Differential Diagnosis
The patient's symptoms and history suggest a complex psychiatric condition. The following differential diagnosis is organized into categories:
- Single most likely diagnosis
- Major Depressive Disorder (MDD) with Post-Traumatic Stress Disorder (PTSD) features: The patient's history of depressive symptoms since childhood, suicidal ideation, and feelings of worthlessness and guilt are consistent with MDD. The presence of self-loathing, self-pity, and resentment towards individuals involved in past traumas suggests PTSD features.
- Other Likely diagnoses
- Substance-Induced Mood Disorder: The patient's use of tobacco and marijuana may be contributing to their mood fluctuations and depressive symptoms.
- Borderline Personality Disorder: The patient's difficulties with emotional control, self-loathing, and history of traumatic experiences are consistent with borderline personality disorder.
- Schizotypal Personality Disorder: The patient's history of auditory hallucinations, visual misperceptions, and paranoia towards external events may suggest schizotypal personality disorder.
- Do Not Miss
- Schizophrenia: Although less likely, the patient's history of auditory hallucinations and visual misperceptions requires consideration of schizophrenia, particularly given the potential for severe consequences if left untreated.
- Bipolar Disorder: The patient's mood fluctuations and substance use may be indicative of bipolar disorder, which can be deadly if missed due to the risk of suicidal behavior.
- Rare diagnoses
- Schizoaffective Disorder: This diagnosis is less likely, but possible, given the patient's history of depressive symptoms, hallucinations, and delusional thinking.
- Dissociative Disorder: The patient's history of traumatic experiences and feelings of self-loathing may suggest a dissociative disorder, although this is less likely given the absence of reported dissociative symptoms.