MENTAL DISORDERS. The three tables are not meant to paint a realistic picture of disorders within our socity of our modern time, but rather an attempt to help the DM to give both the PC's and NPC's a range of disorders to choose from when applying them to a game situation. The tables are (1) for biologically or genetically caused disorders and (2) disorders caused by traumatic events, before or after, the character's introduction to the game. I have also included a quick explanation of the mental disorders, their etiology and possible treatment (treatment atleast for the behavioral, i.e. traumatic, disorders, since the technology did not exist at that time to do proper research regarding neurobiology, neurochemistry and anatomy). Since it is impossible to forfill the DM-fascists wish to compress a description of mental disorders to a A-5 leaflet, I have included a lists of psychological textbooks for the DM who wishes to induce more terror and realism when his players goes schizo. These books should be avaliable at any good bookstore. But lets get down to the nitty-gritty details of the mental disorders and dive into the dark and deep pits of the broken human soul... DISORDERS RANKED BY EFFECT ON ROLEPLAY. 1. GROSSLY IMPAIRED. The character is in the terminal (fatal) stages of the disorder. Death caused by biological factors, suicide or abnormal behavior is common if not treated. The character is unable to complete any task given to him; he must be feed, dressed and washed. If in any social interaction; the character does not communicate logically, abnormal behavior cause distress in observers and he might hurt himself if left unattended. This stage is typical of cataconic schizophrenias (cataconic's are much like autistic children), after prolonged substance abuse, severe depression or obsessive compulsive disorders. 2. VERY POOR. Marked impairment in both social relations and occupational functioning. The character cannot perform but very easy tasks. Character is seen upon as the 'the dirty madman in the cave'. Saving throws, spellcasting and hit rolls are done at -6. The character is most of the time (80 percent) under the control of the disease. This stage is typical of disorganized and paranoid schizophrenias, obsessive-compulsive disorders, somatoform disorders, dissociative disorders, psychosexual disorders and manic- depression. 3. POOR. Marked impairment in either social relations or occupational functioning, or some impairment in both. Character is able to either conclude ordinary tasks, or have ordinary social relations. Is seen upon as the 'village idiot'. But saving throws, spellcasting and hit rolls are done at - 4. The character is 50 percent of the time under the control of the disease. This stage is typical of the mild symptoms of stereotyped movement disorders, schizophrenic disorders, anxiety disorders, dissociative disorders and psychosexual disorders. 4. FAIR. Moderate impairment in either social relations or occupational functioning, or some impairment in both. Character functions below average, seen upon as 'strange'. Saving throws, spellcasting and hit-rolls are done at -2. The character is 25 percent of the time under the control of the disease. This disease is typical of stereotyped movement disorders, anxiety disorder, mild schizophrenia, dissociative disorders and psychosexual disorders. MENTAL DISORDERS CAUSED BY SEVERE PSYCHOLOGICAL STRESS, SHOCK OR TRAUMA: 1. PHOBIC DISORDERS 2. POST-TRAUMATIC STRESS DISORDER 3. PSYCHOGENIC AMNESIA 4. PSYCHOGENIC FUGUE 5. MULTIPLE PERSONALITY 6. EXOGENOUS DEPRESSION-MANIA / MANIA OR DEPRESSION 7. STEREOTYPED MOVEMENT DISORDERS. 8. PSYCHOSEXUAL DISORDERS. 9. SOMATOFORM DISORDERS. 10. OBSESSIVE-COMPULSIVE DISORDER. MENTAL DISORDERS CAUSED BY BIOLOGICAL OR HEREDITARY REASONS: 1. SCHIZOPHRENIC DISORDERS. 2. SUBSTANCE ABUSE. 3. ENDOGENOUS DEPRESSION-MANIA / MANIA OR DEPRESSION 4. PANIC DISORDER 5. GENERALIZED ANXIETY DISORDER DESCRIPTION OF MENTAL DISORDERS: Stereotyped movement disorders: -Tics: Involuntary rapid movement of a functionally related group of skeletal muscles or production of noises or words. This disorder seem to disappear under periods of stress. For example; Thor the Fighter would make strange clicking noises with his mouth, but during combat he would behave just any other person. -Tourette's syndrome: This is tics with a vocal element. The vocal tics include various sounds such as clicks, grunts, yelps, barks, sniffs, and coughs, or words. In 60 percent of the cases reported, an irrestible urge to utter obscenities is present. Thor the Fighter (our subject) would during conversation speak sentences like this "Well, you know, fu**!, I was walking down, shi*! fu*!damn whore!, the street..." -Stuttering : Frequent repetitions of prolongations of sounds, syllables, or words or frequent, unusual hesitations and pauses that disrupt the rhytmic flow of speech. The disorder seem to peak when there is a special pressure to communicate, as making a speech. Thor would undoubtly avoid speak to his troops. -Sleepwalking : Rise from sleep, walk about for several minutes to a half hour, usually occuring between 30 to 200 minutes after onset of sleep. The subject can be awakened only with great difficulty, and upon awakening, remembers nothing of the