mickume/dnd_drow · Datasets at Hugging Face

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In my view, the opportunity for Astarion to resolve this conflict only arises when the player prevents him from completing the ritual (that’s why I will NEVER ascend this guy). Astarion states, "It's time to start living again," implying a fresh start and the potential for self-discovery.
B. Psychological defense mechanisms
TL;DR: Psychological defense mechanisms, or as I like to call them, "mind tricks," are the sneaky ways our brains protect us from scary emotions. Astarion is like that friend who uses humor to dodge their emotional issues. He's also a pro at thinking everyone thinks like him. Oh, and Astarion has a bit of an identity crisis. He hates his tormentor but also kinda wants to be him. He thinks being like the bad guy will give him freedom. Lastly, he's got a talent for making up "logical’ reasoning for him self-harming and causing harm to others.
Psychological defense mechanisms, also known as ego defenses, can be most simply described as strategies for avoiding and reducing potentially threatening emotions such as fear or anxiety, which occur beyond our conscious awareness or in an automated manner. On one hand, they are essential for maintaining psychological equilibrium, but on the other hand, when used excessively and inadequately, they can be a source of psychological issues (I am too lazy at this point to find a reference).
In conversations with Astarion, he often swiftly redirects discussions away from uncomfortable thoughts and emotions. He frequently resorts to humor or addresses distressing subjects with a smile. An illustrative example can be seen in the nightmare scene from the EA game, where, upon waking, he recounts a terrifying dream involving his tormentor, only to follow it with laughter and a change of topic.
In moments of vulnerability, when the player describes his appearance with a degree of empathy, Astarion's response may be interpreted as touched. However, should the player extend their description and express care, he promptly shifts the dynamic with humor, saying, "Just call me beautiful and call it a day."
Astarion also frequently voices a preference for not dwelling on negative emotions, advocating for their closure in the past, and emphasizing a focus on what lies ahead.
Projection and Displacement
Astarion frequently exhibits projection tendencies, assuming that others share his thought processes and act in a manner that mirrors his own "instinctive" behaviors. He often accuses the player of manipulation or harboring similar views regarding sex, viewing it primarily as a momentary pleasure and a means to an end.
Furthermore, when he desires power, he projects his own ambitions onto others, presuming that everyone else harbors the same aspirations.
In the context of deciding whether to kill or release vampire spawns, Astarion also projects his own desires onto them, assuming that each of them craves death, as he himself longed for it during his captivity.
In romantic situations, he frequently assumes that the other person expects the same things as he does and tends to verbalize statements that he himself would like to hear.
Shaping Responses
As I mentioned in the suppression part, Astarion often exhibits a demeanor contrary to the emotional charge of his statements.
He recounts his traumas with a smile, punctuating sentences with a subdued laughter. He frequently maintains an open and proud stance, even when recounting situations in which he felt small and vulnerable. This may be an unconscious defense mechanism safeguarding his psyche from complete alignment with the cruelty of his circumstances.
Astarion dissipates tension by summoning emotions and adopting a stance at the opposite end of the emotional spectrum, aiming to avoid the negative emotions he perceives as threatening or for which he currently lacks the resources to process without undermining his psychological homogeneity.
It is intriguing to note that only halfway through the game do we begin to observe a congruent emotional expression in response to what Astarion shares about his past.
I am convinced that in Astarion's case, a profound identification with his tormentor has taken place. By "adopting" the traits of another, an individual may become emboldened to engage in behaviors they perceive as forbidden in their own right, yet acceptable for the person they identify with.
On one hand, Astarion despises Cazador and fears becoming like him. On the other hand, he also holds contempt for himself and replicates some of Cazador's actions. In his world, Cazador was the sole symbol of power, the only entity with free will. Lacking an alternative framework, Astarion, too, yearns to experience freedom, and his ego becomes armored in Cazador's behaviors in an attempt to finally attain that sense of liberation.
This complex psychological dynamic reveals Astarion's internal struggle and his longing for autonomy, as well as his willingness to adapt to an identity that he perceives as granting him the freedom he so desperately seeks.
Rationalization
Astarion frequently justifies his potentially hurtful behaviors with various reasons. An illustrative example of this can be seen in the rationalization of his disregard for his own boundaries and needs, as he perceives this as the only means to forge alliances. He rationalizes self-harm for the "greater good." Similarly, when causing harm to others, he constructs what he believes to be rational explanations for his actions, devoid of distortions from past patterns he has learned.
