manipulative, but they are not malingering. Until they get professional help, they are often unaware that these things are not acceptable, because even though people tell them so, they are often focused on assigning blame to others for their reactions.

Always remember, you are still writing a human being, though these are the extremes of the human condition.

If you came here looking for help with BPD, know that it’s out there. Start with this article here and then search for a therapist in your area who specializes in DBT.


Anne is a former supervised therapist and current author. You can read her books, stare at her Twitter, or stalk her on Facebook if you want.

The Psych Writer comments on 11 Things People Do Because of Anxiety

When writing about depression, I came across an article a friend shared on Facebook. It’s a good article, written by a layperson who obviously did his research. He got everything on the nose–except for #11.

But I’ll get to that in a minute. First, I’d like to tell you when you’re writing an anxious character and you need to use show instead of tell, use this article as a guide. Don’t tell your audience the person has anxiety disorder, show them. Like with any disorder, you’re not going to tell them all about it, you’re going to show them all about it. Make the reader lean in and wonder what the hell is wrong with this character. Make them wonder why the character is obsessing over something trivial to the point of being ludicrous, for example.

The only reason I object to #11 in this article is because while anxiety does burn up a person’s energy, this type of burnout can be indicative of much, much more than Generalized Anxiety Disorder. Yes, anxiety wears a person out, but if it is to the point where a person cannot get out of bed, this is much more serious. It can be indicative of a physical problem, a nutritional deficiency, or Major Depressive Disorder. Any person who has anxiety should never, ever ignore this symptom and let their therapist or physician know immediately.

There are many different types of anxiety disorders, which I will go into later on for The Psych Writer (after an exploration of Munchausen Syndrome and Munchausen-By-Proxy).

In the meantime, enjoy this article from Simon Segal, and let me know what you think in the comments.

Source: 11 Things People Don’t Realize You Are Doing Because Of Your Anxiety

Wendy Howard tackles Beverley Allitt: Women in Horror

I really enjoy Wendy Howard’s writing. As a part of February’s Women In Horror Month, I had the privilege of meeting her in virtual space and writing an article about torture.

Maybe I’m biased towards Wendy because she shares a name with one of my favorite characters of mine (Wendy Willow). Nah. She’s just a compelling writer.

This was one post that Wendy wrote for WiHM. She discusses a very real serial killer who had Munchausen Syndrome AND Munchausen-By-Proxy Syndrome. These are both rare conditions, and to have them together was, as I said in the comments, “like finding a unicorn. A horrible, flesh-eating unicorn, but still.”

In my series The Psych Writer, I will be tackling both Munchausen and MBP. I think it would make for some interesting characters if handled correctly, and I like to pick things apart. As I said, Munchausen Syndrome and MBP are rare, but they’re fun to explore (as long as you’re not the one suffering from it).

Enjoy Wendy’s article and sleep tight.

Read here: Beverley Allitt: Serial Murderer and Evil Woman In Pop Culture | Women in horror

The Psych Writer on Major Depressive Disorder, Part Three – MDD with Psychotic Features

This is the final installment of The Psych Writer series on Major Depressive Disorder. This week, we turn our focus on MDD with Psychotic Features.

Of course, when writing any disorder, focus on showing rather than telling, and remember, your character is human. Give them more dimensions than their disorder.

What’s tricky about writing MDD with psychotic features is not making it look like schizophrenia or bipolar with psychotic features. You will need to make sure that the depressive features are most prominent, otherwise the reader isn’t going to get it.

Naturally our writings are always open to interpretation by the reader–that’s what makes it such an enriching experience. It’s not the focus on the symptoms that makes the writing interesting, anyway. It’s the expression of the character and their life that makes the reading compelling.

So, we’ve already reviewed what MDD is all about, but what about psychotic features? Psychotic is a word that’s used in lay terms that tends to get confused with other terms (hell, even I’ve confused the terms when I was exhausted at one point). Psychotic is a term for losing touch with external reality.