route traversed. -Sleep terror : Abrupt awakening from sleep (usually 30 to 200 minutes after onset of sleep) usually beginning with a panicky scream. Substance abuse disorders: -Drugs. As everyone knows, drugs can be very destroying to a persons life, and a PC addicted to it, crave it and use all means to get it. In order to classify the seriousness of the addiction, the DM should decide the price, availability and legality of the drug. Remember that addiction runs a person life, and each day he will make an attempt to get what he desires. Thor likes to get drunk, but his party-style goes over the line, and soon he drinks each day, and is incapicated by the alchohol most of the time, unable to do most things properly. Schizophrenic disorders: The schizophrenic are one of the most interesting, and by the same time the most common, mental disorder in both our time and in the past. But schizophrenic's are not multiple personalities patients, the name simply arises from the fact that emotion and thought are divided, as when a normal person relates with feelings how he witnessed an airchrash, a schizo will simply tell the story with a seemingly neutral emotional aspect. A schizophrenic can have one of these classes of the disorder: -Disorganized -Cataconic -Paranoid A Disorganized Schizophrenic patient exhibits essential features such as marked incoherence and flat, incongruous, or silly affect. Associated features include grimaces, mannerisms, hypochondriacal complaints, extreme social withdrawal, and other oddities of behavior. A patient with this disorder would most likely seem to be 'mad'. Little, if nothing, he communicates, would seem logically or coherent. Thor would promptly be put in a dark room and, sadly, there would be little chance of recovery. A Cataconic Schizophrenic patient exhibits symptoms as marked psychomotor disturbance, which may involve stupor, negativism, rigidity, excitement, or posturing. Sometimes there is rapid alternation between the extremes of excitement and stupor. Mutism is particulary common. A patient with this disorder would, for example, sit down in a position and not move for hours. If moved by others, he will promptly resume the position. The patients often report a feeling of horror that if they move, they will die. Thor, once a strong and brave warrior, sits down silently at the floor and remains there for the rest of day, not making a sound. His friends tries to communicate, but are unable to do so. A Paranoid Schizophrenic patient exhibits symptoms as prominent persecutory or grandiouse delusions, or hallunications with a persecutory or grandiose content ("they are after me, the son of the king!"). In addition, delusional jealousy may be present. Within all the three classes of schizophrenia's mentioned here, hallunications and delusions are present. The patient will see and hear things others dont, and these might be of great terror for the patient (blood running down the walls etc). Depression: -Bipolar; manic-depressive -Unipolar; manic or depressive Depression can take two forms, one is the type where the patients exhibits both the manic and depressive symptoms. The patients is either manic or depressive. The manic period last usually shorter than the depressive period. The other other form of depression is where the patient is either depressed or manic. The patient toggles between normality and manic or depressive states. The causes of the disease can either be endogenous (internal factor) or exogenous (external factors). Symptoms of depression are sadness, lack of motivation and low self- esteem. Mania symptoms are euphoric mood, racing thoughts, frenetic acts and insomnia. Thor the Depressed is most likely to have a very low look on life, general passivity and little interest in work and social settings. Thor the Manic on the other hand will probably make a lot of new friends, have increased sex-drive, and spend a lot of money on projects he fancy for the day, for so the next day progress to another money-pit. A character under such a manic disorder will propably be seen upon, if having a light disease, as a great person with a lot of ego and personality. Note that many great leaders suffered from mania! Anxiety disorders: -Phobic disorders: are defined as when the fear is out of proportion to the danger the phobic object possess. Agoraphobia (fear of places of assembly, crowds, open spaces) Social phobia (fear of being observed doing some humiliating) Specific phobia (animals, inanimate objects and illness-injury) Phobias can be caused by a traumatic event in childhood, but can also have genetic background, like why so many detest spiders and snakes. -Panic disorder: this is a disorder where the patient suffer frequent panic attacks; he will be overcome by dread and terror and will quit whatever skill he was doing, and try to return to, for him, a safe place, most likely his home. Upon time, if not treated properly, the disorder will accelarate, and the patient will be locked in a vicious circle of social avoidance and lock himself inside his house. The panick attacks occur frequently, often several times a week. The patient will exhibit all signs of a fear reaction; i.e. palpitations, sweating and trembling during such an episode. -Generalized anxiety disorder: this