TL;DR: The whole cognitive therapy deal is like when your brain plays tricks on you. It's like you're wearing glasses that make you see everything in a specific way. Astarion, our buddy here, has a bunch of these thought patterns that served a purpose during his enslavement, but in a safe environment they are no longer useful and can be self-destructive and cause suffering.
As the very name implies, this approach centers on the individual within a cognitive (thoughts and attention processes) and behavioral (actions) context. Within the realm of cognitive-behavioral psychotherapy, a general definition of case conceptualization is embraced: "Determining the patient's problem in the light of the mechanisms of their functioning in the language of a given theory" (Popiel & Habrat-Pragłowska, 2008). In this perspective, conceptualization places its focus on the cognitive sphere of the client and how this sphere influences behavior, physiology, and emotions. The therapist formulates hypotheses regarding the cognitive mechanisms contributing to the patient's issues, as well as environmental triggering factors and factors sustaining these issues (Słysz, 2017).
A significant portion of conceptualization within this approach is also rooted in accurate diagnosis based on ICD-10 (soon ICD-11) and/or DSM-V, as well as questionnaires (Słysz, 2017). However, we do not have the opportunity to undergo a diagnostic process with a fictional character, and I do not intend to speculate about specific psychopathological labels. Therefore, I will concentrate on the cognitive profile.
Cognitive distortions
The conceptual framework of cognitive therapy is based on the premise that an individual's subjective interpretation of their early life experiences influences and perpetuates core beliefs (schemas) concerning the self (Felgoise et al., 2006).
I am confident that we could identify more cognitive distortions in Astarion. However, the original content provided in official materials is rather limited. Unlike psychoanalysis, here, we can only rely on what the client has verbalized, what we have observed in their behavior, and our inferences from their general statements. Unfortunately, we do not have the space here for headcanons and more extensive speculations.
Is this even interesting at this point?
TL;DR: Yep, he is traumatized. Likely, has PTSD.
According to the textbook definition (DSM-V), trauma is an individual's reaction to experiences that threaten life or physical integrity. Trauma can encompass experiences such as physical violence, sexual abuse, war, serious accidents, or sudden death, which emotionally shake a person.
I personally prefer the perspective of the World Health Organization (WHO), which views trauma as a subjective experience for the individual. What may be traumatic for one person may not be traumatic for another. WHO defines trauma as an excessive response to a stressor that exceeds an individual's ability to cope with it. This means that trauma is not limited to life-threatening experiences but also includes events that can disrupt the psychological and emotional well-being of a person, such as conflicts and significant losses.
In psychology, Levine's approach (2012) is also popular. He observed that trauma is not directly linked to external events that cause physical or psychological pain. It is also not directly related to the pain itself. Levine focuses on the body's and the nervous system's response to trauma. Trauma arises when a person is unable to release blocked energy or follow physical and emotional responses (fight, flight, freeze) that are a natural response to injury. It is caused not by an external event but by an internal process. This process gains momentum when there is a lack of a compassionate witness - social support.
Please keep in mind that this is a simplified translation, and the full depth and nuance of the original text may be lost in the process. If you need a more comprehensive and nuanced translation, consider consulting with a professional translator or a native speaker with expertise in psychology.
All these trauma frameworks (DSM-5, ICD-10, Levine, 2012) concur that trauma can potentially precipitate the development of Post-Traumatic Stress Disorder (PTSD) within an individual.
This appears to be the only diagnosis that I dare to posit within this comprehensive conceptualization. I firmly believe that the character of Astarion conspicuously manifests symptoms indicative of PTSD, and I can confidently speculate that such might have been the intentions of the writers as well. It is worth noting that this analysis is conducted without the benefit of professional psychological oversight, a factor which generally informs a more meticulous assessment.
For this assessment, I will be utilizing the latest ICD-11 classification, which is readily accessible online (
). It is crucial to note that my approach to this work is grounded in a commitment to individualized analysis. Unlike traditional practices where supervision by a professional psychological team is common, this endeavor has been undertaken independently. This decision was motivated by a desire to promote a more profound sense of personal ownership and responsibility in the process.
In the additional criteria of ICD-11, it is emphasized that many individuals may experience overwhelming feelings of shame and guilt following traumatic events. As previously mentioned, Astarion consistently grapples with guilt for what has transpired in his life. It appears that he assumes responsibility even for the decision to undergo a transformation into a vampire.
TL;DR: Go for EMDR, BrainSpotting, Somatic Experiecing or even better: all of them at once.
This section is primarily intended for readers grappling with trauma and/or PTSD/C-PTSD.
