Differential Diagnosis

The patient's presentation is complex, with a history of intellectual disability, PTSD, trauma, and abuse. The current symptoms of anxiety, self-loathing, perseveration, emotional dysregulation, irritability, and impulsivity suggest several potential diagnoses. Here is a differential diagnosis organized into categories:

• Single Most Likely Diagnosis
  • Post-Traumatic Stress Disorder (PTSD) with Complex Trauma: The patient's history of witnessing her father's attempted suicides, his eventual death, and her mother's death from cancer, combined with a history of trauma and abuse, supports this diagnosis. The current symptoms of anxiety, emotional dysregulation, and perseveration are consistent with PTSD, especially given the patient's ongoing therapy for PTSD and EMDR.
• Other Likely Diagnoses
  • Attention Deficit Hyperactivity Disorder (ADHD): The patient's history of psych testing suggesting ADHD, along with current symptoms of impulsivity and perseveration, supports this diagnosis.
  • Adjustment Disorder with Mixed Emotional Features: The patient's recent history of significant losses (both parents) and her current symptoms of anxiety, emotional dysregulation, and irritability could be indicative of an adjustment disorder.
  • Depressive Disorder, Unspecified: Although the patient denies feeling depressed and having anhedonia, her symptoms of self-loathing, emotional dysregulation, and irritability could be indicative of a depressive disorder, especially given her history of trauma and loss.
• Do Not Miss Diagnoses
  • Bipolar Disorder: The patient's symptoms of irritability, impulsivity, and emotional dysregulation could be indicative of a bipolar disorder, particularly if there are underlying mood swings or if the patient's symptoms worsen over time.
  • Neurodevelopmental Disorder Associated with Prenatal Alcohol Exposure: Given the patient's history of intellectual disability, it is essential to consider the possibility of prenatal alcohol exposure, which could contribute to her current symptoms and cognitive functioning.
• Rare Diagnoses
  • Traumatic Brain Injury (TBI): Although less likely, it is essential to consider the possibility of TBI, especially if the patient experienced physical abuse during her childhood, which could contribute to her current cognitive and emotional symptoms.
  • Dissociative Disorder: The patient's history of trauma and abuse, combined with her current symptoms of emotional dysregulation and perseveration, could be indicative of a dissociative disorder, such as dissociative identity disorder or depersonalization disorder.