Jeannie Campbell

Jeannie Campbell is a Licensed Marriage and Family Therapist in California. She is Head of Clinical Services for a large non-profit and enjoys working mainly with children and couples. She has a Masters of Divinity in Psychology and Counseling and bachelors degrees in both psychology and journalism. Jeannie started doing character therapy in March of 2009. Her Treatment Tuesdays feature assessments of fictional characters and plot feasibility while her Thursday Therapeutic Thoughts take a psychological topic and make it relevant to writers. She can be found at her blog, The Character Therapist, at

Therapeutic Thought on The Therapist’s “Bible”

Most writers who have been writing for any length of time study the craft. Alongside our favorite fiction titles we have Swain, Maass, Dixon, Collins, Browne & King, and Bellcraft books on our shelves.

I suggest you make room for one more.

The Diagnostic and Statistical Manual of Mental Disorders (DSM) is the one book all mental health providers reference when assessing their clients and making a diagnosis. Published by the American Psychiatry Association, it is colloquially known as the therapist’s bible.

It’s also the one book you should have at your fingertips if ever you decide to give your characters a mental disorder.

For about $74 on Amazon, you can take a dip in a mental health pool of almost a thousand pages. For every common disorder, like depression, and lesser-known disorder, like trichotillomania—Google it, you know you want to—you can find out the following information to make your characters multidimensional:

1. Diagnostic Features
This section gives writers exactly what they need to know to write about any disorder. You’ll find a common list of symptoms and how many symptoms must be present for a diagnosis to be made. You wouldn’t want your character exhibiting only two symptoms if five are required for a disorder or syndrome.

2. Subtypes and/or Specifiers
When you have a medical concern, you have a choice of which type of doctor to see. Doctors can specialize in internal medicine, pediatrics, family medicine, or anesthesiology. But they are all doctors, sharing the commonalities of having gone to medical school and completed a residency. Some disorders can be broken down like this, too. For example, paranoid schizophrenia is characterized by delusions and hallucinations, while people with catatonic schizophrenia can be almost completely immobile or move like a Gumby doll. But both still fall under schizophrenia because they share certain characteristics.

Specifiers do just what the word implies: They give additional specifics on a disorder, usually about the onset or duration. I suppose this would only be useful if you wanted to be more exact or sound more professional to your readers, if you were to include a scene where a psychologist tells your protagonist what his diagnosis is.

3. Associated Features and Disorders
A writer needs to know features that are frequently associated with a particular disorder to bring it to life on the page. For example, if a writer births a heroine struggling with bulimia, then it would be important to include that gradually her teeth enamel begins to erode and her hair starts to thin. These types of medical or physical findings make a literary portrayal more realistic, because it spans across many spectrums.

4. Specific Culture, Age, and Gender Features
Because we write about various cultures and time periods and for adults and adolescents of all ages, we need to do our research about whether the disorders we select to inflict upon our characters are appropriate in these regards. This section will give the particulars you need.

5. Prevalence
Just how prevalent is Tourette’s disorder in children? What is the

likelihood that a person in an inpatient psychiatric setting would not have an identified personality disorder? What’s the lifetime risk to develop Dementia Due to Parkinson’s Disease? If you’ve ever wondered these types of things, you’ll find this section very helpful.

6. Course
The course of any given disorder can vary, but in this section, a writer will learn the typical lifetime pattern of a disorder. What does that mean? You’ll learn the typical age range when symptoms first show up and whether symptoms show abruptly (like PTSD) or gradually (like Alzheimer’s). You can also find out the typical length of the illness and how it progresses over time (whether it stays stable, gets worse, or can improve).

7. Familial Pattern
A writer can learn how common a disorder is among first-degree relatives. If your hero’s father had narcissism, how much more likely would your hero have it?

8. Differential Diagnosis
Utilizing this section might be useful if you ever decide to do the ol’ switcheroo on your reader. What if one of your characters exhibits depressive symptoms, and your reader believes it to be personal, but then later learns that her symptoms are due to the medical condition of hypothyroidism? Symptoms can sometimes overlap but have very distinct origins.

You might not want to spend $74 for all this information, and that I can understand. You can find all the diagnostic features (Section 1) for each disorder on the Internet. For instance, if you wanted to find out about the depressive disorder cyclothymia, you could do a search for “cyclothymia DSM criteria.”

Should you decide to buy the book, be aware that an updated version is coming out in 2012. Currently DSM is in a text-revised 4th edition (DSM-IV-TR). The next edition, DSM-V, will include information gathered from ongoing studies that change the face of mental disorders. New diagnoses will emerge while some disorders will be absorbed into something else. Outdated versions of DSM aren’t good for anything more than a fascinating read to see how far science and culture have come.

As a Christian counselor, I always say the Bible and DSM are the only two books I need. As a writer I’d say the exact same thing. We write about people, and research shows that one in every twenty-five individuals has a mental disorder. So to have the type of information above consolidated into one source would be essential for any writer.


The Character Thrapist