Mikan Tsumiki

Mikan Tsumiki (罪木 蜜柑), is a student of Hope's Peak Academy's Class 77-B, and a participant of the Killing School Trip featured in Danganronpa 2: Goodbye Despair. Her title is the Ultimate Nurse (超高校級の「保健委員」 lit. Super High School Level Health Committee Member).

She, along with Class 77-B, returns in Danganronpa 3: The End of Hope's Peak High School to explore their school life leading up to The Tragedy.

Appearance
Mikan has fair skin and long, choppy, dark, plum-colored hair that is cut unevenly as a result of bullying. The longest point of her hair appears to be just past her fingertips, whereas the shortest point is slightly above her neck. Her bangs flow straight down, but are also cut at visibly differing levels. She has pale gray-mauve eyes that almost constantly convey anxiety or tearfulness. There is a beauty mark under her left eye's corner.

She wears a nurse uniform which consists of a pale pink short-sleeved shirt with a white collar and puffed sleeves trimmed with white. A short, pale blue, slightly wrinkled pleated skirt is visible underneath. Mikan wears a white apron over this which is tied behind her neck with a ribbon. It is marked with two red lines on the left side of the apron, one going down to her middle and another short red line perpendicular to the vertical one in a simple design. As well as this, she has bandages wrapped around her left forearm and hand, excluding the fingers, and around her right leg from her mid-thigh to above her ankle. Additionally, she has a square gauze band-aid on her left kneecap and wears pale pink crew length socks and white loafers.

During her high school years, she wore the standard Hope's Peak Academy uniform with off-white crew length socks. Her hair was somewhat longer, this time the longest point of her hair being her mid-thigh, and the shortest being her shoulder. Her bandages were placed differently, this time her left knee and entire right leg being wrapped along with her left forearm, as well as a band-aid being placed on her right cheek.

As the Ultimate Despair, she wears a white, old-fashioned, buttoned nurse uniform with a white nurse's cap, marked with the same red line symbol on her apron in her first appearance. This time, she has bandages wrapped around her right forearm and left leg from her mid-thigh to her ankle. She wears one elbow-length medical glove on her left arm, a glove on her right hand that cuts off at her bandages, and a black strap wrapped around her right thigh. As well as this, she wears plainer loafers and can be seen with a syringe, presumeably as a weapon of sorts.

Personality
Mikan is an extremely meek, paranoid and fragile individual who suffers from hazardously low self-esteem as a result of severe abuse and bullying. This has resulted in many behavioral symptoms such as being easily intimidated, breaking down and crying with little provocation, profusely apologizing and nervously stuttering while speaking. She constantly worries about annoying, boring or offending others, going so far as asking Hajime Hinata if it would be alright for her to remember his name when introducing herself. This delicate persona makes her a natural target for Hiyoko Saionji's predatory and cruel personality. However, as the Ultimate Nurse, Mikan tends to act much more confident while doing her job, and she is knowledgeable and intelligent. Her medical knowledge proves to be useful in murders, as she provides autopsy reports, including information on the corpse's state, details on injuries, cause of death, and time of death. Furthermore, she sometimes gives (often unwanted) health advice to others concerning things like eating and sleeping, and may occasionally start to describe things like bodily functions in way too much detail in her wish to give the other students' information on the subject at hand. Unlike most students, Mikan has even mentioned that she likes being on Jabberwock Island, because her classmates acknowledge her and her talent makes her useful.

Perhaps because of her high understanding of human physiology, Mikan is shown to be very skilled at reading people's faces, but she tends to over-analyze them and is quick to assume that she is disliked by those around her. She generally wants to be liked by and help other people, but her utter lack of confidence and wish to not be a bother causes her to rarely assert herself or state her feelings openly; if she feels the need, she will more than likely ask for permission from her peers to do so. This is exacerbated considerably during Class Trials, where despite her talent being incredibly useful for solving a murder, she will rarely ever speak up by her own accord. Since her social intuition is generally poor, if there is an awkward pause in a conversation, she will immediately begin to panic and apologize, believing it to be her fault. However, despite lacking many basic social skills, Mikan does actively attempt to gel with her surroundings by altering aspects of her conduct to suit what she projects as the thoughts of her peers. Notably, she appears exaggeratedly clumsy and often ends up in embarrassing and revealing poses, leading her to apologize profusely, though it's been heavily implied and even pointed out by Hiyoko that Mikan does these poses on purpose in order to gain attention and pity. Because of her insistently klutzy and cloying personality, even for all the pity and leeway she generally receives from her kinder classmates, many of them do still see her as somewhat off-putting, incompetent or irritating, causing them to distance themselves from her rather than outright mistreat her.

Because of the severe abuse she has incurred in the past, Mikan is very awkward and has a warped perception of both positive and negative social interaction. When treated with any sort of individual respect or sympathy, her first response is most often outright confusion, and sometimes assuming she has done something wrong. When first becoming friends with Hajime, she offers him to beat, strip, draw on or do other bad things to her, and states that she has done so multiple times with previous schoolmates so that they won't hate her and will continue to associate with her. She relates this to a belief that being ignored is even worse than being abused, thinking that the people who don't bully her don't care about her existence at all, a prospect that scares her much more. If someone treats her well and is outwardly kind to her in the long-term, she tends to become obsessive and cling to them, similar to the behavior of a stalker, which is interpreted as being extremely creepy (by Hajime at least), showing that she is unable to compartmentalize and reciprocate those positive feelings in a normal, healthy way. This was taken full advantage of by her supposed beloved, who turned that affection into a pathological, slave-like subservience.

