Differential Diagnosis

The patient's symptoms and history suggest a range of potential diagnoses. Here is a categorized differential diagnosis:

• Single Most Likely Diagnosis
  • Schizotypal Personality Disorder: The patient's long-standing feelings of being watched, thought broadcasting, and paranoid delusions, combined with their history of social anxiety and a family history of schizophrenia, make this diagnosis a strong consideration. The patient's ability to distinguish reality from non-reality and the absence of marked psychotic symptoms also align with schizotypal personality disorder.
• Other Likely Diagnoses
  • Anxiety Disorder: The patient's history of social anxiety, current feelings of fear and anxiety, and avoidance of certain situations (e.g., Zoom sessions) suggest an anxiety disorder. However, the patient reports less social anxiety than before, which may indicate a decrease in symptoms.
  • Post-Traumatic Stress Disorder (PTSD): The patient's history of a toxic relationship with verbal and physical abuse, harassment, and a restraining order could contribute to PTSD symptoms. However, the patient does not report marked avoidance or hyperarousal symptoms.
  • Obsessive-Compulsive Disorder (OCD): The patient's reports of thought blocking, feeling like their mind gets stuck, and questioning coincidences could be indicative of OCD. However, the patient does not report compulsions or repetitive behaviors.
• Do Not Miss Diagnoses
  • Schizophrenia: Although the patient denies perceptual disturbances and reports being able to distinguish reality from non-reality, the family history of schizophrenia and the patient's symptoms of paranoid delusions and thought broadcasting warrant consideration of this diagnosis.
  • Major Depressive Disorder: The patient reports sleeping a lot lately and low concentration, which could be indicative of depressive symptoms. Although the patient denies persistent or marked periods of low mood or anhedonia, it is essential to monitor for depressive symptoms.
  • Trauma- and Stressor-Related Disorder: The patient's history of trauma and abuse could contribute to a range of trauma-related symptoms, including anxiety, depression, or PTSD.
• Rare Diagnoses
  • Delusional Disorder: The patient's paranoid delusions and thought broadcasting could be indicative of a delusional disorder. However, the patient's symptoms have been present since freshman year, and the patient reports being able to distinguish reality from non-reality, making this diagnosis less likely.
  • Brief Psychotic Disorder: The patient's reports of possible previous auditory hallucinations (AH) via persecutory voices, although denied currently, could suggest a brief psychotic disorder. However, the patient's symptoms have been present for an extended period, making this diagnosis less likely.