Differential Diagnosis

Chief Complaint

Patient reports:

alternating between flooding and drought.

Pulse: wading.

Blood pressure: holding its breath.

History of Present Illness

When asked when symptoms began

patient responded:

when someone taught me

love could be revoked.

Affection

came with terms and conditions.

Forever

was always printed

in disappearing ink.

Assessment

Patient exhibits

catastrophic anticipation,

memorizing

every exit

before anyone

reaches

for the doorknob.

Patient displays

unstable relationships

marked by the pull and release

of tides

that can’t determine

where the ocean ends

and land begins.

Patient reports

an unstable sense of self.

Describes experience of identity

failing to remain recognizable

between encounters.

Differential Diagnosis

Rule out: thyroid dysfunction.

Rule out: substance-induced mood disorder.

Rule out: bipolar spectrum disorder–episodic, not pervasive.

Rule out: complex PTSD-dysregulated, but not this hungry for love.

Plan

Continue diagnostic evaluation.

Monitor affective variability.

Return if symptoms persist.

Return if abandonment seems imminent.

Return if every silence sounds final.

Patient advised:

do not confuse recognition with resolution

Final Impression

Patient meets criteria for Borderline Personality Disorder.

Etiology: multifactorial.

Duration: unknown.

Prognosis: beyond the scope of this report.