How to effectively show mental health issues in a story?

I am writing a story at the moment and wanting to show how mental health issues can affect someone’s day to day life. My character is a young woman of 25 working in a New York City Library. She lives alone and generally keeps herself to herself. Her issues stem from being severely bullied as a child and suffers with; Anxiety, OCD, Depression and Eating Disorders. I have never had mental health problems but to make my story more believable I would love to get peoples thoughts and opinions. How do you show characters in your story who suffer with their mental health?

Hey! I can help with this if you want to DM me :))

I suffer both OCD, anxiety and social anxiety… so I appreciate you asking about this.

It shows that you actually care to portray it as realistically as you can, so thank you for that! :blush:

I’m currently writing about my experience with anxiety into a story of my own, so I don’t wish to share that publicly as I’ll be using my experience myself… and I’d like to be the first to tell my own story!

But I’m not adding my OCD into the story, so I can share some bits about that.

When it comes to OCD, for me… I like things my way. For example: If someone comes and changes something after I arranged it exactly as I like it… I get very upset and angry. I can’t help it… even if they were only trying to help, I get very worked up in myself and verbally lash out, whilst putting things back as they were… because it wasn’t their business to touch my things in the first place, let alone rearrange them.
They’ll be like: “I was trying to save you a job” and I’ll respond bitterly like: “Well you actually made more work for me, because now I have to do it all again.”

I get annoyed whenever someone turns mugs upside down, instead of putting them open side up.

I have major OCD with hand washing [had this since I was 4 years old]… I trust nothing that anyone else has touched. And if I do accidentally touch something that doesn’t belong to me, I’m quick to wash my hands with antibacterial soap.
When I go out for a meal, I always take my own cutlery, because just the very thought of using someone else’s cutlery or cutlery that has had someone else’s mouth on it absolutely disgusts me… and at least I know my own cutlery is clean. Because I personally cleaned it myself.

[There’s so much more I could add, but I don’t want to bore you. If you’re interested in knowing more on my experience with OCD, you can always reach out and ask me.]

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Thank you so much for this, I’m doing some reading around the issues I plan for my character to have so that I can weave it all into various parts of the story.

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Have you been diagnosed with OCD?

I’ve been looking for someone who actually has been, rather than all the germaphobes and perfectionists who like to scream that they do to ask a few questions of for a character of mine. I’ve done a lot of research, but I also know that nothing is as good as firsthand experiences.

If you’d be able to help, I’d really appreciate it. If you don’t feel comfortable doing it, that’s fine too!

What kind of eating disorder your character is suffering from?

I have yes, I was diagnosed as a young child after my mum had concerns about my behaviour. And the OCD stuck with me through adulthood too.

I am a germaphobe too, an absolute hygiene freak… but the OCD is related to completely different behaviours, the doctors say that it’s a mental related illness and it’s not so easy to explain. Such as the constant need to wash hands, even if I’ve only touched my own stuff [which is always ridiculously clean]. I wash them so much everyday, that I’m actually prone to really bad eczema because of it. But I don’t know why I do it… all I know is that I need to.

And then there’s the OCD with wanting everything to be a certain way. Once I’ve gotten something exactly as I like it, you can’t touch it or move it or rearrange it. It has to be exactly as I had it. I can’t even explain why this one happens, but it affects me so much if someone changes something or moves it out of place.

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Anxiety, OCD, depression, and eating disorders are pretty broad. Think about how these disorders affect this person specifically, since it’s different for everyone. As for eating disorders, do research on one (or more, depending on your character) specific disorders, since eating disorders are so broad.

For my own characters, I make sure to portray the physical symptoms of these mental disorders and/or struggles. For those with anxiety, trichotillomania (hair-picking disorder) or dermatillomania (skin-picking disorder) can be common. If your character washes her hands excessively due to OCD, that’ll show up on her hands’ skin. For depression, maybe that means periods of poor hygiene. For eating disorders, it depends on the disorder. For bulimia, physical symptoms can include rotting teeth and poor gag reflex. For binge eating disorder, there can be fast weight gain and stomach cramps.

