[18O] With compulsive behaviors, anger outbursts, and self-destructive tendencies

Patient Description

An 18-year-old individual assigned 'other' at birth reports experiencing compulsive decision-making, obsessive behavior towards a specific race, self-destructive behaviors, and inappropriate amounts of anger. These anger outbursts occur almost daily, lasting about 30 minutes, and have been present for the past two years. The patient also reports difficulty falling asleep and staying asleep. They have experienced feelings of sadness or hopelessness recently and have had thoughts of self-harm or harming others. There is no substance use reported. The patient has a family history of psychiatric illnesses such as depression and anxiety. They were diagnosed with depression at age 11 and ADHD around age 6. Currently, they are taking 50 mg of Zoloft daily and 5 mg of Melatonin. The patient notes that they tend to obsess over people who show them kindness, leading to compulsive decisions and self-destructive behaviors, which they feel limits their social and romantic relationships.

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Arora's Assessment

What might be happening

Based on the symptoms and history you've provided, here are some possible explanations:

1. Obsessive-Compulsive Disorder (OCD)

  • Rationale: Your description of obsessive thoughts about people who show you kindness and compulsive decision-making aligns with symptoms of OCD. OCD is characterized by unwanted, persistent thoughts (obsessions) and repetitive behaviors (compulsions).
  • Typical Treatments: Treatment often includes cognitive-behavioral therapy (CBT), specifically exposure and response prevention (ERP), and medications such as selective serotonin reuptake inhibitors (SSRIs) like Zoloft.

2. Depression and Anxiety

  • Rationale: Your history of depression, feelings of sadness, hopelessness, and self-destructive behaviors suggest that your depression may not be fully managed. Anxiety can also manifest as irritability and anger outbursts.
  • Typical Treatments: Adjustments to your current medication, additional therapy sessions, or exploring other medications might be necessary. CBT is also effective for managing both depression and anxiety.

3. Attention-Deficit/Hyperactivity Disorder (ADHD)

  • Rationale: ADHD can contribute to impulsive behaviors and difficulty managing emotions, which might be exacerbating your current symptoms.
  • Typical Treatments: Behavioral therapy and medications like stimulants or non-stimulants can help manage ADHD symptoms.

What you can do

Self-Destructive Behaviors and Anger

  • Seek Professional Help: It's crucial to consult a mental health professional as soon as possible. They can provide a comprehensive evaluation and adjust your treatment plan.
  • Coping Strategies: Practice mindfulness and relaxation techniques such as deep breathing exercises, meditation, or yoga to help manage anger.
  • Journaling: Use MDandMe to journal your symptoms, track your progress, and share insights with your healthcare provider.

Obsessive Thoughts and Compulsive Decisions

  • Therapy: Cognitive-behavioral therapy (CBT) and exposure and response prevention (ERP) can be very effective. Discuss these options with your therapist.
  • Medication: If your current medication isn't fully effective, your doctor might adjust the dosage or try a different medication.
  • Mindfulness: Engage in mindfulness practices to help manage obsessive thoughts.

Sleep Issues

  • Sleep Hygiene: Maintain a regular sleep schedule, create a restful environment, and avoid caffeine or electronics before bed.
  • Melatonin: Continue taking melatonin as prescribed, but discuss any ongoing sleep issues with your doctor.

What you should look out for

Given the severity of your symptoms and the potential for self-harm, it's important to seek medical care as soon as possible. Reasons to seek care even more urgently include:

  • Worsening Thoughts of Self-Harm: If you have any immediate thoughts of harming yourself or others, seek emergency help immediately.
  • Increased Impulsivity: If your compulsive behaviors become more frequent or severe.
  • Changes in Mood: Any significant changes in your mood, such as increased sadness or hopelessness.

Remember, while I can provide information and suggestions, it's essential to consult with a healthcare professional for a formal diagnosis and treatment plan. If you have more questions or need further assistance, feel free to continue the conversation.

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4 mo ago


People Also Ask


What are the common symptoms of Obsessive-Compulsive Disorder (OCD)?

Common symptoms of OCD include persistent, unwanted thoughts (obsessions) and repetitive behaviors or mental acts (compulsions) that the person feels driven to perform. These can interfere significantly with daily activities and social interactions.


How can depression and anxiety manifest in daily life?

Depression and anxiety can manifest as persistent sadness, hopelessness, irritability, anger outbursts, difficulty concentrating, and changes in sleep or appetite. These symptoms can affect one's ability to function in daily life and maintain relationships.


What are effective treatments for managing ADHD symptoms?

Effective treatments for managing ADHD symptoms include behavioral therapy, which focuses on developing organizational skills and coping strategies, and medications such as stimulants (e.g., Adderall, Ritalin) or non-stimulants (e.g., Strattera) that help improve focus and reduce impulsivity.


What strategies can help improve sleep issues related to mental health conditions?

Strategies to improve sleep issues include maintaining a regular sleep schedule, creating a restful environment, avoiding caffeine and electronics before bed, and using relaxation techniques like deep breathing or meditation. Melatonin supplements can also be helpful, but it's important to discuss ongoing sleep issues with a healthcare provider.

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