I'm writing a character who is autistic, and already prone to anxiety. Plot is, put basically, someone is after them and their uncle. Would it be unreasonable to have the MC become more anxious, and how could I portray this properly?

It seems quite reasonable for your character to become more anxious in this circumstance. In fact, I’d be more surprised if your character didn’t become more anxious.

Escalating anxiety can be shown in a couple different ways, specifically:

Developing additional symptoms
Amping up the existing symptoms

I’ll go into a little more detail:

Developing additional symptoms:

Take a look at the symptoms of the various anxiety disorders.

You can pick a few more symptoms from the criteria of the specific disorder(s) your character is experiencing. Note that it’s rare (but not impossible) to have a character experience every single symptom.

I also suggest considering adding panic attacks (see criteria here), if your character does not already experience them.

Amping up existing symptoms:

Increase the intensity, frequency, duration, scope, prevalence, and / or consequences of existing symptoms.

Here are a couple examples:

The character has had trouble sleeping due to anxious thoughts keeping them awake. To escalate it, you could have your character double the time it takes for them to fall asleep.

The character has a specific phobia about needles. To escalate it, they might start experiencing phobic reactions to additional stimuli, such as being in a hospital or seeing a doctor.

The character has agoraphobia when in a crowd or in an enclosed space with other people. It can escalate to the point where the character is too anxious to leave their house entirely.

I’m leaving the autistic part aside, as that’s more @scriptautistic‘s area of expertise. However, I will say that meltdowns are probably more likely to be triggered when your character is in a more anxious state.

Disclaimer

#mythicxsol #anxiety #social anxiety #generalized anxiety disorder #symptoms #criteria #prognosis #phobia #needles #panic attacks #Panic disorder #agoraphobia #Characterization #character critique #this is not psychological or medical advice #this is writing advice

scriptshrink

Anonymous asked:

Hi! My character has Panic Disorder and Generalized Anxiety Disorder (undiagnosed at the time) and is under a ton of stress, to the point where he basically has a mental breakdown (he starts having a panic attack but the symptoms are worse than usual and it doesn't stop, even after like 3 or 4 hours) and ends up checking himself into a mental hospital, which he spends 3 weeks in. Would that be realistic?

CW: suicidal ideation mention

It’s unlikely that your character would have a continuous panic attack for 3-4 hours straight, but your character could definitely have a series of them in quick succession.

The second part of your ask, I’m afraid to say, is not realistic at all.

Firstly, a character would not be checked into psych hospitals if their sole presenting problem is anxiety / panic attacks, unless their anxiety has driven them to the point of being suicidal. (Soon I’ll be making a post on specific inpatient admission criteria! Stay tuned!)

The whole idea nowadays is to treat patients in whatever environment is the least restrictive one possible. Anxiety is treatable on an outpatient basis; there’s no need for the intensity and restrictiveness of inpatient treatment.

Secondly, even if your character was suicidal from the anxiety he’s experiencing, he wouldn’t be kept there for three weeks. The average stay at my hospital for a suicidal patient is 3-5 days.

There are more long-term facilities run by the state - this is more the kind of thing people think of when they hear the words “psych ward.” However, these places are always full, with a waiting list that can last months. Because of the high demand, state hospitals (in my state at least) only accept transfers from psych hospitals like the one I work at, and do not accept any voluntary patients whatsoever.

There are also private inpatient programs that focus on treating a specific kind of disorder, but I’ve never heard of one that only treats panic attacks / GAD.

What would likely happen instead is that your character would present at an ER, get a dose of an anxiolytic if they’re actively having a panic attack, and get a referral to an outpatient psychiatrist.

Note - The Shrink is basing her response on the policies of the American psych hospital that I am currently interning at. Policies my vary.

Disclaimer

scriptshrink

surules-blog asked:

In my story I have a character who suffers from panic attacks&high anxiety because of severe bullying in her past.Certain things set her off,such as questions about her past,certain events and names,or someone touching too close to the cuts on her wrists.She calms herself mostly with candy or things like yoyo.Really anything that gets her to focus on something else.I'm wondering 1.whether all this is accurate for someone with this condition, and 2.whether there's anything else I'm should include

Here are some answers courtesy of the Scriptshrink consultants!