Hello! It looks like the parts for OCD have been answered well, so I won’t rehash that. However, for eating disorders, it’s going to vary greatly based on what type of eating disorder you include. Generally, there are four main categories/diagnoses for eating disorders: Anorexia nervosa, bulimia nervosa, binge eating disorder, and nonspecified. I’ll go through each.

  1. Anorexia Nervosa and Bulimia nervosa

I have to explain these two together and you’ll see why soon, I’ll start with anorexia. Anorexia is probably the most “popular” in the media as far as eating disorders go because it’s the most visible to see. The person suffering gets extremely thin because the entire disorder is surrounded by two main factors: distorted body image (body dysmorphia being a common comorbid disorder) and, for this disorder, generally extreme dieting to control weight gain and loss. Someone with anorexia would NOT like to go out with friends to eat and wouldn’t want to talk about food because they would likely be disgusted by that. Anorexics may also excessively exercise as a means to lose weight and (this is a common misconception) someone with anorexia can purge (there is restricting type anorexia and purging type anorexia). The ONLY difference therefore between bulimia and anorexia is, therefore, one criterion that anorexia has the bulimia does not: being extremely underweight. This is a huge common misconception in the media that only bulimics purge and that’s not true, anorexics can purge, the only difference being is that anorexics are dangerously underweight (there’s a BMI requirement) whereas bulimics are not. However, the other difference is that for bulimia it is REQUIRED that you exhibit purging/binging behaviors to qualify for that diagnosis whereas for anorexia you don’t, you can either have the restricting type or the binge/purging type. The common denominator between these two, and all eating disorders, is a distorted body image. For the daily life of someone with these disorders, the physical toll on the body is hard to ignore. Fatigue, deteriorating teeth (for someone who uses vomiting as a purging method), loss of a regular menstrual cycle, slower cognition, and other symptoms of malnutrition. You’d also see daily preoccupation with food. They’d be scared of anything involving food, so if this person is in school, the lunch period would be horrifying for them. Shame and guilt are huge parts of any eating disorder. You’d see them try to hide it, but you’d also see them measuring things, constantly thinking about and planning their days around their meals (or lack thereof).

  1. Binge Eating Disorder

This was only recently added into the DSM, but it’s a very relevant eating disorder nonetheless. Binge eating disorder is essentially when a person, generally in times of stress, binges a large amount of food in one sitting. The big thing here is that there is no compensatory behavior following, because that would be bulimia. Binge eating is often followed by very intense shame and guilt, and during the binges they often feel out of control and ravenous, eating and eating huge amounts of food in a very short amount of time. This is a very fear-forward disease and is really the only eating disorder that doesn’t necessitate an unhealthy body image to qualify for a diagnosis. For someone with this disorder, they’d gain weight rather than lose it, which is why it’s often unrecognized and took so long to be added into the DSM. Someone with this would be driven by shame and guilt, that would be the primary emotions. They’d feel out of control, and they’d also have fear surrounding food. They’d be preoccupied throughout the day with trying to figure out how NOT to binge that day, planning how they were going to avoid it.

  1. Unspecified

Essentially, this is for any preoccupation with food that causes distress to a person but doesn’t qualify for any of the other ones. This is what I had when I was in high school because, for me, I would restrict food to feel hunger pains as a means of self-harm as opposed to other means of self-harm. Other examples could be someone who restricts food but doesn’t meet with BMI requirement for anorexia, but because they don’t have binge or purging behaviors wouldn’t qualify for bulimia either. You could also probably think of other instances where this would apply, too. Maybe eating behaviors that factor into body dysmorphia but don’t qualify for a disorder on their own, but are rather a subset of another disorder. This would really depend on what behaviors your character exhibits.

Hope this helped!

I can also give a bit more of a breakdown like this for depression and anxiety (since there are many different types and they would produce different behaviors) so let me know! Also, in case you were wondering where this info is from, I’m on my last year of college getting my bachelors in psychology, so this info is coming straight from my textbooks/lectures!