Namely, it appears that there is currently a significant amount of discourse surrounding these issues in popular culture and casual conversations, but relatively few individuals are well-versed in the proper treatment of trauma. What's more, only a minority are aware – including some therapists, tragically – that an inadequately chosen therapeutic approach can exacerbate symptoms. Conventional talk therapy is not tailored to patients in severe traumatic crisis. Excessive recounting of a traumatic event can lead to RETRAUMATIZATION (Lmft, 2023). In the therapist's chair, you may find yourself repeatedly reliving the event with an equally or even more pronounced traumatic response.
One of the most widely recognized and empirically effective forms of therapy is Eye Movement Desensitization and Reprocessing (EMDR) therapy, as documented by the World Health Organization in 2013. Theoretically, Cognitive Behavioral Therapy (CBT) is also an option. Similar to CBT with a trauma focus, EMDR therapy seeks to alleviate subjective distress and fortify adaptive cognitions associated with traumatic experiences. However, it distinguishes itself from trauma-focused CBT by not involving extensive narratives of the traumatic event, direct challenges to beliefs, prolonged exposure, or assigned homework, as highlighted by Van Bennekum in 2013. Within the framework of EMDR therapy, clients engage with emotionally distressing material in brief, sequential intervals, concurrently concentrating on an external stimulus. Therapist-guided lateral eye movements represent the most commonly utilized external stimulus; however, various other stimuli, such as hand-tapping and auditory stimulation, are frequently employed (emdr.com, 2022).
Other approaches that you may want to consider are: BrainSpotting and Somatic Experiencing. I encourage reading up more on them online.
Assets/Resources
In any comprehensive conceptualization, the consideration of resources is paramount. In the current spirit of positive psychology, our focus is primarily on assets rather than deficits.
It suffices to say that excessive speculations regarding Astarion's psychopathology have been omitted.
Internal Resources:
External Resources:
Therapeutic Recommendations
The initial step would involve gathering Astarion's expectations from therapy.
To ensure a proper course of treatment, I recommend a thorough psychological-psychiatric assessment to rule out or confirm affective disorders (e.g., depression), personality disorders, neurodiversity spectrum disorders, PTSD, anxiety disorders, etc., and, if necessary, consider pharmacotherapy.
In the first step, a referral should be made to a trauma-informed, LGBTQ+ friendly therapist. Initially, the pivotal aspect of his treatment, in my opinion, would be the processing of trauma. After that, to process maladaptive coping strategies, Astarion can opt for the EMDR approach or choose a therapeutic modality that aligns with his beliefs and needs.
The entire therapy should be centered around resource development and addressing behaviors that do not serve him.
I also recommend mindfulness exercises and therapy, something an elf might particularly appreciate.
Support groups could also prove valuable.
Arain, M., Haque, M., Johal, L., Mathur, P., Nel, W., Rais, A., Sandhu, R. S., & Sharma, S. (2013). Maturation of the adolescent brain.
Neuropsychiatric Disease and Treatment
Association, A. P. (2015).
DSM-5 Classification
. American Psychiatric Publishing.
Biggs, A., Brough, P., & Drummond, S. (2017). Lazarus and Folkman’s Psychological Stress and Coping Theory. In
Stress and Coping Theory. The Handbook of Stress and Health.
Cong, C. W., Wu, S. L., & Tan, S. A. (2019). Problem-focused coping and depression among adolescents: Mediating effect of self-esteem.
Current Psychology
De La Santé, O. M., Organization, W. H., Who, & Staff, W. (1992).
The ICD-10 Classification of Mental and Behavioural Disorders: Clinical Descriptions and Diagnostic Guidelines
. World Health Organization.
Dragons, D. &. (2014).
Dungeons & Dragons Player’s Handbook (Core Rulebook, D&D Roleplaying Game)
. National Geographic Books.
Dual-Continua-model-Keyes-Lopez-2002.png (698×524)
emdr.com. (2022, October 20).
What is EMDR? - EMDR Institute - EYE MOVEMENT DESENSITIZATION AND REPROCESSING THERAPY
Felgoise, S., Nezu, A. M., Nezu, C. M., & Reinecke, M. A. (2006).
Encyclopedia of Cognitive Behavior Therapy
. Springer Science & Business Media.
Felton, B. J., Revenson, T. A., & Hinrichsen, G. A. (1984). Stress and coping in the explanation of psychological adjustment among chronically ill adults.
Social Science & Medicine
Han, C. S., Brussoni, M., & Mâsse, L. C. (2022). Parental autonomy support in the context of Parent–Child Negotiation for Children’s Independent Mobility: "I always feel safer with my parents’ to "Boom! Bust down those walls!’
Journal of Early Adolescence
ICD-11 for Mortality and Morbidity Statistics
Reddit - Dive into anything
Keyes, C. L. M. (2002). The mental health continuum: from languishing to flourishing in life.
Journal of Health and Social Behavior
Keyes, C. L. M. (2005). Mental illness and/or mental health? Investigating axioms of the complete state model of health.
Journal of Consulting and Clinical Psychology
KingBowser. (n.d.).
Reddit - Dive into anything
Levine, P. A., PhD. (2012).
In an Unspoken Voice: How the Body Releases Trauma and Restores Goodness
. North Atlantic Books.
Lmft, J. S. (2023, January 12). Therapy retraumatization.
M, E. & My paralysis demon. (2023). This was revealed to me in a dream.
Popiel, A., & Habrat-Pragłowska, E. (2008).
Psychoterapia poznawczo-behawioralna: teoria i praktyka
Premium 2nd Edition Advanced Dungeons and Dragons Dungeon Master’s Guide
Roll20 - Compendium and Rule Set Directory
Scheck, S. (2014).
The stages of psychosocial development according to Erik H. Erikson