Silver Dragon:

Usually someone with anxiety that is set off by specific past events needs something complicated to distract them, in my experience. Keeping her hands busy is certainly a good idea, but to me, candy is more of a comfort food for depression. People who experience panic attacks tend to need things surrounding them, like a heavy blanket, or things to do with their hands, like a yo-yo.

Rebel:

Does the question asker mean, when the character is trying to calm down, the character is alone and out of a panic attack but in high anxiety, or when in a panic attack? In the former case, a yo-yo would make sense; in the latter, from my experience, there’s not much I can focus on when in a full blown panic attack except try to escape the situation and/or breathe. Candy is, as Silver said above, more of a depression thing, although there are anxiety drops out there that help with minor anxiety. The triggers make sense and work realistically. Consider having the character fidget or move some part of their body when still (ie tapping fingers or bouncing leg up and down quickly). Hope this helps!

Anon32:

I have used hard candy as a sort of “worry stone” in my mouth when I can’t have my hand occupied. The sucking motion also releases endorphins, but I think the ability to sort of stim by rubbing the tongue against a hard candy against the top of the mouth could help calm down a bit. Especially if the character has a reason to associate a certain hard candy with safety. I agree with Rebel that bouncing leg and finger tapping is a common outlet of anxious energy/stim for calming.

Charlie:

Candy is a pretty good one actually. I had a psychologist that taught me mindfulness techniques using chocolate. We chose chocolate because it melts slowly and most of them are pretty textured but anything could work for your character. I find that having something I can taste or smell helps me when I’m having a flashback, so it would definitely be possible for it to apply to anxiety in general.

@mrsq8geek:

When I was at uni and still unable to control when anxiety/panic really took hold, I’d run off to the bathroom and sit in a stall for as long as it took to get my breathing back under control. Hand over mouth is definitely helpful in the moment, to slow hyperventilation. I don’t know if the “she calms herself with” is accurate because it sort of implies the writer wants to use it as an off switch, which… there isn’t always an off switch with anxiety, sometimes you end up on the lab of the computer floor with your friend uncertain what to do to help you.

Thanks so much to the ScriptShrink consultants!

Want to join the conversation and add your experiences to help answer asks? Apply here! // Disclaimer

#surules #asks #silver dragon #anon32 #rebel #consultant #anxiety #panic attacks #food #self injury #bullying #flashbacks #panic disorder #scriptshrink consultants #this is not psychological or medical advice #this is writing advice #personal experiences #coping skills

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scriptshrink

betweenmayandjuly-deactivated20 asked:

I'm not sure if I should ask you or scriptmedic about this, but what are the do's and don't's of calming someone who's having a panic/anxiety attack?

scriptshrink answered:

Courtesy of @scriptautistic:

Things not to do:

Don’t : Yell at them. Especially not to calm down. This is the exact opposite of helpful.
Don’t : Tell them to stop crying/shaking/hyperventilating. They can’t help it.
Don’t : Start panicking as well (if possible).
Don’t : Touch them or move them without permission.
Don’t : Ask too many questions without giving them time to answer. Ask open questions which require lot of reflection or open answers.
Don’t: Force them to do anything they don’t want to do.
Don’t : Leave them alone before they have calmed down completely and told you so. If it’s not their first attack, they probably know how they behave.

Things to do:

Do: Speak as calmly as possible. Have calm gestures. Try to appear as non-threatening, calm, collected and reassuring as possible.
Do : Ask if you can do anything specific to help. Ask if they have medication and if they want to take it. Ask if they want help getting away from a stressor. Once these basics are covered, you can offer them something cold/warm to drink and a hug if you’re comfortable with giving them one.
Do : Try and help them breathe more regularly if they are hyperventilating. You can help them by saying “breathe in…breathe out” in a regular, slow rhythm, or, while hugging them or with their hand on your chest, by telling them to follow your rhythm.
Do : Reassure them if they apologize, feel guilty or are ashamed to be seen like this.
Do: Gently but firmly keep them from hurting themselves.
Do : Once they have calmed down a bit, try to distract them to stop them from getting back into the attack or having another one. You can chat with them, tell them about your day, offer them to play a game, have a walk together, or do anything nice, soothing, and that they like. Comfort food is nice. Warm blankets are nice.
Do: Give them a way to keep in touch with you if you have to go shortly afterwards, or a way to contact someone else/ a hotline which can help.

