Differential Diagnosis for Denise
Single Most Likely Diagnosis
- Borderline Personality Disorder: Denise's history of unstable relationships, emotional dysregulation, impulsivity, and self-destructive behaviors (such as substance abuse and "trading sex for drugs") are consistent with the diagnostic criteria for borderline personality disorder. Her reports of not making emotional connections and only caring about what benefits herself may also suggest a lack of empathy, which can be seen in borderline personality disorder, but is more characteristic of antisocial personality disorder. However, the presence of intense emotional dysregulation, fear of abandonment, and self-destructive behaviors points more towards borderline personality disorder.
Other Likely Diagnoses
- Antisocial Personality Disorder: Denise's self-reported lack of emotional connections, impulsivity, and history of manipulative behavior (such as "trading sex for drugs") could suggest antisocial personality disorder. However, the presence of emotional dysregulation and self-destructive behaviors is more characteristic of borderline personality disorder.
- Substance Use Disorder: Denise's long history of substance abuse, including marijuana, alcohol, meth, and other substances, meets the criteria for a substance use disorder.
- Schizoaffective Disorder: Denise has a reported history of schizoaffective disorder, bipolar type, and exhibits symptoms such as auditory and visual hallucinations, which are consistent with this diagnosis.
Do Not Miss Diagnoses
- Post-Traumatic Stress Disorder (PTSD): Denise's history of "trading sex for drugs" and other potentially traumatic experiences may suggest PTSD. It is essential to assess for PTSD, as it can have a significant impact on treatment and prognosis.
- Neurodevelopmental Disorders: Denise's early onset of substance use (starting at age 13) and her reported history of drinking at age 6 may suggest underlying neurodevelopmental disorders, such as attention-deficit/hyperactivity disorder (ADHD) or fetal alcohol spectrum disorder.
Rare Diagnoses
- Dissociative Identity Disorder: Denise's reports of responding to internal stimuli and having intense emotional outbursts could suggest dissociative identity disorder. However, this diagnosis is relatively rare and would require further evaluation to confirm.
- Intermittent Explosive Disorder: Denise's history of aggressive outbursts and impulsive behavior could suggest intermittent explosive disorder. However, this diagnosis is relatively rare and would require further evaluation to confirm.