#literarycharacterdevelopment

Previously, we talked about what anxiety is, the different types of disorders, and now we’re going to talk about how each of them is treated. Keep in mind that none of these posts are to be used as a way to diagnose or treat people in real-life scenarios. It is merely a broad-overview of mental health disorders intended to help writers create as real-to-life characters as possible.

In a following post, I’m going to be bringing all of this information together to show how you can use the mental health diagnosis of anxiety together to create a plot and character arc. I try to post weekly on Mondays, so if consider following my page if you haven’t already.

In modern medicine, clinicians generally use a combination of medications as well as cognitive behavioral therapy. I am not going to focus on this medication aspect because it is not relevant to the point I’m trying to make.

Often, the first part of treating anxiety is to realize it is taking place. Sometimes it can be hard to admit that anxiety is causing that racing heart sensation, the nausea, and the heart palpitations. Often a person will show up at the ER thinking they are having a heart attack before showing up at their therapist’s office. Or a person with chronic anxiety might turn to less healthy alternatives of stress management such as binge eating or drinking. In cases like OCD, they may participate in ritualistic compulsion practices. In cases like agoraphobia, they may refuse to leave the house.

In this day and age, we are getting better as a society that does not demean people with mental health related illnesses, but we have a long way to go. If a person who previously perceived others with mental health illnesses as weak or crazy, when they develop symptoms themselves, they can be very hard to accept. A major hit to their self-esteem or self-perception can occur. Acceptance may not occur, so the person keeps presenting to the hospital with the same symptoms, but refuses to see a therapist. All this needs to be taken into consideration as it relates to treatments for anxiety. It’s also little details you can add into your character’s profiles to make them more real.

In a controlled environment such as a therapist’s office, the therapist will probably teach their client relaxation techniques to manage their anxiety symptoms when they arise. They will probably discuss different triggers that cause the anxiety to flare up. These triggers might phobias such as claustrophobia or the thought of eating in an anorexic patient. Together, the therapist and client will formulate a plan on how to face these triggers without having an anxiety related response.

For an example, we’ll us a woman with claustrophobia, specifically a fear of elevators. They are probably also afraid of closets, cars, and other tight quarters, but there’s an elevator down the hall so it’s the most convenient problem to deal with at the moment. The therapist may try ‘systematic desensitization’ where the therapist exposes the client to the threatening object in gradually increasing intensities (Videbeck p. 241). For example, they may spend a session looking at pictures of elevators on the computer. Next session, they may stand ten feet from the elevator and watch as it opens and closes while people get in and out. Then they take a peek inside the elevator. Basically, these steps are performed until the client is bored of them—which is the mind’s way of saying something is thoroughly processed. Finally, the client is able to step inside the elevator, not without fear, but without having a full-blown panic attack. They survive their small trip unscathed. This does not mean that elevator rides will be easy from now on. In fact, the client will still probably be scared of elevators, but they, themselves, will be braver. The key to this, however, is that the person must face the fear willingly. If the therapist drags them down the hall and shoves them into an elevator, the effects will be disastrous.

Often, this bravery translates into other parts of their life as well. They’re still scared to go to the grocery store, but they survived the elevator and are willing to give the shopping trip a try. They’re still afraid of their overbearing husband, but are willing to stand up to him for once. In the end (theoretically) the client become a braver person overall.

Thing is though, the overbearing husband might not like this change in their wife. They may have preferred being the strong, controlling man with the mouse-like wife. (Think Carol in the Walking Dead). Maybe she will have the courage to leave him. Or, perhaps the husband will have the courage to go to therapy themself to find out why they are the way they are. Who knows? It’s your story.

Next post I’m going to bring together all the elements of my previous posts on anxiety and show how you can use them to create a story/character arc.

Different Types of Anxiety Disorders:

Last post was a broad overview of anxiety as a whole. Now we are going to dive deeper into individual anxiety disorders and what they would look like in your characters.

Agoraphobia: Literally “fear of the marketplace,” agoraphobia is ‘anxiety about or avoidance of places or situations from which escape might be difficult or in which help might be unavailable’ (Videbeck p. 233). This is more than just being a ‘shut-in.’ Many people with debilitating medical conditions can be homebound. The agoraphobe could physically leave the house or be alone, but the overwhelming anxiety is either too much to handle or makes life incredibly difficult. They have trouble shopping, making it to meetings, spending time with friends or family, etc. They may avoid travelling in vehicles. And often, they know their responses to the anxiety are extreme. The agoraphobe often feels trapped in their homes.

So how does agoraphobia develop? It can start with a panic attack at the grocery store with an overwhelming sense of doom and fear of death. The person may end up in the ER only to be told there is nothing wrong with them. They go back to the store a week later and have a panic attack in the parking lot as they think about what happened last time. So they turn around and go home. Then it happens going to work. Then in the car going to the park. Then walking to the mailbox. A person avoids these triggers one-by-one until they just don’t leave the house anymore.