By defaulting to a state of unnaturally intense submissiveness and self-deprecation as a defense mechanism, Mikan is somewhat prone to bizarre outbursts, where the repressed elements of her personality rapidly surface for brief moments before burying themselves again, usually followed by an apology for her erratic behavior. These traits include deep-seated resentment for her abusers, general frustration over how she is treated, various sadistic or otherwise disturbing obsessions, an intense yearning for control, attention and sympathy, as well as her sexual urges. During Chapter 2, she has a fleeting moment of lashing out angrily and shouting "you are done for" and "you're not gonna get away now that I've caught you" at no one in particular and seemingly completely out of nowhere, and then tries to write it off by claiming that she says nonsensical things when she's nervous. During one of the Class Trials, she also mentions that she finds a sudden urge to kill quite understandable (implying she has had such fantasies of enacting revenge on her abusers), and in Island Mode she mentions that she enjoys horror movies because of all the blood and helpless victims, especially appearing to enjoy bully characters getting what's coming for them. She also has a disturbing liking for syringes and shots, repeatedly offering them to Hajime when she gains access to the Pharmacy, and she even chases him around attempting to inject him with one during a Free-Time Event. She is also mentioned to creepily stare at Hajime after their free time together and he sometimes had a feeling that she is forever watching him from somewhere, indicating that she may have stalked Hajime. In spite of her often tightly pent-up demeanor, Mikan also shows by far the most sexual desire among all of Class 77-B's female students, particularly for Hajime. When either extremely tired or inflicted with the Despair Disease, respectively, she ends up cradling his head and falling asleep on top of him on two occasions, as well as unsubtly implying she would like to have sex with him through some brief, coy remarks. Out of the whole class, the blatancy of her sexual innuendos is only rivaled by Teruteru Hanamura.

The dichotomy of Mikan's two-faced psyche is best represented by her mixed motivations for becoming the Ultimate Nurse. Directly contrasting her abusers, Mikan sincerely wants to help those who have endured physical harm, and generally wants to assist and participate in the group. However, she has also admitted that she occasionally relishes the power she holds over the sickly, helpless people who have no choice but to rely on her and listen to her to survive. While acting as a nurse allows her to feel useful, something she doesn't normally feel, it also indulges her selfish urge to assert absolute dominance over something, a sensation she essentially never feels otherwise given her general docility. In her Island Mode ending, she openly contemplates rendering Hajime an invalid so he can stay with her forever, but he convinces her that he'll stay regardless, and thus doing so would be unnecessary. This shows Hajime's deft understanding of how Mikan manically depends on having other people around despite seeing herself as undesirable company, as well as his empathy toward her.

Due to a specific strand of the Despair Disease known as the Remembrance Disease, Mikan recovers her lost memories during Chapter 3, reverting her back to a Remnant of Despair, accompanied by a drastic personality shift which gradually reveals itself as she begins to be suspected as the blackened during the Class Trial. All of her repressed, negative and selfish traits take dominance within her, causing her to become angry, manipulative and dangerous, and in a private moment with Hajime, somewhat seductive. She is highly embittered and clearly aware of her maltreatment, and in distinct opposition to before, boldly calls the others out on it, even those who defended her in the trial but otherwise ignored her day-to-day. She angrily questions why everyone hates and bullies her, and blames her classmates exclusively for her evil deeds and transition into Despair, taking advantage of their pity in an attempt to escape her accusations all the while. Before her remembrance, Mikan was primarily self-effacing and would adapt to her environment for the benefit of others and to reduce conflict; but once the Despair Disease sets in, she is cunning and deceptive purely to preserve herself, even at the cost of the others' lives. As she turns increasingly violent and unstable, her apologizing habit still persists, repeatedly asking to be forgiven in a way that seems to be reflexive or like a mantra, but while also staunchly denying her charges to the point of angrily pulling her hair when accused. When finally backed into a corner and revealed as the culprit, Mikan ultimately finds solace in her beloved, and says that her motive for murder was simply her affection for them. She claims to no longer care about anything except that person, believing they were the only one who ever loved and accepted her. In Danganronpa 3, Mikan's brainwashed Ultimate Despair form has a resemblance to a sadistic horror nurse, and it's indicated that she tortures her victims with her medical equipment and knowledge, as well as sexually harasses them.

After awakening from her coma, Mikan reverts to her original temperament, and Junko Enoshima's brainwashing is undone. She is shown to feel guilty for her actions as an Ultimate Despair and decides to atone along with her other classmates. Notably, she is seen capable of fighting, as she rescued Hiyoko wielding a massive syringe. She also independently took care of Kyoko and saved her life. While obviously still very insecure, she now appears happier and closer with her classmates, and even has a friendlier relationship with Hiyoko.

Ultimate Nurse
Because there was no one to take care of her wounds, Mikan learned to take care of herself from a very young age. As she became more and more skilled in this area, she took an interest in nursing, realizing that it gave her a feeling of control over sick and injured people - as weaker people would have to depend on her completely, and their lives would be in her hands. Her skills in this field eventually continued to grow and she seemed to have developed almost all the necessary skills and abilities required of a nurse such as being able to give first-aid, creating various medicine/drugs, being capable of performing surgery, critical analysis of her patients condition in a moments notice and adaptability in dealing with medical emergencies.

As the Ultimate Nurse, Mikan's medical knowledge proves to be useful in murders. She provides autopsy reports, including information on the corpse's state, details on injuries, the cause of death, and time of death. Furthermore, she sometimes gives (often unwanted) health advice to others. She also appears to be more confident while she is nursing. Unlike most students, she likes being on Jabberwock Island, because her classmates acknowledge her and her talent makes her useful.

As talented as she is, Mikan's abilities as a nurse have limits; she doubted she could keep Fuyuhiko Kuzuryu alive due to the injuries he sustained during Peko Pekoyama's execution, One Woman Army. Nonetheless, her abilities are highly effective, as she was able to successfully revive Kyoko Kirigiri after the Final Killing Game, where she was near-death after using Seiko Kimura's medicine to survive her NG Code Poisoning.

In other languages
Mikan's talent as it appears in official translations of Danganronpa material.

