Differential Diagnosis
Single most likely diagnosis
- Anxiety Disorder: The patient's history of health anxiety, agoraphobia, and excessive reassurance seeking behavior are all consistent with an anxiety disorder. The patient's symptoms of emotional distress, torment, weepiness, and dark terrifying emotions are also typical of anxiety disorders. The fact that the patient's symptoms improved with 5-HTP, a serotonin precursor, and then worsened after a hangover and vomiting, suggests a possible link between serotonin levels and the patient's symptoms.
Other Likely diagnoses
- Adjustment Disorder: The patient's symptoms of emotional distress and anxiety began after a series of stressful events, including contracting COVID-19, moving to a new apartment, and starting a new relationship. The patient's symptoms may be a response to these stressors, which is consistent with an adjustment disorder.
- Somatization Disorder: The patient's history of health anxiety and excessive reassurance seeking behavior, combined with the presence of physical symptoms such as nausea and vomiting, suggests a possible somatization disorder.
- Trauma- and Stressor-Related Disorder: The patient's history of trauma, including living in a noisy and stressful environment for six years, and the patient's symptoms of anxiety and emotional distress, suggest a possible trauma- and stressor-related disorder.
Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Pheochromocytoma: The patient's symptoms of anxiety, palpitations, and sweating could be consistent with a pheochromocytoma, a rare tumor of the adrenal gland that can cause excessive catecholamine production.
- Thyroid Storm: The patient's symptoms of anxiety, palpitations, and sweating could also be consistent with a thyroid storm, a life-threatening condition that occurs when the thyroid gland produces excessive amounts of thyroid hormone.
- Neuroendocrine Tumor: The patient's symptoms of anxiety, flushing, and diarrhea could be consistent with a neuroendocrine tumor, such as a carcinoid tumor.
Rare diagnoses
- Mitochondrial Disease: The patient's symptoms of fatigue, nausea, and vomiting, combined with the presence of a MTHFR gene mutation, suggest a possible mitochondrial disease.
- Mast Cell Activation Syndrome: The patient's symptoms of anxiety, flushing, and gastrointestinal symptoms could be consistent with mast cell activation syndrome, a rare condition characterized by excessive mast cell activation.
- Ehlers-Danlos Syndrome: The patient's symptoms of anxiety, gastrointestinal symptoms, and joint hypermobility could be consistent with Ehlers-Danlos syndrome, a rare genetic disorder that affects the body's connective tissue.
The therapy session may have been relevant in that it may have triggered a worsening of the patient's symptoms, possibly due to the emotional distress and anxiety that it caused. The fact that the patient's symptoms improved with 5-HTP and then worsened after a hangover and vomiting suggests a possible link between serotonin levels and the patient's symptoms. The patient's methylation report showing impaired folate and BH4 cycles, moderate methionine cycle efficiency, and slow breakdown of neurotransmitters may also be relevant, as it suggests a possible genetic predisposition to anxiety and mood disorders.