#* hc.

dysthymia & major depressive disorder. cloud develops dysthymia during his childhood. i wouldn’t call it simply major depressive disorder because his behavior doesn’t occur for mere weeks at a time. it’s on a larger scale and persists for at least two years ( one year in children and adolescents ). most people would assume that any depressive disorder would cause someone to become, well, depressed. but the interesting thing about adolescents is that they are actually more prone to irritability than so - called ' depression ’. 

criterion as per the dsm - v ( taken verbatim ) is presented below:

‘ a. depressed mood for most of the day, for more days than not, as indicated by either subjective account or observation by others, for at least 2 years.

note: in children and adolescents, mood can be irritable and duration must be at least 1 year.

b. presence, while depressed, of two (or more) of the following:

poor appetite or overeating.

insomnia or hypersomnia.

low energy or fatigue.

low self-esteem.

poor concentration or difficulty making decisions.

feelings of hopelessness.

c. during the 2-year period (1 year for children or adolescents) of the disturbance, the individual has never been without the symptoms in criteria a and b for more than 2 months at a time.

d. criteria for a major depressive disorder may be continuously present for 2 years.

e. there has never been a manic episode or a hypomanic episode, and criteria have never been met for cyclothymic disorder.

f. the disturbance is not better explained by a persistent schizoaffective disorder, schizophrenia, delusional disorder, or other specified or unspecified schizophrenia spectrum and other psychotic disorder.

g. the symptoms are not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition (e.g. hypothyroidism).

h. the symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. ’

symptoms that apply: insomnia, low self - esteem, poor concentration / difficulty making decisions, feelings of hopelessness.

i’m going to be tackling this going down the list.

a. in cloud’s childhood, cloud comes off as fairly irritable, especially towards tifa’s friends. his lack of self - esteem showed itself in a heightened opinion of himself, as arrogance tends to. he decided he was better than the other kids, therefore he shouldn’t be bothered that he can’t hang out with them. this is relatively weak, admittedly, to what i will be discussing next. it’s only one symptom as opposed to the two required. 

b & c. the event that took place when he was nine and tifa was eight, after the death of her mother and the trip to mt. nibel, really hammers the point home. because of his perceived incitement of the expedition rather than his attempt to help tifa, he was met with the ire of the adults and dissuaded from talking to tifa. this introduces way more irritability in the form of cloud’s anger problem and inappropriate feelings of guilt that are associated with an episode of major depressive disorder.

according to an article published by the h.arvard medical school: 

‘ symptoms can grow into a full-blown episode of major depression. people with persistent depressive disorder have a greater-than-average chance of developing major depression. while major depression often occurs in episodes, persistent depressive disorder is defined as more constant, lasting for years ’.

at least, cloud experiences a major depressive episode ; at most, he develops the full - blown disorder. given that he’s been experiencing persistent depressive disorder with at least two points in his life where he has had a major depressive episode ( mt. nibel, failing to make it into soldier, during advent children ), i’d wager that the latter situation is the reality. 

d. since major depression disorder is chronic and tends to come in episodes during particularly taxing times, it can still be present when one is diagnosed with dysthymia. major depressive disorder comes with four additional symptoms: excessive guilt / feelings of worthlessness, s.uicide ideation, loss of interest, psychomotor agitation / r.etardation. cloud does indeed experience excessive guilt, as discussed above, and i would wager that he does go through a period where he has feelings of worthlessness and he definitely loses interest in making friends.

e, f, g. i wouldn’t classify cloud’s ‘ substance - related illness ’ / mako poisoning as grounds for a manic episode. nor does it cause substance - related depression ; this is merely the situation framing his contact with mako.

h. this condition causes a lot of issues in cloud’s social life as shown by his relationship to the other kids ( though it was in part due to their exclusivity ) and his easy - to - anger personality.