Expression Reader
Like Hajime said, Mikan is very perceptive. She is very skilled at reading other people's faces. She knew what Hajime was thinking when she examined his face in the fourth Free Time Events. Mikan could easily know what others would think about her based on their actions and their reactions. However, due to her very low self-esteem, Mikan over-analyzes and assumes others hate her if she notices even a slight indication of boredom, hesitation or annoyance in others. She also uses her perceptiveness to tell when and how someone is ill.

Prior to the Tragedy
Mikan had a harsh life as a child. She was physically, emotionally, and possibly sexually abused by people in her family and in other places, like school. Among other things, she mentioned being splashed with water, smeared with mud, and getting burned with cigarettes. The bullies would beat her up, cut her hair, draw on her, use her as a target for dart games, make her responsible for their debts, and tell her to eat bugs and make her imitate animals. She was even told to strip at times. In addition, she didn't have any friends.

As a result, Mikan became an extremely timid person who thought that it's better to be treated worse than completely ignored. She feared loneliness and lack of attention more than the abuse and let people do whatever they wanted with her.

Because there was no one to take care of her wounds, Mikan learned to take care of herself from a very young age. As she became more and more skilled in this area, she took an interest in nursing, realizing that she could have a feeling of control over sick and injured people ー as the weaker people, they would have to depend on her completely and their lives would be in her hands.

She previously attended Lapis Lazuli Girl's High School before enrolling in Hope's Peak Academy as the Ultimate Nurse, in Class 77-B. Her life at least seemed to get better, and she befriended her first friends ー Ibuki, Hiyoko, Mahiru Koizumi, and Sato. During their time together, they discovered a corpse in the music room. This was later revealed to be Fuyuhiko Kuzuryu's sister, Natsumi Kuzuryu, who was murdered by Sato. A few days later, Sato was killed by Fuyuhiko. Hiyoko suggested that Mikan enter the classroom, where Mikan found Sato's corpse. This part of Mikan's life was revealed in "Twilight Syndrome Murder Case".

Episode 01 - Hello Again, Hope's Peak Academy
Mikan arrived late and rushed to her classroom, making her trip in an embarrassing pose. Her new homeroom teacher, Chisa Yukizome comforted her and asked why there were only five students that attended the class. Chisa became furious after Mahiru explained to her that most of the students didn't go to the class because they didn't have to. Mikan became depressed after Chisa referring them as "rotten oranges" (腐ったみかん, kusatta mikan), which was misunderstood by her, thinking that Chisa insulted her personally. Mikan and the others were forced by her teacher to set out to search for her classmates.

In a men's bathroom, Mikan screamed ! when she heard Nekomaru Nidai's heavy voice, referenced to a particular scene in the movie. Throughout the day, Mikan and the others were able to retrieve most of their classmates. Returned to their class, Mikan worried about Hiyoko's condition but in return, Hiyoko insulted her as a rotten orange. Chisa went to retrieve two remaining students, asked her students who have been gathered to clean their classroom. When she took the cleaning equipment, Mikan tripped in another embarrassing pose.

After returning to the classroom, Chisa was happy to see that Mikan and the others had waited and that the classroom was clean. When the students once again bring up that they didn't have to go to class, so long as they have their talent, Chisa reminded them that talent isn't everything, and wanted them to build strong relationships and "hope" with each other.

Episode 02 - My Impurest Heart for You
Mikan treated her teacher after she fainted due to the stress she faced when Akane Owari and Nekomaru were in their training session.

Later after they repaired their classroom, Mikan and the others were playing games that Chiaki brought. When she, Sonia Nevermind, Mahiru, and Chiaki played  games together, Mikan clumsily dropped bombs on the entire area.

During the break, Mikan and her classmates happily ate Teruteru Hanamura and Hiyoko's together. However, to their unaware, Hiyoko already poured a bottle of aphrodisiacs within the food, making Mikan and the others lost their body control. Mikan held Peko Pekoyama from reaching Fuyuhiko Kuzuryu, begging her to lend her sword's "tip".

After the "aphrodisiacs incident", Mikan treated everyone in the nurse's office. Mikan was impressed by Chiaki's effort earlier, protecting Hiyoko from Teruteru's attack. In the next day, Mikan agreed with Chisa's decision to elect her as the class representative.

Episode 03 - A Farewell to All Futures
At the beginning of the episode, Mikan and her classmates walked past Hajime heading toward the Main Course building. She was worried after Kazuichi Soda was bitten by one of Gundham Tanaka's hamsters. Later that day, Mikan and her classmates were shown on the school's park. She and Sonia played with a rabbit there.

Several days later, Mikan looked worried at Mahiru who was crying on Hiyoko's chest after she heard the news of her friend's death from Reserve Course, Sato.

Episode 04 - The Melancholy, Surprise, and Disappearance of Nagito Komaeda
The two-in-row murder cases of Natsumi Kuzuryu and Sato affected Mikan's class, still showing no spirit when Chisa announced the annual practical exam that will start on the next day. Not only that, she and her classmates must bid their farewell to their beloved teacher Chisa as she transferred to the Reserve Course after the bombing incident involving one of her classmates, Nagito.

Episode 05 - The Beginning of the End
Mikan is part of Chisa's welcome back party. She was dismayed when Hiyoko told Chisa that now that she had grown, she can bend Mikan's bones in any direction she wanted.

The Ultimate Imposter, disguised as Ryota Mitarai, later found Mikan and brought her to care for the real Ryota Mitarai. The Imposter revealed to her that they have no identity of their own and that they and Ryota made a deal that they would assume his identity, and live life while Ryota worked tirelessly on his anime.

Mikan assumed that the Imposter wouldn't let her leave alive now that she knew their secret, and thought that they wanted to rape her. However, the Imposter gently told her that they trusted her. Mikan started crying and thanked them, saying no one has ever been so nice to her. The Imposter advised her to toughen up since they will be upperclassmen starting tomorrow.