The patient who is psychotic can experience any of the following, with some examples for illustrative purposes:

  • delusions – believing someone has bugged their home, is being gang stalked, they have a terrible disease, or that they’re the Archduke Ferdinand.
  • hallucinations – seeing, hearing, tasting, or smelling things that aren’t there, such as seeing a person that no one else can see.
  • anxiety – the person may seem anxious and restless.
  • withdrawal from family and friends – sometimes due to the delusions and hallucinations, the patient withdraws from social interactions. This is not just an “oh, I don’t want to go to the mall.” This is more like they don’t answer any of their phone calls and they stop talking to people entirely. Think the most extreme form of withdrawal possible.
  • suicidal ideation and actions – they may attempt to kill themselves or think about it all the time.
  • disorganized speech – this isn’t your average non-sequitur. Disorganized speech is often completely incoherent. There are several types of DS:
    • word salad – seemingly random words put together in a sentence. “My pants raisin toggle the burp slurped in a cat.”
    • derailment – completely unrelated or tenuously related ideas put together as if they were related. “I have to pick up my dry cleaning. There’s a bar in the street that keeps me from walking to the park.”
    • neologisms – words that are made up. “I took my wife to the helgistahooven for a new haircut.”
    • perseveration – a response repeated uncontrollably (this can be verbal or gestural). “Did you pack a pair of socks?” “Socks, socks, socks, socks, socks, socks, socks…”
    • thought blocking – when a person stops talking abruptly in the middle of a sentence without any explanation. “I went to the store and-” *silence*
    • pressured speech – rapid speech that sometimes is incoherent.
  • difficulty concentrating – this is pretty self-explanatory.
  • hypersomnia or insomnia – sleeping too much or not enough.
  • suspicion of others and situations – this is usually due to delusions.

Keep in mind that the person with psychosis is typically unaware of these symptoms and signs. They are often so out of touch with external reality that they have no idea that their delusions or hallucinations aren’t real, and that their behavior has changed to be out of the ordinary.

Here you see there are some things that crossover with depression, such as suicidal thoughts or actions, anxiety, and withdrawal. Knowing this, it’s easy to understand how difficult differential diagnosis can be.

The standard treatment for MDD with psychotic features is antidepressants and antipsychotics. If that doesn’t bring relief, ECT (electroconvulsive therapy) is another common method.

Overall, when writing a character with this disorder, there’s an opportunity to do a little reality bending. Just don’t make it too much of a trope.

Coming up for The Psych Writer, we’ll tackle some of the following subjects (not necessarily in this order):

  • Bipolar Disorder I and II
  • Munchausen Syndrome
  • Munchausen-By-Proxy Syndrome
  • Anxiety Disorders – Generalized Anxiety Disorders, Panic Disorder, PTSD
  • Schizophrenia
  • Autism Spectrum Disorder
  • Personality Disorders: Exploring the three clusters of the ten disorders.

I also take requests. Any disorder you’d like me to explore? Contact me via Facebook.


Anne is a former supervised therapist at the Master’s level who abandoned it all to become a writer. Visit her shiny Author Page to learn more about her and read some of her more macabre thoughts on paper (or eBook).

The Psych Writer on Major Depressive Disorder, Part Two – Treatment Resistant Depression

Welcome to part two of my series on Major Depressive Disorder (MDD). If you’re looking for the introduction to what MDD is all about, you can find that here.

Last week in part one, I wrote about writing a character with MDD, after detailing the symptoms for the disorder (link in the first paragraph). This week, I’m going to discuss Treatment Resistant Depression (TRD), which I still like to pronounce as ‘turd,” because it really is a turd. When you’re writing a character and would like them to have TRD, it’s important to understand what it is.

So rather than go on with a laundry list of how your character may be written, I’ll go through what TRD is and how it is treated. Then you can decide how your character will fit into it or not. Remember, you’re writing your character as a human being, so it’s okay if they deviate a bit. Humans are not their disorder, so neither are your characters.

TRD is defined as MDD that has not responded to a minimum of two antidepressants. Although some literature says only one, in most professional settings, two antidepressants are tried before determining whether  the depression is treatment resistant.

The difficulty lies in determining the threshold for TRD. There is complete remission and partial remission in symptoms, and there is also reduction in severity of depression. So determining what’s enough for the patient is what determines whether depression is treatment-resistant or not. Personally, I prefer elimination of symptoms, and if any are left, then that’s not good enough, so it’s time to try something else or add something to the treatment. But some people are okay with partial remission. It’s sometimes enough to have some relief over no relief, so best practice is to support the patient’s decision if they have good decision making skills.

When a person has TRD, there are things that they can try to get help. Usually treating TRD begins with an increase of dosage or switching medications. If that doesn’t help, then an add-on is usually used. For example, if the SSRI isn’t working, a combination of an SSRI and an NRI may be used.

