Mental Health: How would YOU diagnose this client?

[UumiNurseX]

So I know we don't do medical diagnoses as nurses...of course not. But in the nursing school world, one can't help but to especially when you see a set of signs and symptoms. So here is a case I have but I wouldn't know how to properly diagnose this client...see what you think:

-Client is 27 yr old, 5'5", 162 lbs, african-american female, no children, single

-Does not drink heavily, occasionally wine, quit smoking and claims never smoked "packs". Bought a pack and lasted 3-6 months....was not heavy smoker and smoke 1-2 cigarettes a week to assist in bowel movement.

-Client is a student in strenuous computer science program

-Client talks to herself every morning, in public, and anytime she is alone

-Client is socially isolated: "I have no friends because I tend to run into the wrong people all the time. I feel like a virtual outcast at school. I think people feel as if they can't approach me".

-Client has male friend who states: "I think she has anger problems. When she is mad at me she hits and throws things at me. She has attacked me with knives and screwdrivers". Client's male friend has evident lacerations on lateral side of left arm. Client's male friend states she is sorry quickly after doing so.

-Client worries that people will never like her and do not want her around.

-Client eats out of boredom; eats mostly junk food and is depressed about weight gain.

-Client spends a great amount of time alone

-Client is dishonest about basic background info (i.e. hometown, age, date of birth, high school attended, college attended, etc.)

-Client's male friend states: "She has this nice, sweet side to her that is so lovable. But then she has a side where she is like a female 'Scarface' and is down right scary".

-Client sleeps 5-6 hours a week.

-Client has inadequate water intake (states: "I only drink about 2-3 cups a day, 8 oz cups but can't really drink water unless I ate something chocolate").

-Client states: "I think about death alot of the time. I also wonder why I am here and what is my purpose. God put me here so people could hate me, but why?"

-Client states: "I hate having acne, it makes people hate me".

I have more but don't want to make this post too long....just from what I have gathered it is so hard to tell! Let me know what you guys think!

[Maladroit, BSN, RN]

Not that I know ANYTHING about diagnosing patients, first and foremost I'll state that I know I'm talking out of my VERY limited knowledge. I do have a Bachelor's in Psychology and was raised by two psychologists. I would say it seems like Borderline Personality Disorder. She talks to herself possibly to avoid her loneliness and the rejection from others. Unstable relationships is another tip-off. Thoughts of suicide and deep emptiness make the Borderline Personality Disorder seem fitting. Paranoia about others' opinions of her and them "hating" her are another big defining trait that makes sense, as do the temper tantrums and the like. It almost seems textbook to me...check the DSM though, I'm going from experience and memory here, so that will be more thorough. Other diagnoses to consider: antisocial personality disorder, Schizophrenia (doubt it here, but it's possible). I get curious like that ALL THE FREAKING TIME, so I totally get it. I'm really good at Psych, too bad I don't have a real interest in it. I like the inpatient units, but can't stand outpatient psych - cause that's mostly people just complaining and talking (which is healthy and necessary, but boring). This was fun, thanks.

[kgh31386, BSN, MSN, RN]

my question to the OP is what do YOU think?

[Fitzy819]

I would guess borderline too... but that is totally just a guess. Not antisocial because you said that the male friend states that she feels sorry for her actions after she has hurt him.

When she talks to herself, is she talking to voices or just "thinking out loud"? Does she have any thoughts of suicide?

[UumiNurseX]

my question to the OP is what do YOU think?

Hey! Well, I was stuck between borderline personality and schizotypal personality disorder, but it IS a personality disorder.

[UumiNurseX]

I would guess borderline too... but that is totally just a guess. Not antisocial because you said that the male friend states that she feels sorry for her actions after she has hurt him.

When she talks to herself, is she talking to voices or just "thinking out loud"? Does she have any thoughts of suicide?

When talking to the client, client says she does NOT hear voices. Client says she talks to "people who are real" (certain classmates) as if they were there with her but they are not present.

Client states that she has thoughts of suicide but would never dream about carrying them out for fear of hurting her mother and younger brother.....

(I have like tons of info but would rather give it in increments to avoid long posts)

[nursel56]

All of the above symptoms could be features of any one of hundreds of DSMIV diagnoses! I doubt if the person who is supposed to be diagnosing this stuff (the psychiatrist) even knows himself! Maybe he throws a dart at the copy of the codes on his wall - with very few exceptions he could make a case for any one of them he hits. My particular favorite is bipolar disease without manic phase or the like. Huh? How the heck is that different from regular depression?

http://en.wikipedia.org/wiki/DSM-IV_Codes_(alphabetical)

[~Mi Vida Loca~RN, ASN, RN]

Interesting, I have a lot of experience with BPD and that didn't jump out at me at all. Some other things came across my mind but not that one. I don't think there is near enough information though to try and narrow it down. Psych disorders are so much more involved than a few scenarios and a friends very subjective opinion.

Just my thoughts.