Episode 06 - A Despairfully Fateful Encounter
Mikan is seen packing with the rest of her class as they prepare to move to a new school building. She comments on Fuyuhiko and Peko talking with each other, saying that she thinks it's wonderful.

Episode 07 - The Biggest, Most Atrocious Incident in Hope's Peak Academy's History
Mikan has a private conversation about Ryota with the Ultimate Imposter in a room, where they explained that Ryota has disappeared and left a note. Mikan timidly offered to check if Ryota came back for his belongings and goes to his apartment. There she met with Mukuro Ikusaba who gave her a cold stare.

Mikan found herself tied, gagged, and blindfolded by Mukuro who took her to Ryota. Ryota freed Mikan's gag and revealed that he's been working on his animations in a private room, courtesy of Junko, a blonde haired girl who introduced herself to Mikan. Junko showed Ryota's anime to Mikan, who is moved to tears after watching it. Junko and Mukuro left the two in the room, where Mikan decides to stay with Ryota to watch after him and gave the Ultimate Imposter a note assuring them that she is fine and is helping Ryota.

Episode 08 - The Worst Reunion by Chance
Junko made Mikan watch a brainwashing video containing the recording of the first Mutual Killing game using Ryota's abilities to influence people's minds, thus turning her into an Ultimate Despair. At the beginning of the episode, Mikan is seen massaging Junko's legs. Mikan said to Junko that her classmates are wonderful, especially her homeroom teacher, Chisa, and her class's representative, Chiaki Nanami.

Later, she tries to seduce Ryota, only to be kicked away by Junko.

Upon Nagito's return to the 78th class, he explains that he saw Mikan heading for the western district on the school grounds. Upon Chiaki and Nagito's arrival to Junko's hidden lair beneath the Izuru statue, Mikan is nowhere to be found.

Episode 09 - Chisa Yukizome Doesn't Smile
Mikan meets up with the class carrying a tired and potentially injured Peko, she appears to seem quite normal, wanting to help her classmates in saving Chisa. However, once they arrive at Junko's lair beneath Izuru Kamukura's statue, she stalls Chiaki midway down the stairway as the rest of the class continue on, Mikan then pushes a confused Chiaki through a secret hatch leading to an unknown corridor.

Episode 10 - Smile at Hope in the Name of Despair
Mikan catches up with the class who have continued on ahead through the corridor, Fuyuhiko inquires as to where Chiaki is, Mikan explaining she twisted her ankle and is waiting in one of the nearby rooms to recover. Mahiru and Hiyoko are both pleased Mikan was able to help Chiaki.

Nekomaru and Gundham eventually appear from a dark room to the class' surprise. Gundham thanking Mikan, Nekomaru explains that if it wasn't for Mikan messaging them, they would have never been able to find the rest of the class.

Mikan, now leading the group, approaches a large red door at the end of the corridor, pressing a button which opens the door, the class follows her inside. As Chiaki Nanami's Punishment is being broadcast to them inside the room on multiple monitors, the class begins to fall into despair, while most of them try to resist, Mikan becomes excited that the video is uniting them all. As the broadcast ends, Mikan and the class fell silent, now Ultimate despair, their eyes have become a patterned spiraling swirl.

Episode 11 - Goodbye, Hope's Peak Academy
Mikan and the rest of the class have returned to the classroom, receiving their final lesson before graduation. Chisa stated that she has been honored to be their teacher and started reading a letter she prepared. Mikan and the rest of the class clap with gratitude.

After the speech, red lights turn on, and Chisa started to cry. The patterned swirled return in their eyes as they all make a declaration of what they will do upon graduation. Mikan expressed that she can 'send wonderful medicines to the world's hospitals'.

After bidding her class a final farewell, Chisa activates a bomb that fakes the death of Class 77-B. Mikan and her class stand outside the school grounds as they watch Hope's Peak Academy's destruction.

Chisa's narration later revealed Mikan helped to infect the world with despair.

During the Tragedy
The members of Ultimate Despair did all kinds of horrible things during the Tragedy, causing despair all over the world.

After the death of Junko, the remnants of the Ultimate Despair attached some of her body parts into their own bodies in order to make her survive within them and feel closer to her. They then agreed to an insane plan to have AI Junko take over their bodies, so they could resurrect their leader.

The remnants of Despair are later found by the Future Foundation. Makoto Naegi plans to undo Junko's influence by putting them into the Neo World Program, but the program is taken over by AI Junko, right according to the Ultimate Despair's plan.

Episode 01 - Third Time's the Charm
At the beginning of the episode, in the flashback, Mikan as a member of Ultimate Despair was about to jab one of her tied-up "patient's" eyes until Seiko Kimura of the Future Foundation stopped her, ultimately led into her capture.

Prologue - Welcome to Dangan Island! Panic at the Heart-Throbbing School Trip!?
When Mikan met Hajime for the first time, she became so nervous and confused about how to start the conversation with him that she ended up crying, revealing that she even prepared 5000 different ways to start the conversation only for her to fail.

Chapter 1 - Destination Despair
Mikan accidentally tripped when the students were gathering in the Restaurant, amusing Teruteru and Ibuki verily. Later, she also tripped during the blackout in the Ultimate Imposter's party.

After the discovery of the Ultimate Imposter's corpse, Mikan was initially terrified. However, she managed to gather up the courage and made use of her talent as the Ultimate Nurse by examining the body.

Mikan played a key role in the first trial by pointing out that the Ultimate Imposter was stabbed by a sharp implement about five millimeters in diameter, ruling out the possibility of the glow-in-the-dark knife being the murder weapon, and therefore saving the students from voting for the wrong person as the culprit in the first trial; Despite the constant verbally abusive insults and life-threatening threats she recieves from Hiyoko and Fuyuhiko, making Mahiru upset at him for verbally abusing someone fragile like her.

