Differential Diagnosis
The patient's presentation suggests a complex interplay of psychological and emotional distress. The following differential diagnoses are considered:
Single Most Likely Diagnosis
- Borderline Personality Disorder (BPD): The patient's history of impulsive behavior, risky behavior, and self-harm (wanting to hit herself when extremely mad) are characteristic of BPD. Additionally, the patient's history of trauma, including sexual, verbal, and physical abuse, as well as abandonment by her parents, is consistent with the typical trauma history seen in individuals with BPD.
Other Likely Diagnoses
- Post-Traumatic Stress Disorder (PTSD): Given the patient's history of trauma, including sexual, verbal, and physical abuse, as well as abandonment, PTSD is a likely diagnosis. Symptoms such as impulsive behavior and self-harm can also be seen in PTSD.
- Major Depressive Disorder (MDD): The patient's history of depression and self-harm (wanting to hit herself) suggests that MDD may be a contributing factor to her presentation.
- Dissociative Disorder: The patient's history of trauma and impulsive behavior may also suggest a dissociative disorder, such as dissociative identity disorder or depersonalization disorder.
Do Not Miss Diagnoses
- Suicidal Ideation: The patient's desire to hit herself when extremely mad raises concerns about suicidal ideation, which is a medical emergency that requires immediate attention.
- Psychotic Disorder: Although less likely, the patient's impulsive behavior and self-harm could be indicative of a psychotic disorder, such as schizophrenia or schizoaffective disorder.
Rare Diagnoses
- Factitious Disorder: The patient's history of trauma and self-harm may be fabricated or exaggerated, suggesting factitious disorder.
- Munchausen Syndrome by Proxy: Although the patient is an adult, her history of trauma and self-harm may be related to a childhood experience of Munchausen syndrome by proxy, where a caregiver fabricates or induces illness in a child for attention and sympathy.