i believe that it is also worth noting that the aforementioned article also reveals that ‘ some people with persistent depressive disorder have experienced a major loss in childhood, such as the death of a parent ’. cloud went through the loss of a father at an early age, i headcanon around age 5 / 6, and growing up without a fatherly figure can be rough for a child. i know without a doubt that claudia could only do so much to make sure her son grew up fine. that is not to bring her down or any single mothers down, there is no doubt she loved her son dearly, but it still isn’t something that can be ignored. i’m sure cloud owes his open mind, kindness, and protective nature to her, and that is also something that made him vulnerable to the other kids’ teasing, leading cloud to become depressed and try to be tough and hide his emotions.

post - traumatic stress disorder. it goes without saying that cloud has experienced multiple traumatic experiences in his life. there’s the events at mt. nibel & tifa’s coma, the nibelheim incident, and zack’s death. so instead of proving the trauma that is undoubtedly there, i will instead be speaking of the symptoms that he experiences due to the disorder.

criterion as per the dsm - v ( taken verbatim ) is presented below:

a. exposure to actual or threatened death, serious injury, or sexual violence in one (or more) of the following ways:

directly experiencing the traumatic event(s).

witnessing, in person, the event(s) as it occurred to others.

learning that the traumatic event(s) occurred to a close family member or close friend. in cases of actual or threatened death of a family member or friend, the event(s) must have been violent or accidental.

experiencing repeated or extreme exposure to aversive details of the traumatic event(s) (e.g., first responders collecting human remains: police officers repeatedly exposed to details of child abuse).

note: criterion a4 does not apply to exposure through electronic media, television, movies, or pictures, unless this exposure is work related.

b. presence of one (or more) of the following intrusion symptoms associated with the traumatic event(s), beginning after the traumatic event(s) occurred:

recurrent, involuntary, and intrusive distressing memories of the traumatic event(s). note: in children older than 6 years, repetitive play may occur in which themes or aspects of the traumatic event(s) are expressed.

recurrent distressing dreams in which the content and/or affect of the dream are related to the traumatic event(s). note: in children, there may be frightening dreams without recognizable content.

dissociative reactions (e.g., flashbacks) in which the individual feels or acts as if the traumatic event(s) were recurring. (such reactions may occur on a continuum, with the most extreme expression being a complete loss of awareness of present surroundings.) note: in children, trauma-specific reenactment may occur in play.

intense or prolonged psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event(s).

marked physiological reactions to internal or external cues that symbolize or resemble an aspect of the traumatic event(s).

c. persistent avoidance of stimuli associated with the traumatic event(s), beginning after the traumatic event(s) occurred, as evidenced by one or both of the following:

avoidance of or efforts to avoid distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s).

avoidance of or efforts to avoid external reminders (people, places, conversations, activities, objects, situations) that arouse distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s).

d. negative alterations in cognitions and mood associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred, as evidenced by two (or more) of the following:

inability to remember an important aspect of the traumatic event(s) (typically due to dissociative amnesia and not to other factors such as head injury, alcohol, or drugs).

persistent and exaggerated negative beliefs or expectations about oneself, others, or the world (e.g., “i am bad,” “no one can be trusted,” ‘the world is completely dangerous,” “my whole nervous system is permanently ruined”).

persistent, distorted cognitions about the cause or consequences of the traumatic event(s) that lead the individual to blame himself/herself or others.

persistent negative emotional state (e.g., fear, horror, anger, guilt, or shame).

markedly diminished interest or participation in significant activities.

feelings of detachment or estrangement from others.

persistent inability to experience positive emotions (e.g., inability to experience happiness, satisfaction, or loving feelings).

e. marked alterations in arousal and reactivity associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred, as evidenced by two (or more) of the following:

irritable behavior and angry outbursts (with little or no provocation) typically expressed as verbal or physical aggression toward people or objects.

reckless or self-destructive behavior.

hypervigilance.

exaggerated startle response.

problems with concentration.