I would really appreciate that, what I am thinking of for my story is that my MC was badly bullied in school and because of that she has developed self esteem and body confidence issues. She is currently in a place where she only has a couple of close friends, she lives alone and mostly sticks to herself. I would love your advice though :slight_smile:

Moved to Share Feedback since this is about story ideas. Make sure to check out our Forum Tutorial for more info about creating topics, and feel free to PM me if you’ve got questions. :smiley:

Seeing that she has been bullied with body confidence issues, I’d probably go with bulimia nervosa and MDD, potentially GAD as well. Other disorders withing that realm (except for the other eating disorders) you’d have to have a fairly strong genetic component and see it manifesting outside of stressors, whereas GAD and MDD are general enough that they can be stressor-induced whereas something like bipolar or a specific phobia would be more of a genetic thing. You could look into social anxiety disorder as well.

Also, since you mentioned OCD as well, I would caution against having OCD start after the bullying. OCD is one of those disorders that isn’t really caused by stressors, it’s mainly genetic. So, a person who has subclinical symptoms can have a stressor bring them up to the clinical level, but stress alone cannot cause OCD - you have to have a genetic component and some existence of the disorder beforehand. So, keep that in mind when writing your character.

As for including MDD and GAD in your story, a lot of the symptoms overlap (hence why they’re frequently comorbid). You’d see difficulty sleeping (or for atypical depression, sleeping too much), difficulty concentrating (this can manifest in the story maybe with a character having a hard time keeping attention in class), loss of interest in activities, lethargy, changes in appetite (either increase or decrease), some people with depression will even have noticeably slower physical movements, for anxiety specifically you could see some irritability - but, again, most of the symptoms overlap. A helpful resource could be just googling the DSM and looking at what the diagnostic criteria is and implementing some of that into your story is subtle ways.

Hope this helps!

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Hi!!! I have anxiety and possibly other things (perhaps OCD and depression as well but haven’t been diagnosed).

Anxiety shows up in different ways for a lot of people. The way people described it never sounded like my anxiety. Sweaty palms, hyperventilating, etc are just not things I had. So yeah I’ll just describe it from my own experience to give you another perspective

Anxiety can be as minor as worrying about what other people are thinking about you, to having a panic attack.

For me, sometimes I just get a lot of obsessive thoughts about what people are thinking of me or if they like me or if I’m being weird. This often results in me feeling incredibly down and hard on myself. My flaws are heightened during this in terms of me just thinking I’m the worst person lol. Or sometimes I try to be like, “I’m kind, I like that about myself” and then my thoughts can taunt me like, “if you were really kind you wouldn’t say you were kind, you’re conceited” yk? And it’s not like I truly believed these things, it’s just sometimes part of my anxiety where I have that negative voice inside my head.

My main anxiety is around a specific fear which is of vomiting. If I get really anxious I start feeling nauseous, which makes me think I’m gonna throw up, and that tends to go in a vicious cycle which is basically how my panic attacks work. I used to call them anxiety attacks but I think they’ve always been panic attacks. It’s just this period of the most intense fear and sense of helplessness. Some people say it feels like you’re dying and it doesn’t feel like that to me, I think because that’s not my fear. I’m not afraid of dying, I’m afraid of throwing up so instead my mind gives me those symptoms and convinces me I’m going to throw up.

Usually for me it’s caused by a trigger. If I’m already anxious that doesn’t help. A few days ago I went to see a movie and I had to step out of the theatre because all the dizzying images made me feel dizzy and nauseous. I had overwhelming thoughts of: “what if I throw up here? People are gonna have to clean that up! That would be mortifying!” But I can’t leave!

I used to have days where I’d wake up incredibly anxious for no reason, and my appetite would be gone and I’d go from moments of somewhat calm to extreme fear. Those moments of extreme fear is when I’d get that fast heartbeat thing, but I don’t usually get that otherwise (at least that I can notice, when I’m anxious I’m sure my heart rate goes up).

Anyway, that’s my experience with it! I hope this helps!

If I were you, I’d look through the forums for people with mental issues to understand them better. Thus, you will keep your story realistic and truthful. My sister suffers from anxiety and depression. Fortunately, Canada Drugs works for her, so some days are better than others. As for storytelling, I think it is important not to turn your characters with mental problems into victims.