: Why do authors use variations on a character's name within a single story? I am having trouble understanding why authors use multiple version of a character's name in the same story. I feel

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There are good reasons authors call the same character multiple names. But that doesn't necessarily mean it's a good idea.

The reasons are:

realism - many, perhaps most people in real life are known by multiple different names to different people.
character development - the use of different names can illuminate the relationship between two characters (i.e. is that relationship intimate or formal, respectful or abusive?).

With that said, as you mentioned, it can be confusing. And realism is never an adequate excuse for bad writing decisions. My advice would be to limit use of this technique, and either make sure that (a) it is clear who is being referred to, or (b) confusion is part of the point.

Thus, if your reader already knows your character is named Samuel Johnson, it will be relatively clear if the character is called "Sam," "Sammy," "Son," "Dad," and "Mr. Johnson" by his friend, mother, father, daughter and employee respectively. (As @Amadeus pointed out, it should generally be one name per relationship, and the narrator counts as a relationship.) Or, if your POV character is supposed to be confused when Samuel's college frat brother calls him "Squoink," that can be okay too. But don't assume that just because you, the author, know that "Dr. Stevens" and "Becky" are the same person that the reader will easily or happily make that same jump. And do keep in mind that even a reader who isn't confused may not want the work of learning and keeping track of all the different names.

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Most of us have answered to different names at various points in our lives.
Why We Have Multiple Names
Take my nephew's name; Robert.
Robert is his formal legal name. A common nickname for Robert is Bob (I don't know why, but it is), and that is considered a casual name. Bob is name #2 . Rob (a first syllable of his formal name) is also a nickname; so name #3 ; though in this case most named "Robert" will go with either Bob or Rob, not both.
However, growing up, many people use an affectionate diminutive form of a name by adding "-y" to it, if it sounds right: Bobby and Robby, names #4 and #5 derived from "Robert".
People can gather names by their role, "Dad, Father, Pop, Grandpa" or "Mom, Mother, Mama, Grandma". Name #6.
And finally, people acquire actual affectionate nicknames from their friends in childhood or young adulthood that have nothing to do with their real name, but often something they did, or some unique ability or trait. So a nickname can be name #7.
So somebody might be nicknamed "Runner," not because they were a speedster on the track, but because they are so good at billiards they can "run" a table (pocket all the balls without missing once). It's a rare skill.
Likewise, I knew a guy in college nicknamed "Chugger" because he could chug a beer faster than anybody else in his crowd, and this was considered an admirable talent.
People go by different names because most of us have segmented lives, or different groups of people where we belong, but the groups don't have much interaction with each other. And although we may not have different names in each of these groups, we might.
I have a professional academic life; but my colleagues there (other than one) don't know the name of any of my family and other friends.
I have a domestic life with a spouse and child and grandchild.
I have an extended family life with my siblings, inlaws and their children, call it my "Christmas Family".
I have a "friends" group with similar leisure interests; some people have multiple such groups, each with a specific interest, that do not interact much: A chess-playing group, a writing-group, a tech group, a church or charity group, a political group.
Again, most people use the same name again and again in all of these groups, but not always. In his professional life and political activity groups my nephew goes by "Robert," but at Christmas family gatherings and birthday parties and sports watching parties he will always be "Bobby".
Using Multiple Names in Writing
As you should gather, different names are used in different social circumstances, and can carry different levels of emotional significance or emotional detachment. For my nephew "Bobby" is reserved for the people he grew up with and raised him; it is a personal name reserved for his friends. Call him "Bobby" in his office, and he will correct you: "I prefer Robert."
Some beginning writers take all these names and try to use them for variety, because they think one name sounds too repetitive. Don't worry about that, readers don't care, and it just gets confusing if you are cycling through five names again and again. In narration, pick ONE name and stick with it, even if other characters are using different names.
Instead, use multiple names the way they evolve; in different disconnected (or weakly connected) social circles, and understand that the name a character uses to refer to "Robert" is an indicator of the social circle in which Robert knows them. This can make it clear to the reader, if you ensure only people that knew him in college call him "Runner". Only his mother and family relatives call him "Bobby" (maybe including his wife). Only his professional colleagues call him "Robert".
This will seem more natural to the reader. You can also use it to create minor conflict, a college buddy calling him "Runner" becomes an important client of his firm, where he wants to be called "Robert".

Robert rolled his eyes. "Okay, dude, you keep calling me Runner, I'll start calling you Chugger. You want that?"
Charles lit up. "That's awesome, dude! It's a deal! Gimme five!"
"No, Charlie! its not a deal! Jeezus!"

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The same reason people in real life go by different names in different contexts.

A doctor might go by Dr. Grey with her patients and subbourdinates, Dr. G to very young patients, Merridith to friendly acquaintances, and Mer to close friends, and Merri with her parents. Which name people use for her sets the context for the situation. It would be weird to refer to a doctor by first name in a medical context, and it would be equally weird for lovers to refer to each other by full name when running for their lives. This explains the use of many different names in dialog and first person narration. Even if a story is written in third person, it may be less confusing for the narration to use the same names as people use in the surrounding dialog.

Nicknames can also convey conflict (such as when a character shows anger or disrespect by using an inappropriate moniker), or the evolution of a character (such as a character going by Timmy as a young child and changing to Timothy when he becomes an adult).

How can an author make it clearer that two different names refer to the same person?

In your example of Sammy/Sam, most readers would probably easily see the resemblance, but for names that look or sound very different it is important to establish the names refer to the same character. For cases where a character is sometimes referred to by first name and sometimes by last name, the character should ideally be referred to by full name in the first scene where they are introduced. For nicknames that have no relation to the original name (such as The Rock for a character named Johnson), you probably want to have a transition the first time the less common name is introduced. Maybe the character is listening to a recording of The Rock fighting and a second character says "that's you up there, Johnson."

For much more complicated naming systems, especially where multiple characters end up with the same name in different circumstances, the easiest way to help the reader is to describe some obvious unique feature of the character every time they appear. For example, in War and Peace there are two characters that can be called Nikolai, but one goes by Nikolai the majority of the time and one only uses that nickname when among family unrelated to the first Nikolai. The two characters also have different titles. So the first character is introduced to the scene by the title of Prince if there may be ambiguity and the second is referred to as Little Nikolai or as a hussar.

Which name to choose for a character in a given sentence should always be an intentional choice based on the context. A good writer shouldn't alternate between names for the pure sake of variety, but because the nickname conveys some meaning. All of the different names in War and Peace, for example, are honestly a bit hard to follow, but they are consistent within a scene and the complicated naming scheme is essential to the story because it conveys so much information about where each character fits into a slice of Russian society.

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