Followers who’ve had panic attacks - what helps you calm down? What doesn’t help?

scriptshrink

@pomrania added:

SO TRUE.

Telling someone “calm down” is pretty much NEVER a good idea. If they’re able to, they’ll do it anyways (unless you’ve annoyed them too much by saying stupid things like that); if they’re not, it’s pointless.

I’d add the advice of “stay out of arm’s reach”, because when I’m freaking the hell out, I might mindlessly strike out at anyone who gets too close; and then someone calls security and/or the police and the whole day is ruined. (True story.)

Also, it really does not feel good having people talk about me like I’m not there, even if I’m too busy crying to respond. To me, if you have to call for assistance, move out of earshot. Don’t stop to gawk. I understand curiosity – it’s one of my driving forces – but be discreet about it.

I think of myself as essentially a frightened animal when I’m freaking out that badly, although other people have said that’s not a good comparison to ever say. (Joke’s on you, I’m posting it anyways.)

To me, only time can help; even if the original thing is no longer a problem, everything needs to work its way out of my system. Absolute best-case scenario for me has no unpleasant distractions, and a big fuzzy dog to hug; the more reasonable best-case scenario would be no idiots nearby, and a rhythmic sound to help with my breathing.

@subtletyislost added:

Personally one of the big things for me when I have a panic attack is finding or being handed my inhaler. I also have asthma and when I panic I hyperventilate, which can cause me to breathe in dust or pollen or something else that triggers my asthma, which just makes me panic more. Being given my inhaler and using it forces me to have to focus on something familiar (the steps to using it).

Another thing that helps me is if my teddy bear is around, being handed it can help. I have a strong attachment to the bear, more than some of my human friends, and as long as I have the bear I know even when I panic that nothing imagined/in my head/not physical can hurt me. That calms me a lot. Having my phone helps too, even if i can’t use it, my phone being there gives me the sense that my (long distance) friends are there too.

The only thing (other than the ones already said) that’s ever made it worse for me/not helped me, was people trying to talk to me. To be clear I mean multiple people. If there’s more than one person when someone is panicking, try to remember that for some characters multiple people talking will just make it worse. Try to only have one character talk to the panicked character at a time, preferentially a character they trust.

An Anon added:

You asked for some advice to calm down from panic attacks so here’s a few of my tips. If a person is in a group when they have a panic attack then see if they want to be away from the group (personally I like to be completely alone during an attack and need comfort afterwards bc even one person stresses me out) Also there’s one breathing technique I have is where I tap my finger and count like “1 2 3 4” each gets a tap and that’s when I inhale and the 5,6,7,8 is when I exhale (like dance counts)

Thanks to all three of you for adding to this post! - Shrink

#reblog #betweenmayandjuly #asks #scriptautistic #panic attacks #panic disorder #what do #this is not psychological or medical advice #this is writing advice #guest post #scriptshrink #pomrania #subtletyislost #personal experiences #submissions #addition

scriptshrink

betweenmayandjuly-deactivated20 asked:

I'm not sure if I should ask you or scriptmedic about this, but what are the do's and don't's of calming someone who's having a panic/anxiety attack?

Courtesy of @scriptautistic:

Things not to do:

Don’t : Yell at them. Especially not to calm down. This is the exact opposite of helpful.
Don’t : Tell them to stop crying/shaking/hyperventilating. They can’t help it.
Don’t : Start panicking as well (if possible).
Don’t : Touch them or move them without permission.
Don’t : Ask too many questions without giving them time to answer. Ask open questions which require lot of reflection or open answers.
Don’t: Force them to do anything they don’t want to do.
Don’t : Leave them alone before they have calmed down completely and told you so. If it’s not their first attack, they probably know how they behave.

