Mikan Tsumiki is a student of Hope's Peak Academy's Class 77-B, bearing the title of the Ultimate Nurse. In Danganronpa 3: The End of Hope's Peak High School's Despair Arc, she is shown before the events that lead to the Tragedy, portraying her time as a normal student and her subsequent fall into despair. Her background is marked by severe physical and emotional abuse suffered during her childhood from family members and at her previous school, Lapis Lazuli Girls' High School. This history of mistreatment heavily shapes her personality: she is painfully shy, anxious, and prone to bursting into tears at the slightest provocation. She constantly apologizes, stutters, and assumes that others dislike her, often offering to let herself be hurt or to strip in a desperate attempt to avoid hatred. Mikan is also notably clumsy, frequently falling into embarrassing poses, which she apologizes for repeatedly. Despite her extreme insecurity, she possesses a genuine desire to care for others and demonstrates competence in medical matters, performing autopsies and providing nursing care with more confidence than in her social interactions. Her motivations are driven by a deep-seated need for acceptance and validation, making her vulnerable to manipulation. This vulnerability is exploited by Junko Enoshima, the Ultimate Fashionista, who uses the Despair Video to brainwash Mikan into becoming a devoted member of Ultimate Despair. In the Despair Arc, Mikan is shown worshiping Junko, and her personality shifts from timid to fanatically loyal, willing to commit atrocities in the name of despair. Her key relationships include a cruel dynamic with Hiyoko Saionji, who bullies her relentlessly, and a warmer connection with Ibuki Mioda, who treats her with kindness. She also appreciates Hajime Hinata for his gentle approach. Mikan's role in the Despair Arc is as a member of Class 77-B who succumbs to despair alongside her classmates, ultimately joining the Remnants of Despair and participating in the chaos of the Tragedy. Her development highlights the contrast between her outwardly fragile demeanor and the inner hostility and despair that emerge after brainwashing. Her notable abilities as the Ultimate Nurse include advanced medical knowledge, surgical precision, and the capacity to perform detailed autopsies. When transformed into a Remnant of Despair, she wields a large syringe as a weapon and adopts a white nurse outfit, representing her corrupted caregiving. Her story illustrates how deep-seated trauma can be exploited to turn a compassionate person into an instrument of destruction.