When Teruteru was determined to be the culprit behind the Ultimate Imposter's death, Hajime used the accident where Mikan accidentally tripped during the party as decisive evidence to prove Teruteru's guilt.

Chapter 2 - Sea and Punishment, Sin and Coconuts
Mikan agreed to attend Sonia's girls only party along with the other girls, excluding Mahiru and Hiyoko. She and Ibuki arrive at the diner, the original meeting point of the party, and there they meet with Kazuichi and Hajime who later join the party as well. While she waits for the others at the diner, Akane arrived, injured from her practice session with Nekomaru. Mikan immediately takes her into the bathroom to treat her.

Mikan played another major role by examining the body of Mahiru and verifying that her death by blunt force trauma was instantaneous, proving that her body was moved by somebody else to block the Beach House door; Fuyuhiko angirly and very loudly threatens to murder her if she made that up on purpose, making Mikan scream and cry, thus having Sonia stand up for her. When Mikan tries to comfort a crying Hiyoko after proving her innocence, Hiyoko shouts loudly at her, hoping for her to die, making Mikan wail again. It was also revealed that she was the playable character, in fact, Girl A of the Twilight Syndrome Murder Case, implying that she was close friends with Hiyoko, Ibuki, Mahiru, and possibly Sato during her time at Hope's Peak. When Hiyoko said that she fell asleep after getting drugged unconscious from medicine, Mikan notices that the medicine was from the drugstore and there were prescription medicines left out in the open for taking. Kazuichi tells her (not in an abusive way like Hiyoko and Fuyuhiko) that if she was aware of that from the start, she should've done something about it, nearly making Mikan blubber for an umpeeth time.

The culprit turned out as Peko Pekoyama, Fuyuhiko Kuzuryu's hitwoman. After Peko's execution, Mikan tried to save Fuyuhiko, who had interfered in the execution and injured during the process, but Monokuma ended up having to save him by taking him to the Hospital on the third island after being forced by Monomi.

Chapter 3 - Trapped by the Ocean Scent
In the next day during the group investigation in the third island, Mikan found Fuyuhiko who was treated well and resting in the Hospital. Later, she joined Ibuki's Fuyuhiko welcome back party.

During the Despair Disease outbreak, Mikan treated Nagito fervently to make sure he wouldn't die, staying awake for days on end to keep watch over him. During her stay at the hospital, while treating the sick, she contracted said disease and killed Ibuki by strangulation, to which Hiyoko accidentally became a witness of.

As a result, Mikan was forced to kill her as well by slitting Hiyoko's throat. During the third trial, Mikan's ability as an Ultimate Nurse backfires when Nagito reveals that Ibuki was not killed by hanging herself, but rather by being strangled according to the marks left on the rope. This reveals that Mikan lied when she did Ibuki's autopsy, as she told everyone that Ibuki died by hanging.

Hajime begrudgingly singles Mikan out as the murderer, to which many disagreed at first. Oddly, Nagito agrees and states that the culprit this time was someone he could not forgive, and the reason is later revealed to be because unlike the others, the culprit did not kill for a hope of escape, but for despair.

Once she is voted guilty, Mikan stops struggling and accepts her fate. Before that, though, Mikan tells Nagito that she did not murder for despair, but rather for the sake of the person she loves because they were the only one who accepted her for who she was, leaving Nagito confused.

Mikan was affected by despair disease, which led her to regain all of her memories and remember everything. Her personality changes not due to despair disease but just despair itself. She's also explained that the real name of 'World Ender' is 'Future Foundation' (although it wasn't). Besides it, she also knows who's the traitor that hides among the groups, but she refuses to tell and believed that the others would eventually know when the countdown end.

Just before her execution begins Mikan asks that person to forgive her for dying with the hope of meeting them again.

Epilogue - The Day Before the Future
Currently, Mikan is most likely comatose, just like most of her classmates. However, she and Nagito "died" in the program while knowing that it isn't real - according to Monokuma, this increases their chances of waking up.

Real-life
After Nagito awoke from the simulation, he learned that all of his friends, including Mikan, were alive and awake from the Neo World Program. He boarded the boat with the rest of Class 77-B and they all then headed for the Future Foundation Headquarters.

Side - Hope: The Academy of Hope and Students of Despair
At some point after the end of the Killing School Trip, Mikan and the rest of her comatose classmates were awakened by Hajime, whose personality had blended with Izuru Kamukura's due to his experiences in the Neo World Program. Purged of Junko's brainwashing, the now-former Remnants of Despair joined Hajime on a ship that took them to the ruins of the Future Foundation headquarters, where Ryota Mitarai was attempting to broadcast a "Hope Video" to brainwash the world into never feeling despair again.

Led by Hajime, Mikan and the former members of Class 77-B engaged Ryota's army of brainwashed Future Foundation soldiers in an attempt to reach the broadcasting tower where the Ultimate Animator was hiding. Venturing into the underwater facility beneath the main building, Mikan somehow procured a giant syringe, which she used to disable the former Ultimate Nailist who was threatening Hiyoko. Despite showing her usual abrasive attitude towards the Ultimate Nurse, Hiyoko reluctantly offered her gratitude for the timely assistance, bringing Mikan to joyful tears. After Ryota was talked down and the brainwashing video was disabled, Mikan attempted to speak with Makoto, only to be cut off by Nagito. She joined the rest of her friends in broadcasting a video in their "Ultimate Despair" personas, claiming responsibility for the recent chaos in the Future Foundation to conceal the truth of the Final Killing Game from the world, before returning to Jabberwock Island.

On the boat ride home, Mikan held up a drug vial labeled Antagonist, which Nagito realized was made by Seiko. Mikan explained that she had found someone who used the drug to save themselves from the NG Code Poisoning of the bracelets of the Final Killing Game, entering into a comatose state instead of dying, of which Mikan was able to revive them from. It is shown later that the person whom she was referring to was Kyoko Kirigiri.

Execution

 * Main Article: Bye-Bye Ouchies!