disorder takes place over much longer time than the panic disorder. The disorder is more chronic, in the way that the patient will have anxiety over very long time, a month or so, where he will exhibit signs of shakiness, dizziness and feel very anxious and anticipates that something dreadful will happen to him. A character will surely feel very gloom and unsecure, often with the added effect of being unable to complete certain tasks, and certainly avoid going into deep, unexplored dungeons! -Obsessive-compulsive disorder: a patient with this disorder, will have obsessive thoughts and/or compulsive behavior. A patient with the obsessive disorder will have recurrent, persistent ideas, thoughts or images that are experienced as invading thoughts and are sensed as senseless or repugnant. Attempts are made to ignore or supress them, which most likely will make it more worsen. An example is Thor who thinks about his sword and how he must clean it as much as possible in order to satisfy the strict rules of the army. Soon, Thor, cleans his swords hundreds of times each time. This behavior, cleaning the sword, is called compulsive behavior; repetive and seemingly purposeful behaviors that are performed according to certain rules or in a stereotyped fashion. The reason for doing so is to provide a release of tension (Thor is certain the officer will be satisfied with the clean sword), but reccuring thoughts might restart the behavior. -Post-traumatic stress disorder: after Thor's patrol got viped out by orcs in the Ozorka pass, he suffered reccurent and intrusive recollections of the event, and often feeling and acting as if the battle has happening all over again. He also had nightmares of the event, often every night. This are the typical of post-traumatic stress disorder. This follows a traumatic event, as a nature or man-made catastrophe, which the patient survived. Often guilt-complex are common; Thor felt guilty about the fact that he only survived the battle. Thor also feels detached from rest of the society, and has diminished interest in his current work (or other activity). He also retells the tale with marked neutrality, i.e. with no feelings. Sleep disturbance is common, and certain objects can initiate a reliving of the event (f.x. the colors of Thor's unit) Somatoform disorders: Somatoform disorders are physical symptoms suggesting physical disorder. A person who claims to be blind, can be so due to a traumatic event, i.e. Thor saw his team be wiped out, and he does not want so no more. The patient is usually not aware of it. Dissociative disorders: The essential feature is a sudden, temporary alteration in the normally functions of conciousness, identity, or motor behavior. If the alteration occurs in conciousness, important personal events cannot be recalled. If it occurs in identity, either the individual's customary identity is temporariliy forgotten and a new identity is assumed, or the customary feeling of one's own reality is lost and replaced by unereality. -Psychogenic amnesia Sudden inability to recall important personal information that is too extensive to be explained by ordinary forgetfulness. Thor remembers nothing of the riding accident, though the memory will return completely shortly. This amnesia is especially common after a traumatic incident. -Psychogenic fugue Sudden unexpected travel away from one's home or customary place of work, with inability to recall one's past and the assumption of a new identity. The disorder is initiated by severe psychological stress such as marital quarrels, military conflict or natural disaster. Usually the fugue is of brief duration and the travel involved is limited. Rapid recovery -Multiple personality The existence within the individual of two or more distinct personalities, each of which is dominant at a particular time. The dominant personality determines the individual's behavior. Each individual personality is complex and intergrated with its own unique behavior patterns and social relationships. The latter includes fears, dislikes, sexual preferences and intelligence and wisdom. Usually the personalities are not aware of the existence of each other, and certainly not can a player decide which personality runs the character! That is determined by the DM! - Depersonalization disorder. The symptoms of depersonalization involves an alternation in the perception or experience of the self so that the usual sense of one's own reality is temporarily lost or changed. This is manifested by a sensation of self-estrangement or unreality, which may include the feeling that one's extremeties have changed in size, or the experience of seeming to perceive oneself from distance. In addition, the individual may feel 'mechanical' or as though in a dream. If often occurs during the presence of mild anxiety or depression. Psychosexual disorders: -Paraphilias: Fetishism : the use of nonliving objects is a preferred or exclusive method of achieving sexual excitement. Transvetism : use of cross-dressing for the purpose of sexual excitement. Zoophilia : the act or fantasy of engaging in sexual activity with animals is a preferred or exclusive method of achieving sexual excitement. Pedophilia : The act or fantasy of engaging in sexual activity with prepubertal children is a