Komi Shouko diagnose.

Swagernator said:
Shes also an anime girl character.

epidemia78 said:

yeah she's got a bad case of animegirlitis

Heliogale said:
A lot of the comment replies are ragging on this post for being too wordy but your thinking is well-explained overall however honestly, I don't really agree with it. The diagnosis I think Komi would be more fitting of is probably Generalized Anxiety Disorder with a strong indication of social scenarios being a leading trigger for anxiety. Cognitive Behavioural Therapy would help her in processing her anxiety triggers and learn coping mechanisms for sure but she definitely doesn't show enough depressive tendencies to warrant an anti-depressant prescription considering that the side effects would probably do her situation more harm than they could help. Clonozapam taken as-needed could be used for bringing down the intensity of panic attacks but she definitely doesn't need the mood stabilization of stronger medications like Xanax either considering that she is a teenager and thus is naturally prone to mood-swings which she'll likely grow out of. It's still an anime and those are always dramatized for the plot anyway. I'm only a psychiatric student and yet while I see where you're coming from for a lot of it, the medication side of your explanation needs further understanding of the long terms effects involved in these prescriptions, especially if you'd want a teenager to take them.

PsychVstar said:
Do not read this if you do not want to read something that may take some while!!!
Also, I am doing this because I am very interested in Psychotherapy and thought this would be fun and not because i am some creepy, over analyzing fan. This post is meant as a training for myself.

In the following I will diagnose Komi medically, as a psychiatrist/psychotherapist would, and describe what successful therapy would look like for her.

I am not a psychiatrist/psychotherapist, so no one should take this diagnosis seriously, let alone apply it to themselves if they have symptoms like Komi. If any of the Symptoms sound familiar please seek professional help.

I do not even have to start from scratch for the diagnose, as the Anime already alludes several times to the illness Komi suffers from: social anxiety disorder.
Symptoms that are shown in the series and speak for a social anxiety disorder would be symptoms like blushing (erythrophobia), trembling, heart palpitations, sweating, shortness of breath, speech inhibition and frequent slips of the tongue (when she tries to speak).
Although Komi seems to have a very pronounced anxiety disorder (unable to talk to someone when they look at her/ are close to her, even with family members, and very pronounced symptoms) it is remarkable that she does not isolate herself completely socially. Of course, she only does not because she is a fictional character and the anime/manga couldn't attract a wide audience otherwise. Instead of withdrawing, Komi tries to communicate with her outside world through writing, which is accepted because of her physical appearance in the anime. If she was not physically attractive for her classmates, she would hardly be able to get anyone to take her seriously. A big motivational help for her to communicate with her surrounding is of course her goal (to make 100 friends), the will and the power to change something about herself that makes her feel miserable and her two best friends Tadano Hitohito and Osana Najimi who support Komi achieving her goal.
Of course, this support is not enough for such a pronounced social anxiety disorder, which is why a therapy supported by medication would make sense.
I think cognitive behavioral therapy would be the most effective psychotherapeutic treatment. Affected people review and change their negative evaluation patterns and basic beliefs. At the same time, they learn to take risks and to deal with possible mistakes and rejection. Claims to perfection are questioned, and self-acceptance and independence from the opinions of others are strengthened. In my opinion, this therapy would also be very helpful because Komi shows positive tendencies in changing her behavior (Goal,Friends). A therapist could be a great help in counseling for next steps and would also be a good companion or emotional support.
Possible medications to support the therapy would be the antidepressants that are often used when someone has social anxiety disorder, such as SSRIs (Escitalopram, Paroxetine, Sertraline) and MAOs (Phenelzine). It should be noted, however, that Phenelzine, although it shows almost the best results, causes a strong weight gain, which could cause problems when it comes to communication, because Komi's communication is only accepted because of her physical appearance. Assuming phenelzine doesn't work for her, but she gains weight, it takes away a lot of opportunity. Also, SSRIs and MAOs take weeks or months to start working.  Therefore I think benzodiazepines would be more affective. Unlike antidepressants, these drugs do not take effect after weeks or even months, but a few minutes after ingestion. In addition, benzodiazepines generally have a comparably favorable side-effect and interaction profile, but always carry the risk of abuse. However, I consider this risk to be low in Komi's case as there are no signs of addiction in her or her family's history, at least as far as I know. Similar to antidepressants, benzodiazepines are available in a wide range of active substances, whereby several substances may have to be tested on individual patients until a suitable benzodiazepine is found. Half-life and duration are also taken into account in the selection process. In my opinion, benzodiazepines with a fast onset of action would be appropriate for Komi, as it seems to me that she has panic attacks frequently in the anime. Specifically, that would be Alprazolam (Xanax) 0.5mg twice a day or 1mg Clonazepam once a day.

This concludes what I wanted to say in this post. After finishing this "essay" I realized that my diagnose is not really completed I would say. At least that is how it feels like. So maybe add something if you want to or think something should be done differently.

I want to remind you guys again I am no psychiatrist or psychotherapist so do not take anything I said seriously.

Furthermore English is not my first language so please forgive me for my grammar and language mistakes.

Bye and have a great day!