Sometimes playing around with medications doesn’t help, though, and sometimes it does exactly what it’s supposed to do. But if it doesn’t work and the patient isn’t already in counseling, they can try a combination of medication and psychotherapy.

Other treatment avenues are Electroconvulsive therapy (ECT), Transcranial magnetic stimulation (TMS), and Vagus nerve stimulation (VNS). Most people cringe when they hear “ECT,” but that’s because they associate it with what they’ve seen in the movies and in old videos when the treatment was actually horrible. Now, the patient is given a sedative and most sleep through it. I’ve watched it done (on video rather than in vivo) and the experience was underwhelming. Of course, there are risks with ECT, including short-term memory loss, but for some patients it beats the hell out of MDD/TRD.

Now, finally, the numbers. This is something you may want to consider when creating a character. Around 10% to 30% of people have TRD, and that number varies on the spectrum of TRD (whether it’s full or partial remission, reduction in severity, etc.). So when you’re creating this character and you want to give them TRD, consider Special Snowflake Syndrome (SSS).While it’s recently been co-opted as a political inflammatory term, I refuse to use it in that manner. SSS means that your character has become a little too precious. If you give them TRD, make sure that they don’t come out corny and cliched, and actually make their suffering real rather than something they manage to brush off whenever it’s inconvenient to your plot.

If you came here looking for help with depression, please seek the help of a licensed professional in your area. Depression is a horrible, soul-sucking disorder that takes your life piece-by-piece. Don’t let it take control over you. Call for help. It’s out there.


There is little more horrific than what lies in our own imaginations. If you love reading about nightmare worlds and strange happenings, check out my author page. You can also follow me on Twitter or Facebook.

The Psych Writer on Major Depressive Disorder, Part One

Disclaimer: This is not a substitute for medical advice and is for educational purposes only. If you read this and any of the below sounds like you, seek the help of a licensed professional in your area.

Depression is a big topic. There are different types of depressive disorders, but for the purposes of this post, I’m going to focus on Major Depressive Disorder (MDD), which affects about 6.7% of the US population. That’s around 15 million adults.

Last week, we reviewed an introduction to MDD, and I still didn’t even get into all of it. So I’ll do that here, briefly. Because of the many sufferers of MDD, there get to be a whole slew of levels of severity and specifiers. While you’re writing about these characters who have these disorders, don’t forget they are a person and they are not their pathology.

Nothing is worse than a character whose only interesting thing about them is their disorder. Remember Forgetful Jones from Sesame Street? Even he had more than one dimension. He was a cowboy. So if a cowboy Muppet with amnestic disorder can be more than just a one-dimensional character, Depressive Jones can, too.

When you decide to write from a place where your character has MDD, decide what type they have. This can be mild, moderate, or severe. They can have psychotic features (delusions, hallucinations, etc.). They can have partial or full remission as well. (Partial remission is having some of the symptoms but not meeting the full criteria for MDD for a period of less than two months. Full remission is an absence of symptoms for more than two months.)

MDD also can come with certain specifiers, such as with anxious distress or with catatonia, but there are too many specifiers to go into without scaring you away from the subject forever. I could likely write a book on each of the specifiers. So, in the interest of time and space constraints (which I will now call space-time constraints to either irritate or amuse mathematicians and physicists), I won’t list them all here. You may wish to skip over certain specifiers, but with psychotic features you can often cross it over with supernatural fiction. This should be handled carefully, though, because otherwise you risk it becoming a trope.

Another important thing to remember is that MDD distorts a person’s perceptions. I used to tell patients that their brains were trolling them. This troll brain is part of the illness. It is best expressed through Beck’s cognitive triad. The person with depression has a negative view of themselves, of the future, and of the world. They often don’t believe they’ll ever get better, this is the way it is, and that there is no one or nothing that can help them. This triad does not necessarily apply to all people with depression all of the time, but there tends to be more leaning towards negative and pessimism during the course of a depressive episode.

When writing from a therapist’s point of view, your character would see the person as ill. They would note things such as poor attention to personal hygiene, being tearful, and a depressed affect (they look “sad” or “down”). It’s an ethical therapist’s job to help a patient process their thoughts and reframe things that happen to them–to teach them how to rethink things. They also do things such as medication education and other interventions. Treatment often consists of Cognitive Behavioral Therapy (CBT).

An unethical therapist would do things such as foster dependency, and interventions that keep the patient depressed and vulnerable to manipulate them into doing things the patient would not normally do. People with depression can be quite vulnerable, and so open to suggestion in order to find relief, a therapist without ethics could possibly ruin the patient’s life further.

