What is the diagnosis for a patient with a history of childhood trauma, including verbal abuse by their father and sexual abuse by their stepbrother, presenting with symptoms of extreme self-loathing, negative self-image, depressed mood, suicidal ideations, auditory and visual hallucinations, paranoia, and a history of substance use, including tobacco and marijuana, with no prior psychiatric hospitalizations or psychotropic medication use?

Major Depressive Disorder (MDD) with Psychotic Features: Gavin's symptoms of extreme self-loathing, negative self-image, depressed mood, low energy, disturbed sleep, and occasional visual disturbances, along with "voices in my head," suggest a depressive disorder with psychotic features. The history of trauma, substance use, and suicidal ideations further support this diagnosis.

Post-Traumatic Stress Disorder (PTSD): Given Gavin's history of verbal and sexual abuse, PTSD is a likely diagnosis. Symptoms such as paranoia, guilt, anger towards their past self, and visual disturbances could be related to PTSD.
Substance-Induced Depressive Disorder: Gavin's use of marijuana and alcohol could be contributing to their depressive symptoms, and it's possible that their substance use is exacerbating an underlying depressive disorder.
Borderline Personality Disorder: The presence of self-loathing, negative self-image, and suicidal ideations, along with a history of trauma, could suggest borderline personality disorder. However, more information about Gavin's relationships and behavior patterns would be needed to confirm this diagnosis.

Schizophrenia: Although less likely, schizophrenia should be considered due to the presence of psychotic symptoms such as "voices in my head" and visual disturbances. It's essential to rule out schizophrenia, as it would require a different treatment approach.
Bipolar Disorder: Gavin's mood fluctuations and use of substances to manage their mood could suggest a bipolar disorder. However, there is no clear evidence of manic or hypomanic episodes, making this diagnosis less likely.

Schizoaffective Disorder: This diagnosis is considered rare, but it could be a possibility if Gavin's psychotic symptoms are prominent and occur independently of their depressive episodes.
Dissociative Disorder: Given Gavin's history of trauma, a dissociative disorder could be considered, especially if their visual disturbances and "voices in my head" are related to dissociative symptoms. However, more information about their dissociative experiences would be needed to support this diagnosis.