Relationships

 * Love Interest:

Junko Enoshima
While under the influence of the despair disease in Chapter 3, Mikan recovered her memories of school life. At the end of the trial that unveiled her identity as the culprit, she revealed that she did it for the sake of 'her beloved', claiming that they forgave and accepted her for who she was, in stark contrast to the maltreatment she had been exposed to her entire life, and that they would appreciate her actions if they were alive.

Mikan proceeds to ramble feverishly about how their love transcends the cruelty of her misdeeds, and how this person was a major factor in her drastic personality change. Due to her wording and the circumstances of her past, it is heavily implied that this person is Junko, who may have brainwashed her.

This is later confirmed in Danganronpa 3 - Despair Arc where their relationship is revealed. Mikan is brainwashed by Junko, and acted towards her in a way similar to Mukuro Ikusaba, only much more insane and unnatural. She is glad when Junko abuses her or gives her attention, and learns to share Junko's love of despair.

However, Mikan later returns back to her original state, before the brainwashing, no longer holding these feelings for Junko and even assisting the Future Foundation in wiping out despair.


 * Class 77-B:

Hiyoko Saionji
Throughout the game, Mikan becomes a constant target for Hiyoko's bullying. Despite Hiyoko being over thirty centimeters shorter than Mikan, she has constantly pushed around and made into the butt of Hiyoko's jokes. Despite Hiyoko's bickering and attitude, Mikan still cares for Hiyoko and likes to give her tips on how to stay healthy, although Hiyoko merely shrugs these comments off.

Hiyoko often refers to Mikan as a 'filthy pig' or 'ugly bitch', to which Mikan apologizes constantly for or asks why the other is so mean to her. It is revealed in Chapter 2's motive, Twilight Syndrome Murder Case that Mikan and Hiyoko, being Girl A and Girl B respectively, were in the same group of friends and knew each other very well during their time in Hope's Peak. It has been stated that this group was Mikan's first friends. However, their relationship was the same, and in the Danganronpa 3 chart, Mikan apologizes after Hiyoko calls her "pig puke". Still, Hiyoko also states that Mikan is very useful in situations where someone needs medical attention.

However, deep down, Hiyoko actually does care for Mikan. For example, in Danganronpa 3 manga, it was revealed that Hiyoko accidentally hurt Mikan when she and Mahiru ran into her while walking to school. Losing focus as she was too busy bullying Mikan, Hiyoko tripped over her sandals and scraped her knee, accidentally tripping and wounding Mikan, who was trying to clean Hiyoko's wounds, as well. After seeing what she had done, Hiyoko ran away in shame, forcing Mahiru to go after her. When Mikan tended to Hiyoko's wounds in the nurse's office, Hiyoko tearfully claimed responsibility for the incident and offered to clean Mikan's wounds in return, an act which delighted the Ultimate Nurse. The two were later seen walking out of the office holding hands, showing that Hiyoko did think of Mikan as a friend.

During the Killing School Trip, however, Hiyoko ended up being murdered by Mikan along with Ibuki, due to being at the wrong place at the wrong time since the latter had witnessed Mikan's attempt on killing Ibuki. Mikan later makes up for this by rescuing Hiyoko from a brainwashed man when she comes back from her comatose state. She cries tears of joy when Hiyoko reluctantly, but sincerely, thanks her. Mikan is later seen celebrating with Hiyoko, Mahiru, and Ibuki on the ship, indicating that she and Hiyoko have now become friends.

In Mikan's relationship chart in the art book, Hiyoko called Mikan as a frog-pig-garbage-scum woman.

In the non-canon "Danganronpa V3" bonus mode Ultimate Talent Development Plan, Hiyoko decided to meet up with Mikan in the nurse office since she was in a bad mood. Mikan was surprised and curious how Hiyoko would meet up with her. Mikan then smiled that Hiyoko came to be friends with her and chat along which Hiyoko decline and telling her to not smile. In the end, Hiyoko states how she forgot about her nervousness when she talked with Mikan.

Ibuki Mioda
Prior to The Tragedy, Ibuki was one of Mikan's first and best friends, which was later revealed in Monokuma's second motive, "Twilight Syndrome Murder Case". Ibuki, along with Mahiru, was the only one in their class who addressed Mikan by her first name back then.

Ibuki takes joy in watching Mikan fall into humiliating poses, however, no real harm is actually intended on her side. She is often one of the first to notice when Mikan finds herself in these situations and claims that Mikan looks so adorable whenever she is embarrassed. Despite usually finding it entertaining, Ibuki sometimes shows concern for her, namely when Nagito knocked her down in Side: Hope and Ibuki was the first one who tried to chase after her. Mikan is very shy around Ibuki and is often interrupted by her. Ibuki still cares for Mikan after the murder incident and even forgives her for it and treated Mikan as one of her closest friends as usual. Ibuki's taste in music deeply disturbs Mikan, who reacted in horror upon hearing Ibuki play for the first time.

During the Killing School Trip, when infected with the Despair Disease, Mikan targets Ibuki as her first victim, due to Ibuki's illness turning her naive. Mikan kills Ibuki by strangulation, but despite this, the two remain close friends upon awakening from their coma and are even seen celebrating together on the ship alongside Mahiru and Hiyoko.

In Mikan's relationship chart in the art book, Ibuki described Mikan as cute.

In New "Danganronpa V3" bonus mode Ultimate Talent Development Plan, Mikan was relieved to see Ibuki awaken. Mikan was surprised when Ibuki stated how she forgot who she was. Mikan was also calm to hear that her friend was okay. Mikan shows concern for Ibuki when she plays all by herself. Ibuki states how she trusted a helpful person like her. In the end, Ibuki complimented Mikan as a cute person when she made a sad face as well.

Mahiru Koizumi
Mahiru was another one of Mikan's best friends before the Tragedy. Mahiru addressed Mikan as Mikan-chan and was one of the few in their class who called Mikan by her first name.