In my view, the opportunity for Astarion to resolve this conflict only arises when the player prevents him from completing the ritual (that’s why I will NEVER ascend this guy). Astarion states, "It's time to start living again," implying a fresh start and the potential for self-discovery.

B. Psychological defense mechanisms

TL;DR: Psychological defense mechanisms, or as I like to call them, "mind tricks," are the sneaky ways our brains protect us from scary emotions. Astarion is like that friend who uses humor to dodge their emotional issues. He's also a pro at thinking everyone thinks like him. Oh, and Astarion has a bit of an identity crisis. He hates his tormentor but also kinda wants to be him. He thinks being like the bad guy will give him freedom. Lastly, he's got a talent for making up "logical’ reasoning for him self-harming and causing harm to others.

Psychological defense mechanisms, also known as ego defenses, can be most simply described as strategies for avoiding and reducing potentially threatening emotions such as fear or anxiety, which occur beyond our conscious awareness or in an automated manner. On one hand, they are essential for maintaining psychological equilibrium, but on the other hand, when used excessively and inadequately, they can be a source of psychological issues (I am too lazy at this point to find a reference).

In conversations with Astarion, he often swiftly redirects discussions away from uncomfortable thoughts and emotions. He frequently resorts to humor or addresses distressing subjects with a smile. An illustrative example can be seen in the nightmare scene from the EA game, where, upon waking, he recounts a terrifying dream involving his tormentor, only to follow it with laughter and a change of topic.

In moments of vulnerability, when the player describes his appearance with a degree of empathy, Astarion's response may be interpreted as touched. However, should the player extend their description and express care, he promptly shifts the dynamic with humor, saying, "Just call me beautiful and call it a day."

Astarion also frequently voices a preference for not dwelling on negative emotions, advocating for their closure in the past, and emphasizing a focus on what lies ahead.

Projection and Displacement

Astarion frequently exhibits projection tendencies, assuming that others share his thought processes and act in a manner that mirrors his own "instinctive" behaviors. He often accuses the player of manipulation or harboring similar views regarding sex, viewing it primarily as a momentary pleasure and a means to an end.