I’m not sure if it’s as interesting to write about a therapist treating someone with depression as it is to write about someone who has depression, but even then, it’s important to give your characters full dimensions.

No matter what, though, write your character as a person first, and their condition second. Otherwise, you risk making a flat character that’s nothing more than a stereotype.

If you came here looking for help with depression, please seek the help of a licensed professional in your area. Depression is a horrible, soul-sucking disorder that takes your life piece-by-piece. Don’t let it take control over you. Call for help. It’s out there.


There is little more horrific than what lies in our own imaginations. If you love reading about nightmare worlds and strange happenings, check out my author page. You can also follow me on Twitter or Facebook.

The Psych Writer: Introducing Depression

This is part of a series of The Psych Writer. I tend to write about pretty heavy topics because they’re mainly about mental illness, and though there are many things we can laugh and joke about to alleviate pain, these topics can be painful for some. So I ask you to stay with me and be tough. Put on your writer’s cap and use one of my favorite defense mechanisms–intellectualize with me.

And now, for a disclaimer: None of this is a substitute for professional medical advice. This is for the sole purpose of writing a character with realistic tones. Of course, there’s always poetic license. If you have Major Depressive Disorder (MDD), note your individual experience may vary. If you see yourself in anything I’m describing, consult with a licensed clinician in your area for help.

This is only an introduction. MDD is a complex mood disorder with several possible complications and offshoots, so in order to keep your eyes from falling out of your head (disclaimer: not responsible for deleterious effects), I am going to have to break it up into parts other than this introduction.

So for now, let’s just get to know what MDD is all about. MDD has a lengthy symptom list. The DSM-5 lists MDD as a mood disorder. I’m going to attempt to put it all into plain English here for you, using the copy I have at home.

Here are the criteria for diagnosing Major Depressive disorder:

  • The symptoms must be present daily or nearly every day for a minimum of two weeks before a diagnosis can be made. That means it’s persistent and pervasive.
  • The symptoms must be a change from how the person functioned previously.
  • Five or more of the symptoms must be present during that two-week minimum period. On top of that, the person must have either a depressed mood (feelings of emptiness, sadness, irritability) or loss of interest and pleasure (aka anhedonia). They can have both, but at least one of these must be consistently present.
  • You’re not allowed to include symptoms that can belong to other medical conditions. In other words, they want you to make sure it’s not something else before treatment. Other physical conditions to rule out include:
    • Central nervous system diseases (e.g., Parkinson disease, dementia, multiple sclerosis, neoplastic lesions)
    • Endocrine disorders (e.g., hyperthyroidism, hypothyroidism)
    • Drug-related conditions (e.g., cocaine abuse, side effects of some CNS depressants)
    • Infectious disease (e.g., mononucleosis)
    • Sleep-related disorders
    • Adjustment Disorders
    • Anemia
    • Chronic Fatigue Syndrome
    • Dissociative Disorders
    • Hypochondriasis
    • Hypoglycemia
    • Hypopituitarism (Panhypopituitarism)

    Other psychological conditions to rule out include:

    • Dysthymia
    • Bipolar Disorder
    • Anxiety Disorders (e.g, PTSD, OCD, GAD)
    • Eating Disorders
    • Personality Disorders
    • Schizoaffective Disorder
    • Schizophrenia
    • Somatic Symptom Disorders

      ET CETERA

Okay, so now, the clinician gets into the symptoms. Symptoms of MDD (remember, there is a minimum of five with depressed mood and/or anhedonia being one of them) include:

  • Depressed mood most of the day, nearly every day for at least two weeks. The person can report this themselves (“I feel sad,” “I feel empty,” or “I feel hopeless), or it can be observed by others (“Patient appears tearful.”). For kids and teenagers, there is often a sharp increase in irritability, although irritability is sometimes seen in adults with depression, too. It’s just more often seen in the young ones.
  • Noticeably losing interest and/or pleasure in all or almost all activities that the person enjoyed before. This can be self-reported or by observation from someone else.
  • Significant weight loss when not dieting or weight gain–within one month, losing or gaining more than 5% of the person’s starting weight–or, an increase or decrease in appetite nearly every day (e.g., the person who used to eat their three square can barely choke down a bowl of pudding every day, or a person who used to eat lightly now eats constantly. In kids, this will be seen as failure to make their expected weight gain.
  • Not sleeping (insomnia) or sleeping too much (hypersomnia) almost every day.
  • Moving around too much (fidgeting) or not moving around enough (lethargy) nearly every day. This criterion is known as psychomotor agitation or psychomotor retardation. It also cannot be self-report alone–this must be observable by others.
  • Lack of energy nearly every day (fatigue). Can be self-reported or observed.
  • Feeling worthless or guilty inappropriately, sometimes to the point of being delusional. This isn’t just basic self-reproach or feeling guilt about an illness. It’s a magnified feeling.
  • Difficulty concentrating or making decisions nearly every day. This can be self-reported or observed.
  • Thoughts of death repeatedly–not just fear of death, suicidal thoughts without a plan, with a plan, or an attempt to commit suicide. This also includes repeated suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide.