Things to do:

Do: Speak as calmly as possible. Have calm gestures. Try to appear as non-threatening, calm, collected and reassuring as possible.
Do : Ask if you can do anything specific to help. Ask if they have medication and if they want to take it. Ask if they want help getting away from a stressor. Once these basics are covered, you can offer them something cold/warm to drink and a hug if you’re comfortable with giving them one.
Do : Try and help them breathe more regularly if they are hyperventilating. You can help them by saying “breathe in…breathe out” in a regular, slow rhythm, or, while hugging them or with their hand on your chest, by telling them to follow your rhythm.
Do : Reassure them if they apologize, feel guilty or are ashamed to be seen like this.
Do: Gently but firmly keep them from hurting themselves.
Do : Once they have calmed down a bit, try to distract them to stop them from getting back into the attack or having another one. You can chat with them, tell them about your day, offer them to play a game, have a walk together, or do anything nice, soothing, and that they like. Comfort food is nice. Warm blankets are nice.
Do: Give them a way to keep in touch with you if you have to go shortly afterwards, or a way to contact someone else/ a hotline which can help.

Followers who’ve had panic attacks - what helps you calm down? What doesn’t help?

#betweenmayandjuly #asks #scriptautistic #panic attacks #panic disorder #what do #this is not psychological or medical advice #this is writing advice #guest post

scriptshrink

Panic Attacks, Part 2

I was looking through my notes, and I realized I forgot to include two things in my previous post!

There are two kinds of panic attack:

Expected - these happen because of a known trigger.
Unexpected - also known as ‘uncued’ or ‘spontaneous’ panic attacks. These occur out of the blue, and your character would have no idea why they’re freaking out.

Note - Unexpected panic attacks may later be explained through therapy as triggers are discovered / uncovered!

There are also three categories of worries a character could have when they have Panic Disorder.

Physical concern - the character thinks they’re going to have a heart attack, etc.
Social concern - the character is scared of being embarrassed, or fears being judged because of their symptoms
Mental functioning - the character is scared they’re going to ‘lose it’ or ‘go crazy’

#panic attacks #panic disorder #demystifying #worry #anxiety #demystifying the dsm 5 #demystifying the DSM 5

scriptshrink

Panic Attacks / Disorder - Demystifying the DSM-V

A panic attack is one of those things with mental illness that can have a totally different presentation from person to person. As such, people’s ideas of what a panic attack looks or feels like can be vastly different from each other. So here’s the criteria:

A panic attack is defined as a sudden and intense ‘attack’ of fear and discomfort. It reaches a peak within a few minutes, and your character needs to display at least four of the following symptoms:

Heart pounding or racing
Sweating
Trembling / shaking
Feeling short of breath, or like they’re being smothered
Choking
Chest pain
Feeling nauseous or having an upset stomach
Feeling dizzy, unsteady, lightheaded, or faint
Chills or overheated
Feeling numb or a tingling sensation
Derealization or depersonalization – see my post HERE!
Fear of losing control or going crazy
Fear of dying

Note – sometimes, different cultures have specific symptoms such as ringing in ears, sore neck, headache, or uncontrollable screaming / crying, but these don’t count as one of the four symptoms.

Also Note – a panic attack doesn’t always have to occur from a calm state. You can already be pretty anxious, but a panic attack would make it noticibly worse.

Thirdly note – “Panic attack” is not a diagnosis in and of itself. It’s either part of another diagnosis, or a specifier.

Panic Disorder

Panic Disorder is basically repeated, unexpected panic attacks. Here, unexpected means that there’s no obvious trigger for the panic attack.

There’s no requirements on how frequent these panic attacks need to be – just that there’s more than two of them.

At least one of the panic attacks is followed by 1 month or more of the character having either or both:

Consistently worrying about having another panic attack OR the consequences of having a panic attack (such as being worried about losing control, that they’re going to have a heart attack, that they might get into a car crash)
The character’s behavior needs to significantly change in a negative way because they want to avoid having a panic attack. This could be the character trying to avoid situations where they would have to exercise, or avoiding new situations entirely.

The panic attacks can’t be better explained by another medical condition or mental disorder.

Panic disorder is frequently seen with agoraphobia, and there’s a lot of discussion whether or not panic disorder causes agoraphobia, agoraphobia causes panic disorder, etc.

Disclaimer

#panic attacks #panic disorder #anxiety #demystifying the dsm 5 #criteria #agoraphobia #this is not psychological or medical advice #this is writing advice #demystifying #demystifying the DSM 5 #best of scriptshrink