Furthermore, when he desires power, he projects his own ambitions onto others, presuming that everyone else harbors the same aspirations.

In the context of deciding whether to kill or release vampire spawns, Astarion also projects his own desires onto them, assuming that each of them craves death, as he himself longed for it during his captivity.

In romantic situations, he frequently assumes that the other person expects the same things as he does and tends to verbalize statements that he himself would like to hear.

Shaping Responses

As I mentioned in the suppression part, Astarion often exhibits a demeanor contrary to the emotional charge of his statements.

He recounts his traumas with a smile, punctuating sentences with a subdued laughter. He frequently maintains an open and proud stance, even when recounting situations in which he felt small and vulnerable. This may be an unconscious defense mechanism safeguarding his psyche from complete alignment with the cruelty of his circumstances.

Astarion dissipates tension by summoning emotions and adopting a stance at the opposite end of the emotional spectrum, aiming to avoid the negative emotions he perceives as threatening or for which he currently lacks the resources to process without undermining his psychological homogeneity.

It is intriguing to note that only halfway through the game do we begin to observe a congruent emotional expression in response to what Astarion shares about his past.

I am convinced that in Astarion's case, a profound identification with his tormentor has taken place. By "adopting" the traits of another, an individual may become emboldened to engage in behaviors they perceive as forbidden in their own right, yet acceptable for the person they identify with.

On one hand, Astarion despises Cazador and fears becoming like him. On the other hand, he also holds contempt for himself and replicates some of Cazador's actions. In his world, Cazador was the sole symbol of power, the only entity with free will. Lacking an alternative framework, Astarion, too, yearns to experience freedom, and his ego becomes armored in Cazador's behaviors in an attempt to finally attain that sense of liberation.

This complex psychological dynamic reveals Astarion's internal struggle and his longing for autonomy, as well as his willingness to adapt to an identity that he perceives as granting him the freedom he so desperately seeks.

Rationalization

Astarion frequently justifies his potentially hurtful behaviors with various reasons. An illustrative example of this can be seen in the rationalization of his disregard for his own boundaries and needs, as he perceives this as the only means to forge alliances. He rationalizes self-harm for the "greater good." Similarly, when causing harm to others, he constructs what he believes to be rational explanations for his actions, devoid of distortions from past patterns he has learned.

TL;DR: The whole cognitive therapy deal is like when your brain plays tricks on you. It's like you're wearing glasses that make you see everything in a specific way. Astarion, our buddy here, has a bunch of these thought patterns that served a purpose during his enslavement, but in a safe environment they are no longer useful and can be self-destructive and cause suffering.

As the very name implies, this approach centers on the individual within a cognitive (thoughts and attention processes) and behavioral (actions) context. Within the realm of cognitive-behavioral psychotherapy, a general definition of case conceptualization is embraced: "Determining the patient's problem in the light of the mechanisms of their functioning in the language of a given theory" (Popiel & Habrat-Pragłowska, 2008). In this perspective, conceptualization places its focus on the cognitive sphere of the client and how this sphere influences behavior, physiology, and emotions. The therapist formulates hypotheses regarding the cognitive mechanisms contributing to the patient's issues, as well as environmental triggering factors and factors sustaining these issues (Słysz, 2017).

A significant portion of conceptualization within this approach is also rooted in accurate diagnosis based on ICD-10 (soon ICD-11) and/or DSM-V, as well as questionnaires (Słysz, 2017). However, we do not have the opportunity to undergo a diagnostic process with a fictional character, and I do not intend to speculate about specific psychopathological labels. Therefore, I will concentrate on the cognitive profile.

Cognitive distortions

The conceptual framework of cognitive therapy is based on the premise that an individual's subjective interpretation of their early life experiences influences and perpetuates core beliefs (schemas) concerning the self (Felgoise et al., 2006).

I am confident that we could identify more cognitive distortions in Astarion. However, the original content provided in official materials is rather limited. Unlike psychoanalysis, here, we can only rely on what the client has verbalized, what we have observed in their behavior, and our inferences from their general statements. Unfortunately, we do not have the space here for headcanons and more extensive speculations.

Is this even interesting at this point?

TL;DR: Yep, he is traumatized. Likely, has PTSD.

