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Taking Wellbutrin. Have mood swings, feeling abandoned with behaviour and decision making. History of sexual abuse

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Practicing since : 2004
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35 year old female. 5 feet tall. Approximately 108 lbs. In good physical shape. Works out 4x/week. Had taken Celexa in past. Currently taking Wellbutrin. Experienced severe bowel & stomach irritation recently (bloody stool, throwing up blood) 3 months ago. 2 bachelors degrees. Works full time as RN in level 3 NICU & ECMO units. 2 children (ages 7 male & 3 female). Both children both premature. Male at 31 6/7ths weeks & female at 33 5/7ths weeks. Male diagnosed as failure to thrive. Children have same father. Currently separated from husband/father of children for past 9 months due to subject's filing of Civil Protection Order against husband/father of children. Shares custody of children with husband/father of children. Currently in process of divorcing husband/father of children. Born to 16 year old, unwed mother. Raised by maternal grandmother for 1st 5 years of life. Biological father 100% absent. Sexually abused by stepfather from at least age 10-15 & possibly before. Moved multiple times before age 10. 1st sexual experience outside of sexual abuse by stepfather was that of rape at age 15. 14 different sexual partners from age 16-22. Abused alcohol & some soft drugs between ages 13-22. Extended family strictly maternal side, composed nearly all of women from broken families. Experienced domestic abuse both as abuser & abused on a physical, verbal & emotional levels. Although subject does not believe she ever acted as the abuser. No hospitalizations or involvement of police due to domestic abuse. Has been in therapy for past 3+ years. Continues to demonstrate profound swings in mood, behavior & decision making. Often misreads clearly defined intent of others communications. Frequently exaggerates facts of events. Intense feelings of abandonment, betrayal & victimization. Strong tendency to flight when confronted. Has difficulty communicating wants, needs, & feelings to others. Polarized sense of rights & justice as victim. Can be very depressed & sad one moment. & angry, aggressive & violence the next. Subject's biological mother has undergone treatment for various stage 3 cancers over past 3 years & continues to do so. Husband/father of children had been out of work for past 33 months, but is now employed full time. Would like to know probable mental health diagnoses given above info. Please feel free to ask clarifying questions if needed. Thank you for you help.
Posted Tue, 2 Jul 2013 in Mental Health
Answered by Dr. Ashish Mittal 1 hour later
Thanks for your query.

Important aspects of your query are:
•     35 year old female
•     Significant past history of emotional, physical and sexual abuse.
•     History of having multiple sexual partner and multiple substance use.
•     Received antidepressant like celexa in past and currently on wellbutrin. In therapy for past 3+ years
•     Complaints of: swings in mood, behavior & decision making/ Often misreads clearly defined intent of others communications/ difficulty communicating wants, needs, & feelings to others/ very depressed & sad one moment. & angry, aggressive & violence the next/ exaggerates facts of events/ lack of insight for being abuser.
•     Current query: regarding diagnosis of her problem.

Your history is well written. You appear to be a medical person, considering quality and detail of your query. It will be easier to make you understand her complex problem.

She appear to suffering from personality disorder, cluster B type, more specifically mixed histrionic and borderline traits. But for final diagnosis regarding personality she requires some of the following tests to assess personality, which is administered by trained psychologist: Sentence completion test, Rorschach Inkblot Test, Thematic Apperception Test (TAT) or Minnesota-Multiphasic Personality Inventory (MMPI).

Personality disorder is also a predisposing factor for other psychiatric disorders (e.g., substance use, suicide, affective disorders, impulse-control disorders, eating disorders, depression and anxiety disorders) in which it interferes with treatment outcomes of other psychiatric disorder and increases personal incapacitation, morbidity, social complication and mortality of these patients. In her case she is having depressive symptoms. There is also need to look for possibility of bipolar disorder in her case, during follow case.

Persons with personality disorders are far more likely to refuse psychiatric help and to deny their problems than persons with anxiety disorders, depressive disorders, or obsessive-compulsive disorder. Personality disorder symptoms are alloplastic (i.e., able to adapt to, and alter, the external environment) and ego-syntonic (i.e., acceptable to the ego). Persons with personality disorders do not feel anxiety about their maladaptive behavior. Because they do not routinely acknowledge pain from what others perceive as their symptoms, they often seem disinterested in treatment and impervious to recovery.

I hope this information has been both informative and helpful for you. In case of any doubt, I will be available for follow ups.

Wish you good health.
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