Bipolar Disorder: The patient's history of severe mood swings, stress, and difficulty managing emotions, along with the temporary relief from marijuana and improvement in mood with medication, suggests a mood disorder. The presence of visual hallucinations during sleep deprivation could indicate psychotic features, which can be seen in bipolar disorder, particularly during manic or mixed episodes.

Post-Traumatic Stress Disorder (PTSD): Given the patient's traumatic past and difficulty with stress management, PTSD is a plausible diagnosis. The visual hallucinations could be related to flashbacks or dissociative symptoms.
Borderline Personality Disorder: The patient's history of acting out in anger, difficulty letting things go, and mood instability could be indicative of borderline personality disorder. The improvement in mood and reduction in angry episodes with medication and stress management techniques like boxing and mixed martial arts support this possibility.
Substance-Induced Psychotic Disorder: The use of marijuana and its temporary relief followed by the return of symptoms, along with visual hallucinations during sleep deprivation, could suggest a substance-induced psychotic disorder.

Schizophrenia: Although less likely given the patient's age and the presence of clear precipitating factors for the hallucinations (sleep deprivation), schizophrenia is a diagnosis that must be considered due to the presence of visual hallucinations. Missing this diagnosis could lead to inadequate treatment and significant impairment.
Severe Depressive Disorder with Psychotic Features: The patient's severe insomnia, mood changes, and visual hallucinations during periods of extreme sleep deprivation could also be indicative of a severe depressive episode with psychotic features.

Narcolepsy with Psychotic Features: Although rare, narcolepsy can present with hallucinations, particularly hypnagogic hallucinations, which occur during transitions from wakefulness to sleep or vice versa. The patient's history of severe sleep disturbances could potentially align with this, though it's less likely given the other symptoms.
Sleep Deprivation Psychosis: This is a rare condition where prolonged sleep deprivation leads to psychotic symptoms. Given the patient's history of going without sleep for extended periods and experiencing visual hallucinations during these times, this could be considered, though it's more of a symptom complex rather than a standalone diagnosis.