Panic Disorder: ‘is characterized by recurrent, unexpected panic attacks that cause constant concern. A panic attack is the sudden onset of intense apprehension, fearfulness, or terror associated with feelings of impending doom’ (Videbeck p. 233).

Last post we discussed what a panic attack looked like and I have other posts on this subject as well. Visit my website at rwhague.com for more information.

After the first panic attack, the person is left waiting on the next. Soon the anxiety itself is being fueled by anxiety regarding panic attacks. As more panic attacks happen, the more the anxiety increases. The person often feels as if they are going crazy. All they can think about is the next one coming. Every sensation might feel like a threat—even hunger, thirst, tiredness can be interpreted as anxiety coming on.

Specific Phobias: These are things such as claustrophobia (fear of tight spaces), arachnophobia (fear of spiders), etc. Anxiety responses are extreme and can lead to avoidance. This seems as if it would be fine—just don’t go into closets. But when the tight space is an elevator or a car, life can be hampered. Most adults recognize their fear as unreasonable.

Social Phobia: ‘characterized by anxiety provoked by certain types of social or performance situation, which often leads to avoidance behavior’ (Videbeck p. 233). This can lead to isolation or interference in work or habits. The person recognizes their anxiety is unreasonable.

Obsessive Compulsive Disorder (OCD): ‘involves obsession (thoughts, impulses, images) that cause marked anxiety and/or compulsions (repetitive behaviors or mental acts) that attempt to neutralize anxiety’ (Videbeck p. 233). The person experiencing these obsessive and compulsive thoughts and actions do not want them. They are intrusive, recurrent, and persistent. Any attempt to get the thoughts to go away are ineffective. The individual recognizes that these obsessions and compulsions are excessive and unreasonable.

OCD is probably one of the most misunderstood disorders. Keep in mind there are two parts: the anxiety trigger (obsession) and the attempt at solution (compulsion). So fear of germs or contamination can lead to compulsive cleaning—but this is only one type of OCD. Obsession with the number 3 may require things to be done in 3s. Open the door three times before going through it, brush three times before moving on to next section of hair, etc.  Here is a good video that helps explain this disorder: https://www.youtube.com/watch?v=DhlRgwdDc-E

People with OCD are also fully aware of these irrational obsessions and compulsions. They do not want them and feel powerless to their mind’s whims.

Generalized Anxiety Disorder: is ‘characterized by 6 months of persistent and excessive worry (Videbeck p. 233). A person might be anxious through a stressful time of life, but usually these parts of life do not last for more than a few days to a few months. If after 6 months, the person continues to have uncontrollable worrying that impairs social or occupational functioning, they may have GAD.

Once again, the person knows their feelings are irrational. They do not want to be this way. But like a panic disorder, the anxiety often provokes more anxiety. The heart palpitations, tremors, tightness in the chest become intrusive—and when the symptoms abate the fear of their return remains prominent in the sufferer’s mind. This is often accompanied by sleep disturbances and insomnia.

Acute Stress Disorder: ‘development of anxiety, dissociation, and other symptoms within one month of exposure to an extremely traumatic stressor; lasts from 2 days to 4 weeks’ (Videbeck p. 233).

Post Traumatic Stress Disorder: ‘characterized by the reexperiencing of an extremely traumatic event, avoidance of stimuli associated with the event, numbing of responsiveness, and persistent increased arousal; it begins within 3 months to years after the event and may last a few months or years (Videbeck p. 233).

It is important to note that not all suffers of PTSD are the victims. Often, they can be the perpetrators. For example, a soldier who shot a non-combatant accidentally might find themselves struggling with what they did. Usually after a traumatic event, a person has suffered a change in their view of the world. If something evil was done to them, their previously naïve self has endured something beyond their imagination. If they previously viewed themselves a good person, but they committed a travesty, this is a change in their fundamental view of themselves.

Often times, the mind will play the event over and over again as it tries to rectify their previous perceptions to form a more accurate view of the world and themselves. The mind is trying to protect the body by re-living the event and trying to solve it, but this is very distressing for the person to live through again and again.

Symptoms of PTSD include: intense fear, helplessness or horror; reexperiencing (intrusive recollections or dreams, flashbacks, physical and psychological distress over reminders of the event); avoidance of memory-provoking stimuli and numbing of general responsiveness (avoidance of thoughts, feelings, conversations, people, places, amnesia, diminished interest or participation in life events, feeling detached or estranged from others, restricted affect, sense of foreboding); increased arousal (sleep disturbance, irritability or angry outburst, difficulty concentrating, hypervigilance, exaggerated startle response); significant distress or impairment.

Not all flashbacks are obvious to those not experiencing it. The person may ‘zone out’ for a moment or two. Often triggers are very subtle and those around them will not know why the flashback occurred. This is important to keep in mind in regard to children or individuals ho are not fully able to articulate the trigger or even the event that lead to the initial trauma.

And with all of these things, depression is often a common compounding problem that arises. Being anxious all the time uses up a lot of energy and often the body and mind just crash into a depressive state from being keyed up all the time. It is rare to find anxiety without some level of depression present.