According to the textbook definition (DSM-V), trauma is an individual's reaction to experiences that threaten life or physical integrity. Trauma can encompass experiences such as physical violence, sexual abuse, war, serious accidents, or sudden death, which emotionally shake a person.

I personally prefer the perspective of the World Health Organization (WHO), which views trauma as a subjective experience for the individual. What may be traumatic for one person may not be traumatic for another. WHO defines trauma as an excessive response to a stressor that exceeds an individual's ability to cope with it. This means that trauma is not limited to life-threatening experiences but also includes events that can disrupt the psychological and emotional well-being of a person, such as conflicts and significant losses.

In psychology, Levine's approach (2012) is also popular. He observed that trauma is not directly linked to external events that cause physical or psychological pain. It is also not directly related to the pain itself. Levine focuses on the body's and the nervous system's response to trauma. Trauma arises when a person is unable to release blocked energy or follow physical and emotional responses (fight, flight, freeze) that are a natural response to injury. It is caused not by an external event but by an internal process. This process gains momentum when there is a lack of a compassionate witness - social support.

Please keep in mind that this is a simplified translation, and the full depth and nuance of the original text may be lost in the process. If you need a more comprehensive and nuanced translation, consider consulting with a professional translator or a native speaker with expertise in psychology.

All these trauma frameworks (DSM-5, ICD-10, Levine, 2012) concur that trauma can potentially precipitate the development of Post-Traumatic Stress Disorder (PTSD) within an individual.

This appears to be the only diagnosis that I dare to posit within this comprehensive conceptualization. I firmly believe that the character of Astarion conspicuously manifests symptoms indicative of PTSD, and I can confidently speculate that such might have been the intentions of the writers as well. It is worth noting that this analysis is conducted without the benefit of professional psychological oversight, a factor which generally informs a more meticulous assessment.

For this assessment, I will be utilizing the latest ICD-11 classification, which is readily accessible online (

). It is crucial to note that my approach to this work is grounded in a commitment to individualized analysis. Unlike traditional practices where supervision by a professional psychological team is common, this endeavor has been undertaken independently. This decision was motivated by a desire to promote a more profound sense of personal ownership and responsibility in the process.

In the additional criteria of ICD-11, it is emphasized that many individuals may experience overwhelming feelings of shame and guilt following traumatic events. As previously mentioned, Astarion consistently grapples with guilt for what has transpired in his life. It appears that he assumes responsibility even for the decision to undergo a transformation into a vampire.

TL;DR: Go for EMDR, BrainSpotting, Somatic Experiecing or even better: all of them at once.

This section is primarily intended for readers grappling with trauma and/or PTSD/C-PTSD.

Namely, it appears that there is currently a significant amount of discourse surrounding these issues in popular culture and casual conversations, but relatively few individuals are well-versed in the proper treatment of trauma. What's more, only a minority are aware – including some therapists, tragically – that an inadequately chosen therapeutic approach can exacerbate symptoms. Conventional talk therapy is not tailored to patients in severe traumatic crisis. Excessive recounting of a traumatic event can lead to RETRAUMATIZATION (Lmft, 2023). In the therapist's chair, you may find yourself repeatedly reliving the event with an equally or even more pronounced traumatic response.

One of the most widely recognized and empirically effective forms of therapy is Eye Movement Desensitization and Reprocessing (EMDR) therapy, as documented by the World Health Organization in 2013. Theoretically, Cognitive Behavioral Therapy (CBT) is also an option. Similar to CBT with a trauma focus, EMDR therapy seeks to alleviate subjective distress and fortify adaptive cognitions associated with traumatic experiences. However, it distinguishes itself from trauma-focused CBT by not involving extensive narratives of the traumatic event, direct challenges to beliefs, prolonged exposure, or assigned homework, as highlighted by Van Bennekum in 2013. Within the framework of EMDR therapy, clients engage with emotionally distressing material in brief, sequential intervals, concurrently concentrating on an external stimulus. Therapist-guided lateral eye movements represent the most commonly utilized external stimulus; however, various other stimuli, such as hand-tapping and auditory stimulation, are frequently employed (emdr.com, 2022).

Other approaches that you may want to consider are: BrainSpotting and Somatic Experiencing. I encourage reading up more on them online.

