Mental Disorders

Terminology changes rapidly. A psychiatrist of the 1920s would recognize some of these terms, but others would be baffling. Most striking, phrases of a hundred years ago like “lunatic” have become deliberately neutral in tone.

Schizophrenia and Other Psychotic Disorders
In general, psychiatric medications may be of high value in treating such disorders. Beyond the symptomatic behaviors, those who lack such medications also should suffer skill reductions while the effect is strong.

Schizophrenia
(schizophreniform disorder, dementia prae-cox): Mental concentration greatly diminishes; halve all skills requiring concentration. Symptoms include bizarre delusions, paranoia, auditory hallucinations, incoherent speech, seeming emotional detachment, social withdrawal, bizarre behavior, and a lack of the sense of self.

Psychotic Disorders:
interesting behavioral and culture-bound syndromes are known. There is a Capgras’s Syndrome, for instance, in which everyone is perceived as having been replaced by impostor duplicates. In Cotard’s Syndrome (Mire de nega-tion), one is convinced that not only his possessions and status have fallen away, but his body literally loses blood, and the heart, the intestines, etc., begin to rot. In autoscopic psychosis, a phan-tom is thought to follow and imitate the person’s movements. Many more such behaviors exist, and appropriately metaphorical new ones can be imagined and made up.
Many culture-bound syndromes are of briefer duration:

Amok—Malaysia. “Running amok”, an outburst of violence and aggressive or homicidal behavior directed at people and property. Amnesia, return to consciousness, and exhaustion occur following the episode. The killing spree will be done using whatever weapons are on hand. (Ahade idzi be is the Navajo equivalent.)

Boufee Delirant— West Africa, Haiti. Sudden outburst of aggressive, agitated behavior, marked confusion, sometimes with visual and auditory hallucinations or paranoia.

Brain Fag—Nigeria. Impaired concentration and feeling fatigued; pains in the neck and head; the sense that worms are crawling inside the head. Usually attributed to witchcraft.

Ghost Sickness—Navajo. Weakness, loss of appetite, feeling suffocated, nightmares, and a pervasive feeling of terror. Attributed as a sending from witches or malign supernatural powers.

Piblokto— Inuit. “Arctic madness” wherein the afflicted rips off his clothes and runs howling like an animal through the snow. (Myriachit, Siberia.)
Susto—Spain. A variety of somatic and psychological symp-toms attributed to a traumatic incident so frightening that it dislodged the victim’s spirit from his body.

Taijin Kyofusiw—Japan. “Face-to-Face”, anthropophobia, an intense anxiety in the presence of other people; fearfulness that one’s appearance, odor, or behavior is offensive.

Voodoo Death—Haiti, Caribbean. Belief that a hex or witch-craft can bring about misfortune, disability, and death through “spiritual” mechanism. Often the victim self-fulfills the hexer’s prophecy by refusing to heat and drink, resulting in starvation and dehydration. (Mal peusto, Spain). Wucinko —Sioux. Anger, withdrawal, mutism, and immobility, leading to illness and suicide.

Wendigo Syndrome—Cree, Ojibwa, Salteaux. The afflicted believes he is a personification of the Wendigo, a cannibalistic thing with an icy heart. Compare with Ithaqua in the “Creatures” chapter.

Shared Paranoid Disorder (shared delusional disorder, Folie a deux): the character takes on the delusional system of anoth-er paranoid as a result of being in close contact.

Mood Disorders
Depression: symptoms include change in appetite, weight gain, weight loss, too much or too little sleep, sluggishness, feelings of worthlessness or guilt, and suicidal thoughts, hal-lucinations, delusions, or stupor. Skills lowered by 10 to 30 percentiles. There is a predisposition to use alcohol or other substances in an attempt at self-medication.

Mania: character has a fairly constant euphoric or possibly irritable mood. Symptoms include a general increase in activ-ity, garrulousness, increased self-esteem to the point of delu-sion, decreased need for sleep, easily distracted, willingness for dangerous or imprudent activities such as reckless driving, hallucinations, delusions, and bizarre behavior. Lower skills by 10 to 30 percentiles. A predisposition exists to use alcohol or other substances in an attempt at self-medication.