sleep disturbance (e.g., difficulty falling or staying asleep or restless sleep).

f. duration of the disturbance (criteria b, c, d, and e) is more than 1 month.

g. the disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

h. the disturbance is not attributable to the physiological effects of a substance (e.g., medication, alcohol) or another medical condition.

a. we’ve already established that cloud fits this criterion because he has the disorder.

b. cloud experiences intrusive or recurrent memories of the traumatic event (1) in addition to dreams that put him as a player in the burning of nibelheim. he usually takes zack’s role until his memory is restored (2). given that cloud has multiple instances in which sephiroth visits him in a vision while he is awake, there also some instances when they’re just that ... visions / flashbacks of his trauma outside of the influence that sephiroth holds on him (3). cloud experiences distress and pain whenever he’s visited by a vision of sephiroth or the mention of zack’s name (4, 5).

 c. though his behavior is certainly the closed off sort, he doesn’t avoid tifa. in fact, he is drawn to her as a survivor of the event and a supposed dear friend. he does, however, present himself as emotionally closed off, for the most part, save for some softer moments where he acts protective of his newfound friends (1, 2).

d. cloud definitely misremembers the events surrounding the nibelheim incident and zack’s death, instead becoming confused by the memories zack told him about and believing himself to be zack (1). cloud is instilled with the belief that despite now being a merc, he has to be the perfect soldier which would require him to be strong, resourceful, and careful with his emotions. he takes a no -  nonsense approach to life. this tends to fail (2). cloud feels somewhat responsible for tifa’s father’s death even in his false memories and, also, later feels responsible for zack’s death once he knows the truth. he feels that it is in some way his fault (3). cloud maintains a somewhat pissy attitude for the first half of the game, but, ultimately, this doesn’t entirely apply to him (4). cloud feels a diminished interest in being friends with tifa’s friends, especially after the incident that caused his initial trauma and feels even more separated and detached from them. this is also how he handles his initial interactions with the members of avalanche, though they eventually get through to him (5, 6). he’s emotionally closed off, as mentioned above, and is more prone to anger. but people who show him understanding and the praise / acceptance / acknowledgement he secretly wishes for, he cracks a smile.

e. he is easy to anger and gets into fights with the other kids after mt. nibel (1). cloud, somewhat recklessly, goes off to become a soldier. though not conditionally reckless, i do think it’s odd that simply trying to impress someone could push him to do something like that. maybe some part of him wanted to be more than he was, not just to earn tifa’s attention (2). cloud is very alert and aware of his surroundings. it’s in part battle instinct, in part training, in part trauma - induced (3). this one is hit or miss, it really depends (4). no problems with concentration, unless in the throes of a vision (5). we experience how restless cloud is in how easily he wakes up. when tifa knocks, when there’s the clone next door, when he’s at aerith’s house. he’s a light sleeper (6).

f. yes, it’s been more than a month.

g. this does cause social issues.

h. given that this condition was present before cloud’s mako poisoning, it is not the result of a substance. however, mako poisoning did make things worse.

acquired brain injury - mako poisoning. one of the causes of an abi happens to be poisoning compared to trauma caused by an impact or injury in the event of a traumatic brain injury. injuries of this sort can create permanent or temporary damage to one’s psyche --- cognitive, physical, emotional, or behavioral. this happens to cloud twice. given that he doesn’t necessarily recover from his mako poisoning entirely before falling in the lifestream again, his already active condition actually worsens. without zack’s stories to supplement his memories the second time, he completely loses himself and remains vegetative until tifa aids him in piecing together their shared past. it’s not all her, as cloud does have a hand in it, showing that he hasn’t completely lost himself, his mind is merely scrambled in a sort of dissociative amnesia that requires outside help to set right. this contributes to his depression and anger issues ( though, admittedly, they’ve diminished for the most part in his soldier state ). this also contributes to his memory loss. if anyone is curious, i can attempt to write more on this later !