Differential Diagnosis for Tessa

Single Most Likely Diagnosis

• Bipolar Disorder: Tessa's history of significant mood swings, suicidal attempts, and previous diagnoses of bipolar 1 and 2, along with her current symptoms of increased anxiety, poor concentration, feeling down, and racing thoughts, support this diagnosis. Although she doubts the diagnosis of bipolar 2, her past and present symptoms align with the disorder.

Other Likely Diagnoses

• Attention Deficit Hyperactivity Disorder (ADHD): Tessa reports symptoms of feeling overwhelmed, poor concentration, irritability, easily distracted, and difficulty with task organization, which are characteristic of ADHD. Her reliance on writing down important tasks to remember them also suggests difficulties with working memory and organization.
• Major Depressive Disorder: Tessa's current symptoms of feeling down, fatigued, irritable, depressed impulsivity, and little interest or pleasure in activities could indicate a major depressive episode. Her history of suicidal attempts and feelings of worthlessness also support this diagnosis.
• Anxiety Disorder: Given her history of anxiety disorder diagnosis and current symptoms of increased anxiety, this remains a likely diagnosis. The anxiety could be contributing to her overall distress and impairment.

Do Not Miss Diagnoses

• Borderline Personality Disorder: Although not directly mentioned, Tessa's history of suicidal attempts, self-harm (slitting her wrist), and significant emotional dysregulation could suggest borderline personality disorder. This diagnosis is crucial to consider due to its implications for treatment and management.
• Substance Use Disorder: There is no mention of substance use, but given her age and history of psychiatric issues, it's essential to rule out substance use as a contributing factor to her symptoms.

Rare Diagnoses

• Cyclothymic Disorder: If Tessa's mood swings are less severe than those required for a bipolar disorder diagnosis but still significant, cyclothymic disorder could be considered. However, her history of suicidal attempts and hospitalizations suggests more severe episodes, making this less likely.
• Schizoaffective Disorder: Although Tessa denies any history of auditory hallucinations (AVH) or delusions, if such symptoms were present in the past and not reported, schizoaffective disorder could be a consideration. However, without psychotic symptoms, this diagnosis is less likely.