preferred or exclusive method of achieving sexual excitement. Exhibitionism : acts of exposing genitals to an unsuspecting stranger for the purpose of achieving sexual excitement, with no attempt at further sexual activity with the stranger. Voyerism : the individual repeatedly observes unsuspecting people who are naked, in the act of disrobing, or engaging in sexual activity and no sexual activity with the observed people is sought. Sexual masochism : preferred or exclusive method for achieving sexual excitement by being humiliated, bound, beaten, or otherwise made to suffer. Sexual sadism : intentionally inflicted psychological or physical suffering in order to produce sexual excitement. EXPLANATION MODELS FOR MENTAL DISORDERS CAUSED BY SEVERE PSYCHOLOGICAL STRESS, SHOCK OR TRAUMA: 1. PHOBIC DISORDERS When a child is exposed to a traumatic experience, a coupling between the fear and an innocent object present at that time, might occurr. The therapies involving, usually includes showing the patient that the object is not dangerous (flooding; a patient reality checks when he is confronted with the nondangerous phobic objects or modeling; the therapist is a model for the phobic patient in handling the phobic object ) 2. POST-TRAUMATIC STRESS DISORDER Fear disorder that resembles phobias in that it is set off by a specific event. In this case, the specific event is a catastrophic happening beyond the normal range of human suffering. The symptoms may last a lifetime; very little is known about how to cure or prevent them. 3. PSYCHOGENIC AMNESIA 4. PSYCHOGENIC FUGUE Are both a sudden loss of memory caused by unbearable trauma and can be either be general or highly specific. 5. MULTIPLE PERSONALITY This disorder is more frequent than previously believed and seems to involve individuals who are highly susceptible to self-hypnosis, who experience a serious emotional problem between the ages four and six, and who use the creation of alternative personalities to bear this trauma, which they are unable to cope with in any other way. 6. EXOGENOUS DEPRESSION-MANIA / MANIA OR DEPRESSION These theories hold that depression stems from anger turned upon the self, and that individuals who are predisposed to depression are overdependent on other people for their self-esteem and that they feel helpless to achieve their goals. 7. STEREOTYPED MOVEMENT DISORDERS. 8. PSYCHOSEXUAL DISORDERS. 9. SOMATOFORM DISORDERS. 10. OBSESSIVE-COMPULSIVE DISORDER. The theory claims that individuals with the disorder are unable to habituate, dismiss, and distract themselves from disturbing thoughts. Therapy is much like treating phobias; modeling and flooding. EXPLANATION MODELS OF BIOLOGICAL OR HEREDITARY MENTAL DISORDERS: 1. SCHIZOPHRENIC DISORDERS. Today there are two main explanation models for the schizophrenic disorders, biological and behavioristically. The biological model claims that a overproduction of the neuro-transmitter dopamine can cause the etiology of schizophrenia. An excess of dopamine can cause the hallucinatory and delusionary elements of schizophrenia's. Also, since the sensory systems in the brain cortex, is flooded with input from the senses due to the overproduction of signals, the patient is constantly fighting to keep his mind focused. The behavioral model claims that a child exposed to parents who constantly punish the child for doing things it got approval for before the child did it, can in an early age, develop schizophrenia. Chemo-teraphy, which decreases production of dopamine, is one of the most common treatments for this seriously impairing disorder. Also: schizophrenia is a disorder that afflicts the poor more than the rich, and it may be associated with the stresses of society. 3. ENDOGENOUS DEPRESSION-MANIA / MANIA OR DEPRESSION The biomedical school holds that depression is due to depletion in certain central nervous system neurotransmitters, most usually norepinephrine. There are three effective therapies; tricyclic antidepressant drugs, MAO inhibitors, and electroconvulsive therapy (ECT). 4. PANIC DISORDER When we sense danger (a car suddenly skirts out of the road towards us) the brain very quickly assess the situation and if danger is truly present, alarms the sympathetic nervous-system. This system increases hearth rate, lung capacity and open our pupils to let more light in. When a patient has a panic attack, he might simply be misinterpreting the signals of his body; a beating hearth after running to catch the bus or breathing heavily after going up several stairs. The brain, due to some abnormality, sends danger signals to the brain-cortex, which is then experienced as fear by the patient. The therapy consist of 're-programming' the patient to interpret the body signals correctly. 5. GENERALIZED ANXIETY DISORDER This disorder is more like a milder, but long-term, version of the panic disorder. It can be that the patient has a similar brain abnormality, and the brain misinterpret the signals. Why it lasts so ling, is yet not understand, but psycho-dynamic therapy seems to help. LITERATURE LIST: "Abnormal Psychology", Rosenhan og Seligman, 1989 "Psychology", Henry L. Roedinger III ...[et.al], 1991 "Dictionary of Psychology", J.P. Chaplin, 1985 "Brain, Mind, and Behavior", Floyd E. Bloom and Arlyne Lazerson, 1988