And finally, the criteria for these symptoms has to fit as below:

  • The symptoms cause significant distress or inability to function in social situations, on the job, or anywhere a person needs to function.
  • The episode isn’t because of any of the conditions listed previously or because of drugs.
  • The depression isn’t better explained by another psychological condition as listed above.
  • The depression didn’t come with any mania or hypomania. Clinicians can’t count this exclusion if the mania/hypomania is due to a drug/substance or because of a medical condition.

Did you think that MDD was easy to diagnose? As you can see from above, it’s not always clear-cut. That’s why it’s important to pay attention to symptoms.

Keep all this in mind as we venture into the depths of writing MDD, and again, if you need help, contact a licensed clinician in your area for help.


I am a former supervised therapist with experience in the mental health field since I began graduate schooling in 2003. Now, I write about the things in my head.

Discover Stephen Bentley: It’s his turn now…

In case you missed it, a few weeks ago, I was interviewed by the wonderful Stephen Bentley. You can find it here: Discover Anne Hogue-Boucher: Author Spotlight – Stephen Bentley

So now I’d like to chat with you a little bit about Stephen and just how cool he is. I mean, he’s mega-cool. He’s cool with extra cool.

He wrote a book about the events where he was an undercover cop for Operation Julie. If you’re in the UK, then you probably already know that’s a huge deal. It radically changed the way drug busts operated there, essentially setting the standard for future operations.

I think the tale is so thrilling because it’s true, and Stephen is unflinching in his assessments–of himself, his colleagues, and those he was set to watch. Undercover: Operation Julie – The Inside Story tells us a lot about the action but doesn’t come across as cheesy. You don’t feel like you’ve been dropped into an episode of Starsky & Hutch (yes, I’m dating myself with that reference, shut up).

If you haven’t read my interview with Stephen, head on over and take a gander, and while you’re at it, head on over and grab a copy of Undercover: Operation Julie. Then, why not head on over to my Author’s Page and see what I’ve got cooking?

I’m still waiting to hear from a few more of you about The Psych Writer, and I’ll be back with that in just a couple weeks. Currently I’m working hard on NaNoWriMo, tackling a Weird West tale this time. I’ll tell you more about that later.

See you next week, and keep reading.

 

 

The Psych Writer: What Next?

Since we took a break for a few weeks from The Psych Writer after a seven-part series on grief, I’ve noticed that TPW is actually pretty popular. So because I love the subject, and I love to write, and I love to have people read, I was thinking of reaching out to all of you by opening up comments.

What kinds of things would you like to read about next, in the context of writing/creating a convincing character with a mental health issue? There are so many I can write about, including the ones I find are most misunderstood and abused by laypeople who watch far too much television and think that Sherlock Holmes is actually a psychopath (WRONG!) because the writers are ableist twats.

I’ll open the comments up to you, or you can comment via Facebook or Twitter.

What would you like to see next for TPW? Below are a few choices, but you’re welcome to come up with your own.

  • PTSD
  • Major Depressive Disorder and Dysthymic Disorder
  • Bipolar I, II, and Cyclothymic Disorder
  • Schizophrenia
  • Dissociative Identity Disorder
  • Antisocial Personality Disorder
  • Autism Spectrum
  • Borderline Personality Disorder
  • OCD and OCPD

Now I’ll probably work on all of these and more, but I’m reaching out to you, my fine and beautiful reader, for what you’d like to see next.

In the meantime, happy writing, and try not to tear up my inbox too much. *wink*


While I was doing all of this, I was getting a book ready for publishing. If you’re up for a journey through Perdition and back, hop in your car and head for the sign that says Now Entering Silver Hollow. It’s available on several eBook platforms, and in print through CreateSpace and Amazon.