Assets/Resources

In any comprehensive conceptualization, the consideration of resources is paramount. In the current spirit of positive psychology, our focus is primarily on assets rather than deficits.

It suffices to say that excessive speculations regarding Astarion's psychopathology have been omitted.

Internal Resources:

External Resources:

Therapeutic Recommendations

The initial step would involve gathering Astarion's expectations from therapy.

To ensure a proper course of treatment, I recommend a thorough psychological-psychiatric assessment to rule out or confirm affective disorders (e.g., depression), personality disorders, neurodiversity spectrum disorders, PTSD, anxiety disorders, etc., and, if necessary, consider pharmacotherapy.

In the first step, a referral should be made to a trauma-informed, LGBTQ+ friendly therapist. Initially, the pivotal aspect of his treatment, in my opinion, would be the processing of trauma. After that, to process maladaptive coping strategies, Astarion can opt for the EMDR approach or choose a therapeutic modality that aligns with his beliefs and needs.

The entire therapy should be centered around resource development and addressing behaviors that do not serve him.

I also recommend mindfulness exercises and therapy, something an elf might particularly appreciate.

Support groups could also prove valuable.

Arain, M., Haque, M., Johal, L., Mathur, P., Nel, W., Rais, A., Sandhu, R. S., & Sharma, S. (2013). Maturation of the adolescent brain.

Neuropsychiatric Disease and Treatment

Association, A. P. (2015).

DSM-5 Classification

. American Psychiatric Publishing.

Biggs, A., Brough, P., & Drummond, S. (2017). Lazarus and Folkman’s Psychological Stress and Coping Theory. In

Stress and Coping Theory. The Handbook of Stress and Health.

Cong, C. W., Wu, S. L., & Tan, S. A. (2019). Problem-focused coping and depression among adolescents: Mediating effect of self-esteem.

Current Psychology

De La Santé, O. M., Organization, W. H., Who, & Staff, W. (1992).

The ICD-10 Classification of Mental and Behavioural Disorders: Clinical Descriptions and Diagnostic Guidelines

. World Health Organization.

Dragons, D. &. (2014).

Dungeons & Dragons Player’s Handbook (Core Rulebook, D&D Roleplaying Game)

. National Geographic Books.

Dual-Continua-model-Keyes-Lopez-2002.png (698×524)

emdr.com. (2022, October 20).

What is EMDR? - EMDR Institute - EYE MOVEMENT DESENSITIZATION AND REPROCESSING THERAPY

Felgoise, S., Nezu, A. M., Nezu, C. M., & Reinecke, M. A. (2006).

Encyclopedia of Cognitive Behavior Therapy

. Springer Science & Business Media.

Felton, B. J., Revenson, T. A., & Hinrichsen, G. A. (1984). Stress and coping in the explanation of psychological adjustment among chronically ill adults.

Social Science & Medicine

Han, C. S., Brussoni, M., & Mâsse, L. C. (2022). Parental autonomy support in the context of Parent–Child Negotiation for Children’s Independent Mobility: "I always feel safer with my parents’ to "Boom! Bust down those walls!’

Journal of Early Adolescence

ICD-11 for Mortality and Morbidity Statistics

Reddit - Dive into anything

Keyes, C. L. M. (2002). The mental health continuum: from languishing to flourishing in life.

Journal of Health and Social Behavior

Keyes, C. L. M. (2005). Mental illness and/or mental health? Investigating axioms of the complete state model of health.

Journal of Consulting and Clinical Psychology

KingBowser. (n.d.).

Reddit - Dive into anything

Levine, P. A., PhD. (2012).

In an Unspoken Voice: How the Body Releases Trauma and Restores Goodness

. North Atlantic Books.

Lmft, J. S. (2023, January 12). Therapy retraumatization.

M, E. & My paralysis demon. (2023). This was revealed to me in a dream.

Popiel, A., & Habrat-Pragłowska, E. (2008).

Psychoterapia poznawczo-behawioralna: teoria i praktyka

Premium 2nd Edition Advanced Dungeons and Dragons Dungeon Master’s Guide

Roll20 - Compendium and Rule Set Directory

Scheck, S. (2014).

The stages of psychosocial development according to Erik H. Erikson