Mahiru is aware of how shy Mikan tends to be, and is very gentle with her, unlike Hiyoko. Much like everyone else, Mikan's clumsiness surprises Mahiru, who notes that the way Mikan falls into embarrassing poses takes "skill", although she shows the most concern for Mikan. Mahiru was usually the one who tried to cheer Mikan up after she fell in a compromising pose and told her to be careful next time. Mahiru even yelled at Fuyuhiko for making threats to Mikan. Mikan, although really shy around her, seems to like Mahiru, and shows extreme sadness over her death in Chapter 2, even going as far as to blame herself for not accepting Mahiru's invitation.

It was also shown that Mahiru cared for Mikan during their times at Hope's Peak Academy when Mahiru took a photo of Ibuki, Mikan, and Hiyoko to cheer sad Mikan up after Hiyoko yelled at her for being late. Mahiru defended Mikan and tells Hiyoko to stop scaring Mikan after they discover Natsumi's corpse. After the events of the Tragedy and Killing School Trip had ended, Mahiru is seen celebrating with Mikan, along with Hiyoko and Ibuki. Mahiru even approaches Mikan later on, and the two are seen talking together.

Nagito Komaeda
At first, Nagito worries about Mikan, as he scolds Hajime after thinking he bullied her and asks if she's okay after having one of her many exaggerated falls. He is also very humbled during the first trial when he mistakenly assumed that Mikan complimented his appearance when she pointed out that there wasn't any blood on him.

After Nagito caught the Despair Disease, Mikan took care of him along with the others. However, she also caught the disease, and despite his terrible condition, he noticed that she had fallen into despair. Because of this, and the murders she committed for the sake of despair, Nagito lost all respect for her and considered her an enemy, worthy of the name "Ultimate Despair". Unlike the others, he wasn't fooled by her act during the trial and he bitterly refused to forgive her.

However, Mikan told Nagito that he's wrong and claimed that she had killed for "her beloved". Somewhat mockingly, she said that Nagito doesn't understand because he doesn't have anyone to love and isn't accepted by anyone, leaving him at a loss for words.

Later though, after Nagito and Mikan awaken from their comatose state, he doesn't seem to hold any more hatred towards her. This probably means that Nagito's original relationship with Mikan, which was mostly him not paying attention to her, although thinking her talent is amazing, has returned.

Ultimate Imposter
While the two almost never interacted in the game, Mikan's relationship with the Ultimate Imposter is revealed in Danganronpa 3 - Despair Arc. The Imposter took Ryota's place in the class and could not tell anyone this secret. However, when Ryota begins abandoning his health, the Imposter is forced to share his secret with Mikan in order to get her to aid him. Surprisingly, the Imposter was not worried about sharing his secret with Mikan, placing his full trust in her. Mikan agreed to keep his secret. The Imposter was very kind with Mikan and encouraged her to be more confident due to her shy nature. Because she did not experience this kind of treatment often, Mikan instantly took a liking to him and the two appeared to become friends.

Ryota Mitarai
A Fellow member of the Class 77-B of Hope's Peak Academy. Mikan looked after Ryota at the Imposter's request and helped nurse him back to health. It appears that the two have become close friends afterward. However, when Junko brainwashes Mikan without Ryota knowing, she attempts to molest him, completely traumatizing him in the process. Their friendship comes to a complete end due to this, and Mikan joins the Ultimate Despair whereas Ryota joins the Future Foundation.

However, Ryota shows guilt over his role in Mikan's brainwashing. After Mikan was cured from her brainwashing, Ryota decides to leave the Future Foundation, and reside on Jabberwock Island with the former Remnants of Despair where their friendship was eventually repaired.

Fuyuhiko Kuzuryu
Mikan was also physically and verbally threatened much more violently by Fuyuhiko, such as when she talks about the wounds on the victim's body, Fuyuhiko hollers at her, very abusively saying that he'll murder her, making Mikan scream and cry, thus having Mahiru and Sonia stand up for her.

In Chapter 3, after Fuyuhiko's behavior changed after Peko's sacrifice and when Mikan was framed as the culprit and starts to scream in anger over everyone physically and verbally abusing her and blaming her for everything wrong in life; as well as begging constantly to be forgiven, Fuyuhiko reacts and somewhat stutters with an uncomfortable look on his face and notifies how she's gone emotionally unstable.

Real-Life Version
Chiaki is the first person who let Mikan play video games and have fun with her by staying calm. In one of the episodes in Danganronpa 3 - Despair Arc, Mikan apologizes while Chiaki acts puzzled and pushes Chiaki to a secret passageway. In the end, Mikan regrets the whole thing and joins her classmates to stop Ryota to not upload a brainwashing video of hope.

AI Version
Mikan has been shown to be on very friendly terms with the AI version of Chiaki.

In Chapter 2, Chiaki is shown to be spending time with Mikan in the Mirai Hotel lobby. Mikan remarks how kind Chiaki was for teaching her how to play games, and even plays a round against her. Right after Mikan explains that she was happy to be able to play with a friend, which is one of the few instances where Mikan does not apologize for assuming that someone is her friend. After being thanked, Chiaki interjects by saying that Mikan doesn't need to thank her as she had fun too. Hajime's internal dialogue highlights this as he notes how this was the first time he had ever seen Mikan that happy and that he should thank Chiaki for it.

In Chapter 3, when Mikan contracts the Despair Disease, Chiaki is shown to be disappointed in her. Because of their previous interaction and Chiaki's nature as an AI, this can be due to not being able to rehabilitate Mikan as she was supposed to, and feeling disappointed in herself. Though it can also be taken as Chiaki simply being upset about losing a friend she had made herself.

In the same chapter, during the trial, the localization has Chiaki remark the retelling of Mikan sleeping on Hajime as "too much info". However, in the original, she says "itadakimasu" in response, which can be taken as a lewd joke, as it's a phrase used most often before eating as it means "thank you for the meal".