Bipolar Mood Disorder: character oscillates between mood states for weeks at a time, crashing into different mood states, or sometimes states with mixed features (such as being depressed but full of energy).

Substance Abuse Disorder
The character finds solace in using a drug, becomes physically addicted, and spends much time maintaining, concealing, and indulging the habit. Drugs include alcohol, amphetamines, cocaine, hallucinogens, marijuana, nicotine, opium (esp. mor-phine and heroin), sedatives, plutonian drug, space mead, etc.
A character under the sway of such a substance should feel the personal struggle daily. POW rolls might be used to resist or succumb symbolically to cravings. Modifications of -20 per-centiles or more could occur to skills because of withdrawal symptoms. Sanity losses could occur from binges or bad trips. Particular characters might find that drugs promote communi-cation with alien entities and gods. and that dreams about them become ever more vivid and horrifying. Conversely, such sub-stances might function as self-medications, deadening a charac-ter’s fears and offering temporary defenses against Sanity loss.
See list of abused substances which often lead to substance-related disorders below.

Anxiety Disorders
Generalized Anxiety Disorder: character suffers from a vari-ety of physical and emotional symptoms groupable into cer-tain categories.

Motor tension—jitteriness, aches, twitches, restlessness, easily startled, easily fatigued, etc. (halve physical skill percentiles).

Autonomic hyperactivity—sweating, racing heart, dizziness, clammy hands, flushed or pallid face, high resting pulse and respiration, etc.

Expectations of doom—anxieties, worries, fears, and especial-ly anticipations of misfortune.

Vigilance—distractible. inability to focus, insomnia, irritabili-ty, impatience (reduce intellectual skills by one fourth).

Panic Disorder: a discrete period of fear in which symptoms develop rapidly. Within minutes palpitation, swearing, trem-bling, choking, etc. appear, strong enough that the person fears immediate death or insanity. Burdened with the recurrence of these episodes. he or she fears their return. This often leads to a developing agoraphobia.

Agoraphobia: the character needs a successful D100 roll against POW times a multiplier of 1-5 in order to leave home or engage socially. May be linked to panic disorder, as per just above.

Obsessive Compulsive Disorder: character involuntarily expe-riences persistent ideas, thoughts, impulses, etc. involving vio-lence and self-doubt. These ideas are frequently repugnant to the character, but they are so strong that during times of stress the character may be unable to concentrate apart from them, even if necessary for survival.

Compulsions: ritual actions performed by the character intended to affect the future. Though the character may agree the actions are senseless, the need to perform them is over-powering and may last for DIO combat rounds. Even in times of great stress, the character may ignore his or her survival in order to perform the ritual. In a severe condition. for instance, a sufferer might need hours to clean up before he or she was able to leave one room for another.

Post-traumatic Stress Disorder (in WWI. “shell shock”): after a traumatic event, perhaps years later, the character begins to relive the trauma through persistent thoughts. dreams, and flashbacks. Correspondingly, the character loses interest in daily activities. He or she may return to normal once the mem-ories are well explored and understood, but that process will perhaps take years. Today, quicker clinical treatments exist, such as eye movement desensitization and refocusing, or EMDR.

Simple Phobia or Mania: the individual persistently fears a particular object or situation. He or she realizes that the fear is excessive and irrational, but the fear is disturbing enough that he or she avoids the stimulus. In severe cases, the object of the phobia is imagined to be omnipresent, perhaps hidden.
There are as many phobias as one cares to notice or name. Manias are rarer. In a mania, the character is inordinately fond of a particular stimulus, and takes great pains to be with it or near it. When the character’s sexuality is involved, the mania is termed a fetish.
Phobic and manic reactions were stressed in earlier edi-tions of Call of Cthulhu, partly from lack of imagination and partly because such reactions are easy to identify and apply, and sometimes amusing to communicate. In truth, the dis-turbed human mind is a complex maze of behaviors, symp-toms, and concepts, one not nearly so easily described. See the nearby phobia listing.

Somatoform Disorders
Somatization Disorder: character suffers symptoms from dizziness and impotence to intense pain and blindness. Medicine cannot explain the symptoms, but the character does not believe they represent a specific disease.

Conversion Disorder: character reports physical disfunctions suggesting a physical disorder but, though involuntary, the symptoms provide a way to avoid something undesirable or to garner attention and caring. Symptoms range from painful headaches to paralysis or blindness.

