Differential Diagnosis

The patient's presentation is complex, with a history of trauma, impulsive behavior, depression, panic attacks, and self-harm. Considering these factors, the differential diagnosis can be organized into the following categories:

• Single Most Likely Diagnosis

  • Borderline Personality Disorder (BPD): This diagnosis is the most likely due to the patient's history of impulsive behavior, self-harm (hitting herself), intense emotional dysregulation (depression, panic attacks), and a pattern of unstable relationships (doesn't trust others, isolates to self) following significant trauma (verbal, physical, sexual abuse, and abandonment).

• Other Likely Diagnoses

  • Post-Traumatic Stress Disorder (PTSD): Given the patient's history of verbal, physical, sexual abuse, and abandonment, PTSD is a likely diagnosis. Symptoms such as isolating to self and not trusting others could be part of the avoidance symptoms of PTSD.
  • Major Depressive Disorder (MDD): The patient's depression could be a standalone diagnosis or comorbid with other conditions like BPD or PTSD.
  • Panic Disorder: The presence of panic attacks suggests this could be a separate diagnosis or part of the symptomatology of another disorder like PTSD or BPD.

• Do Not Miss Diagnoses

  • Suicidal Ideation or Behavior: Given the patient's history of self-harm and depression, assessing for suicidal ideation or behavior is crucial. It's a potentially life-threatening condition that requires immediate intervention.
  • Dissociative Disorders: The history of trauma could also suggest dissociative disorders, which might not be immediately apparent but are critical to diagnose due to their impact on the patient's functioning and treatment approach.

• Rare Diagnoses

  • Factitious Disorder: Although less likely, the possibility of factitious disorder (where a person repeatedly acts as if they have a physical or mental illness when they are not really sick) should be considered, especially if there are inconsistencies in the patient's reported history or symptoms.
  • Somatization Disorder: Now referred to as Somatic Symptom Disorder, this could be considered if the patient's symptoms are primarily physical complaints that cannot be explained by a medical condition, and if these symptoms are causing significant distress and result in substantial disruption of daily life.

Each of these diagnoses requires careful consideration of the patient's full history, behavior patterns, and symptomatology to ensure accurate diagnosis and appropriate treatment planning.