In Mikan's relationship chart, Chiaki states how Mikan can be helpful with her autopsies.
 * Reserve Course Students:

Sato
In Twilight Syndrome Murder Case, it was revealed that Sato was one of Mikan's first friends. They, along with Hiyoko, Ibuki, and Mahiru spent most of their time together prior to Sato's murder.

Hajime Hinata
Mikan seems to have formed a liking for Hajime as he is the first person (on the Island) to have gone up to her and spoke to her, not wishing to bully her but only to have a casual conversation. Though nervous and stuttering at first, she gradually lightens up, even asking him to come back and talk to her again.

Hajime is also the first person she admits to that she is glad that there is nobody to stomp on her and abuse her on the island. Mikan also chases Hajime around with a syringe a few times, wanting to give him an injection, and was found sleeping on him several times in Chapter 3. In the third trial, she uses him to give herself an alibi in the morning when they first discover the corpse.

In chapter 3, when Hajime accuses Mikan of killing Ibuki and Hiyoko, she becomes furious, and obviously, denies this. This act upsets Hajime, who doesn't want to believe she's the culprit as much the others, who are in shock at his accusation. Despite this, Hajime reluctantly shows evidence that points to her being the murderer. He tells Mikan to give it up, so he can still believe in her in the end. But Mikan's personality has already changed, and she was executed, leaving nothing but her malice for Hajime and the others.

In her free-time events, when Mikan explains her reasons for becoming a nurse, Hajime is disturbed and is afraid to show any signs of weakness or sickness around her. However, he also feels bad for her and believes that she is not to be blamed for the way she is now. She also expresses her liking towards Hajime more than a friend but it was shown that Hajime doesn't exactly share the same feelings as hers.

During the events of Island Mode, Mikan is very happy to be Hajime's friend and has a clear romantic interest in him. In her ending, she is even ready to go as far as to cripple him in some way so that they would be together forever. However, Hajime proposes to her instead, causing her to declare that she would become his own private nurse and take care of him.

Free Time Events & Bonus Mode Guides
The links below are full transcripts and indepth guides for Mikan Tsumiki's relationship routes in Free Time Events, School Mode, and Ultimate Talent Development Plan including her MonoMono Machine Present preferences and most effective dialogue options.

Quotes

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Merchandise
The link below lists all official licensed merchandise featuring Mikan Tsumiki:
 * Main: Mikan Tsumiki Merchandise

Trivia

 * Her first name (蜜柑) means “mandarin”, as in the type of orange, while her last name (罪木) means "sin tree".
 * Her last name could reference how she killed out of the despair Junko had planted inside her.
 * It is also somewhat possible that her last name is meant to reflect her similarity to the biblical, who has committed a sin (the ) related to a tree (the Tree of Knowledge) due to an innate "human" desire to try and do what is forbidden. Similarly, Mikan has committed double murder due to a desire - her presumably romantic attraction to Junko and wish to please her. She is also similar to Eve through the concept of "not being forgiven" for her actions.
 * While her title in the official English translation is Ultimate Nurse, Mikan's original title is Super High School Level Health Committee Member. The "health committee" or “health and hygiene committee” (since 保健 hoken means both “health preservation” and “hygiene”), is a common student committee in Japanese high schools with the duty of preparing and administering first aid during school events, monitoring the school's state of sanitation and promoting health-preserving behavior.
 * One of Mikan's Free-Time Events implies that she is qualified to administer vaccines (like a nurse and unlike a health committee member) - meaning that her circumstances as a health committee member are special.
 * Mikan's Birthday, May 12, coincides with International Nurses' Day.
 * Mikan's death poster in the trial room is crossed out with a nurse's cross, in reference to her Ultimate talent.
 * There is a strong possibility that Mikan suffers from, as she fits nearly all of the symptoms.
 * However, there is a chance Mikan also has, because of stuttering in speech, nervousness in social interaction, fear of bothering, boring, or offending others, and she is easily upset.
 * There is also a strong possibility that Mikan has histrionic personality disorder, as she also fits nearly all of those symptoms.
 * Mikan is implied to be able to develop feelings for multiple genders.
 * After the Class Trial in Chapter 3 of Danganronpa 2: Goodbye Despair, Mikan confesses that she committed murder for the sake of a gender ambiguous person she called "my beloved", who is implied at the time and later revealed to be Junko Enoshima: "What I did... was for the sake of my beloved. If only they were still alive... They'd be so happy. My beloved... was the only one... That's right, the only one who... never hated me. They forgave my existence. They forgave me and accepted me. They gave me value. They loved me. I loved them with all my heart and they returned it in full. [...] And it was also my beloved who created the me that everyone can't forgive. But my beloved still forgives me and still accepts me... "
 * During the course of Mikan's Free Time Events, it's heavily implied she develops feelings for Hajime due to his friendship towards her. In her last Event, she states she believes in Hajime's kindness with the reasoning "Because you...are the person who has forgiven me.", which is the reason she gave for her feelings towards Junko.
 * Mikan makes a cameo appearance in Danganronpa Another Episode: Ultra Despair Girls on a poster in the hospital in Chapter 1.
 * Mikan's Japanese voice actress, Ai Kayano, also voiced Kotomi Ikuta.
 * In Island Mode, she mentions that she enjoys horror movies because of all the blood and helpless people.

Appearances in Other Media

 * Mikan is included in the collaboration of Danganronpa 3 x Hōkai Gakuen.
 * Mikan is included in the second collaboration of Identity V x Danganronpa as a skin for Doctor, Emily Dyer.
 * Mikan is included in the third wave of Danganronpa 1.2 Reload x Divine Gate.
 * Mikan appears as a dress-up item in Atgames.
 * Mikan appears in Sengoku Asuka ZERO x Danganronpa 3: The End of Hope's Peak High School collaboration as one of the many collectibles.

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