Hypochondriasis: character believes he or she suffers from a serious disease. No physical cause for reported symptoms will be found, but the character continues to believe the disease or condition exists, often with serious consequences to the per-son’s normal life.

Body Dysmorphic Disorder: character suffers from perceived flaws in appearance, usually of the face, often of the hips or legs. Behavior may alter in unexpected ways to cover up the flaws or to calm anxieties.

Dissociative Disorders
Dissociative Amnesia (Psychogenic Amnesia): inability to recall important personal information, brought on by a desire to avoid unpleasant memories. The character needs a POW x I roll to recall such details or the cause of the amnesia. Since the horror of the Mythos is the probable cause of this amnesia, the keeper may choose to reset Cthulhu Mythos to 0 and maxi-mum Sanity to 99 while this disorder holds sway: the horror returns when the character’s memories do.

Dissociative Fugue: character flees from home and/or work, and cannot recall his or her past. Once the flight halts, the character may assume an entirely new identity.

Dissociative Identity Disorder (Multiple Personality Dis-order, or MPD): character appears to harbor more than one personality, each of which is dominant at times and has its own distinct behavior and even different social relationships. Players may need several or many investigator sheets for their investigator’s different personalities.

Addictions (Substance-Related Disorders)
Substance use and abuse occurs in all segments of all soci-eties. By definition, abuse indicates decreased work or school performance, accidents, intoxication while working or driving, absenteeism, violent crime, and/or theft. Urine and blood tests can confirm suspected abuse. Substance use may worsen or mimic other psychiatric disorders relating to depression, anxiety, mania, or psychosis.
Many people successfully use substances recreationally, without substantial or even observable changes to their lives. A fraction are not so fortunate. Their lives change, as they increasingly cling to and come to depend on one or more such substances.
Alcohol, amphetamines, cocaine, and the opiods (opi-ates) are addictive substances most frequently resorted to in earlier game eras. They and more are used in the present day.
Abuse often leads to dependence, which is characterized by developing tolerance, withdrawal states, and a pattern of increasing procurement of the substance. Dependence may be emotional and social in context.
Therapy includes making sure someone hasn’t over-dosed, ruling out other substances possibly present in the blood, and medical support. Long-term treatment lasts six months to a year, with the goal of creating longer and longer periods of abstinence.

Alcohol: symptoms include poor judgment, talkativeness, mood changes, aggression, impaired attention, amnesia-like states. Use can also cause a flushed face, uncoordination, and slurred speech. Withdrawal can cause mild shakiness, hang-overs, and other symptoms. Delirium tremens can include seizures and delirium requiring active medical intervention.

LSD, mushrooms, peyote: 8-12 hour duration of high with flashbacks after abstinence, visual hallucinations, paranoid thoughts, false sense of achievement and strength, suicidal or homicidal tendencies, depersonalization, derealization. Treatment requires talking down; for severe agitation, seda-tives or antipsychotics plus restraints may be needed. Lysergic acid diethylamide was synthesized in 1943.

Amphetamines and cocaine: the user may be alert, talkative, euphoric, hyperactive, irritable, aggressive, agitated, some-times paranoid. There may be visual and tactile hallucina-tions such as formification, the feeling that insects are crawl-ing across one’s skin. Cocaine use may be quickly followed by a crash phase. Craving for these drugs can last for years.

Opiods (opium, morphine, heroin): symptoms include euphoria, drowsiness, anorexia, lessened sex drive, hypoactivity, and passivity; physically, nausea and slow heart rate. In themselves, needle tracks in arms and legs can develop into a medical problem. Treatment is a weaning-off process using methadone(unknown until recently), itself highly addictive.

Phencycladine (PCP, Ketamine, “Special K”): 8-12 hours duration of high, hallucinations, paranoid thoughts, catatonic state, violent behavior, convulsions, anesthesia for instance, can punch a hand through a windshield and shatter every bone in the arm, but not feel it until the drug wears off). If attempting to talk down such a user, the talker may get his face punched in, or more. Isolate until the behavior calms; use antipsychotics if the person is on a rampage. These and similar drugs are new, and exist only in the present era.

