If anyone wants me to make a “diagnosis” of a Star Trek character, feel free to ask I’ll gladly do it.
(Just don’t ask for Deep Space Nine or Voyager yet; I haven’t watched them.)
Next, I’ll present Leonard “Bones” McCoy with either Obsessive-Compulsive Disorder (OCD) or Generalized Anxiety Disorder (GAD) you can decide which one fits him best.
Or maybe he’s just a neurotypical idiot with good friends.
Leonard “Bones” McCoy Headcanon: OCD
Control:
McCoy needs things done his way.
When something gets out of his control whether it’s one of Kirk’s reckless missions or one of Spock’s logical experiments he gets upset.
He constantly tries to impose order even in chaotic situations, leading to his endless arguments with Spock:
"For God’s sake, man, that’s not natural!"
Interpretation:
That need for control isn’t simple stubbornness it’s a way to calm the anxiety caused by uncertainty. Order and rules provide him with emotional safety.
Perfectionism:
McCoy can’t stand the idea of acting without morality or humanity.
His medical and personal decisions are guided by firm ethical principles:
"It doesn’t matter if he’s the enemy he’s still a living being."
Interpretation:
His ethical perfectionism and obsession with doing the right thing are traits typical of moral-type OCD or obsessive-compulsive personality.
It’s not about irrational fear it’s an intense need to act according to his internal moral compass, even if it means clashing with the captain or Starfleet command.
Thinking and Resistance:
McCoy often rejects new technology or overly abstract ideas.
In the AOS films, he mocks the transporters:
"I got disintegrated and reintegrated, Jim that’s not natural!"
In TOS, he prefers traditional methods and distrusts Spock’s experiments.
His rigidity isn’t just conservatism it’s a way to maintain a predictable environment.
Familiar routines reduce his anxiety. Sudden changes drain him mentally.
Functionality:
He’s constantly worried about Jim, Spock, the crew, everything.
He’s always anticipating catastrophe:
"I told you this would happen, Jim."
Yet his worry never paralyzes him; he acts even when afraid.
That chronic worry is part of obsessive anxiety.
For McCoy, hypervigilance becomes competence he uses worry as fuel, not as a barrier.
Routines:
Although the series doesn’t show clear rituals, there are patterns:
He keeps his sickbay meticulously organized.
He gets irritated if someone touches or rearranges his instruments.
He repeats phrases like:
"I’m a doctor, not a…"
That phrase is almost a ritual mantra reaffirming his identity and control.
Repetitive language and routines act as emotional regulation tools.
Hypermorality:
When something goes wrong, McCoy immediately blames himself even if it wasn’t his fault.
In The City on the Edge of Forever, his moral anguish over causing an accident is extreme; he feels not only guilt but ethical shame.
This exaggerated guilt is common in moral OCD.
For McCoy, “causing harm” isn’t just a medical mistake it’s an existential failure.
Empathy:
He’s deeply empathetic but his empathy burdens him.
He feels others’ pain as if it were his own.
His sarcasm is a defense mechanism:
"Don’t cry for me, Spock… you couldn’t anyway."
Behind the sarcasm is repressed compassion feeling too much hurts him.
Moral OCD often comes with hyperempathy: the obsessive mind fixates on others’ suffering because it can’t bear the thought of causing harm.
Headcanon: Generalized Anxiety Disorder (GAD)
Uncontrollable Worry:
McCoy lives in constant anticipation of disaster.
From the very first scenes in TOS and AOS, his inner (and outer) dialogue is full of:
"Jim, that’s not going to work,”
“This will kill us all,”
“For God’s sake, Spock, that doesn’t make sense!”
Interpretation:
GAD is defined by incessant anticipatory thinking.
McCoy doesn’t expect things to go wrong he assumes they will, as a defense mechanism.
Worrying makes him feel prepared.
Hypervigilance:
As a doctor, he’s constantly on alert scanning for symptoms, danger signs, and questioning every medical decision or captain’s order.
Even when everything seems fine, he still doubts:
"I don’t like this, Jim. Something’s off."
His mind can’t switch off.
His anxiety channels through caring making him a brilliant professional but mentally exhausted.
To McCoy, watching over others is how he loves them.
Response to Anxiety:
In many scenes, he looks tense fidgeting, breathing rapidly, gripping something (a tricorder, a glass, his hands).
In AOS, when he teleports for the first time, he experiences real physical panic:
"I got disintegrated and reintegrated, Jim!"
Physical symptoms palpitations, tremors, hyperventilation are typical.
McCoy doesn’t dissociate his anxiety; he somatizes it. His body and mind react as one.
Thoughts:
He tends to exaggerate possible outcomes: if Spock conducts a dangerous experiment, he assumes it will explode; if Kirk takes a risky mission, he imagines his death.
"Jim, that’s suicide!"
Even when nothing bad happens, McCoy has already lived the worst-case scenario in his mind.
Catastrophic thinking is his way of “preparing” for pain
if he imagines the worst, he believes he’ll handle it better if it happens, even though it only drains him.
Difficulty Relaxing:
Even in calm moments (a dinner, downtime), he’s still tense, frowning, thinking of what could go wrong.
When others relax, he stays on as the group’s emotional radar.
His nervous system never leaves alert mode.
He doesn’t know how to just be only how to prevent.
Calmness makes him more nervous than danger.
Sarcasm as Defense:
His sarcasm isn’t just bad temper it’s containment.
His sharp humor “I’m a doctor, not a…” or “For God’s sake, Jim…” lets him vent emotional tension without breaking down.
Humor works as a pressure valve.
His irony masks someone who feels too much, all the time.
Hyperempathy:
His anxiety doesn’t revolve around himself it’s about others.
He fears losing his friends, especially Kirk and Spock.
When one of them is hurt, his tone shifts from irritated to desperate.
GAD often includes intense fear of loss or abandonment.
For McCoy, caring is how he controls his fear of being left alone.
