Differential Diagnosis
The patient's presenting problems and current symptoms suggest a complex mental health condition. The following differential diagnosis is organized into categories:
- Single most likely diagnosis
- Borderline Personality Disorder (BPD): The patient's lifelong chronic depression, anxiety, narcissistic tendencies, suicidal ideation, and past trauma, along with current symptoms such as impulsiveness, frequent aggression, and negative self-talk, are consistent with BPD. The patient's lack of goals, feelings of emptiness, and difficulty concentrating also support this diagnosis.
- Other Likely diagnoses
- Major Depressive Disorder (MDD): The patient's feelings of hopelessness, lack of motivation, and little interest or pleasure in doing things are characteristic of MDD. The patient's suicidal ideation and death thoughts also support this diagnosis.
- Post-Traumatic Stress Disorder (PTSD): The patient's past trauma and current symptoms such as anxiety, impulsiveness, and negative thoughts/negative self-talk are consistent with PTSD.
- Bipolar Disorder: The patient's racing thoughts, impulsiveness, and buying things without thinking about it may indicate a manic or hypomanic episode, suggesting bipolar disorder.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Schizophrenia: Although less likely, the patient's disorganized thinking (e.g., racing thoughts, negative thoughts/negative self-talk) and suicidal ideation warrant consideration of schizophrenia.
- Neurodevelopmental disorders (e.g., ADHD): The patient's difficulty concentrating, impulsiveness, and frequent aggression may be indicative of an underlying neurodevelopmental disorder.
- Rare diagnoses
- Narcissistic Personality Disorder: While the patient's narcissistic tendencies are noted, this diagnosis is less likely given the presence of other more prominent symptoms.
- Dissociative disorders: The patient's past trauma and feelings of emptiness may suggest a dissociative disorder, although this is less likely given the absence of more characteristic symptoms such as dissociative amnesia or identity disturbance.