Psychosexual Disorders
This is an exceedingly diverse group. Homosexuality is no longer considered a mental disease, but it was believed such until the 1960s. Recognizable disorders include transsexual-ism, impaired sexual desire or function, nymphomania and satyriasis, and the paraphilias. Most of these disorders are so explicit as to be not playable in most roleplaying groups.

Eating Disorders
Since nearly all such cases are diagnosed in the United States and Canada, anorexia nervosa and bulimia nervosa might be classified as cultural syndromes. but they are conditions that may continue for many years, sometimes to the considerable danger of the patients.

Anorexia Nervosa: the character has an overpowering fear of becoming fat, and consequently loses weight (S1Z) and CON at a rate decided by the keeper. Even when skin and bones, the character is sure to feel too fat. Without intervention, death may follow.

Bulimia Nervosa: the character frequently eats high caloric food during secret binges. An eating episode may continue until abdominal cramping or self-induced vomiting occurs. Feelings of depression and guilt frequently follow such episodes.

Sleep Disorders
These include insomnia (character has difficulty falling asleep or staying asleep) and narcolepsy (character frequently falls asleep, almost anywhere). Characters performing demanding tasks such as driving a car or flying a plane may need CON rolls to stay awake.

Night Terrors: sleeping character awakes after several hours of sleep, usually screaming in terror. Pulse and breathing are rapid, pupils are dilated, and the hair stands on end. The char-acter is confused and hard to calm down.

Somnambulism: sleepwalking. As with night terrors, this behavior occurs in the first few hours of sleep. An episode may last up to thirty game minutes. During the sleep-walk the face is blank and staring, and the walker can be roused only with difficulty. Waking, the walker recalls nothing of the activity.

Impulse Control Disorders
These include pathological gambling, pathological lying, klep-tomania, and pyromania.

Intermittent Explosive Disorder: the character is recognizably impulsive and aggressive, and at times sustains uncontrollable rages which result in assault and/or destruction of property.

Personality Disorders
These long term disorders are often unpleasant to be around, even if only roleplayed. Some general types include antisocial, avoidant, borderline symptoms of many sorts, compulsive, dependent, histrionic, narcissistic, passive-aggressive, para-noid, schizoid, and schizotypal. Keepers who investigate these disorders will find much to work with within the category, but their consistent expression in roleplaying may foster anger and unpleasantness within the group, and disappoint players with different expectations.

Other Disorders
These are mostly symptoms, or specific instances of disorders already mentioned above. They existed in the previous edition of the rules, and functioned as quickly understood characteri-zations for roleplaying. Among them were criminal psychosis, panzaism, quixotism, and megalomania. Any disorder men-tioned in previous rules is still playable.

Phobia Listing
Acrophobia: fear of heights
Ailurophobia: fear of cats
Androphobia: fear of males
Aquaphobia: fear of water
Astraphobia: fear of lightning
Astmphobia: fear of stars
Bacteriophobia: fear of bacteria
Ballistophobia: fear of bullets
Belonephobia: fear of pins and needles
Botanophobia: fear of plants
Blennophobia: fear of slime
Claustrophobia: fear of enclosed spaces.
Clinophobia: fear of beds
Demonophobia: fear of demons
Demophobia: fear of crowds
Dendmphobia: fear of trees
Doraphobia: fear of fur
Entomophobia: fear of insects
Ergophobia: fear of work
Gephyrdmphobia: fear of crossing bridges
Gynephobia: fear of females
Hematophobia or Henophobia: fear of blood
latrophobia: fear of doctors
lchthyphobia: fear of fish
Monophobia: fear of being alone
Necmphobia: fear of dead things
Noctophobia: fear of night Nyctophobia: fear of darkness
Ondontophobia: fear of teeth
Onomatophobia: fear of a certain name
Ophidiophobia: fear of snakes
Ornithophobia: fear of birds
Pediphobia: fear of children
Phagophobia: fear of eating
Pyrophobia: fear of fire
Scoleciphobia: fear of worms
Spectrophobia: fear of ghosts
Taphephobia: fear of being buried alive
Thalassophobia: fear of the sea
Tomophobia: fear of surgery
Vestiophobia: fear of clothing Xenophobia: fear of foreigners
Zoophobia: fear of animals