What causes extreme lows and highs and anger control issues?

Question

Hi doctor,

I have recently noticed that I have been having a pattern of symptoms since I was a teen, which have gotten worse in recent years. I have extreme lows and highs, unstable relationships and anger control issues. I have noticed that I do not react to bad news the way people around me do. I tend to scream, harm myself and substance abuse. I have been to my GP twice and both times they have said they cannot refer me to a psychiatrist because my symptoms are not severe enough. I feel like I have a personality disorder but I want to have a diagnosis. This is proving impossible for me. Can you shed some light on this?

Answer 1

Hello,

Welcome to icliniq.com.

You are reporting symptoms like mood fluctuations, unstable relationships, anger control issues, self harm, substance abuse, etc. I can understand why you feel like having a personality disorder but these symptoms can also happen in people without personality disorders. You may be probably having traits but whether you will reach the threshold for referral to specialist mental health team/psychiatrist will be best judged by your GP based on your history and clinical presentation. I will advise you to maintain a log of your symptoms on a regular basis like a diary. Record significant events like self-harm episodes.You can use a mood diary online and share it with your GP during your next review.

I note that you are on Prozac (Fluoxetine) for just over a month (attachment removed to protect patient identity). You should be able to see therapeutic response by around 6 -8 weeks. If there is no signficant improvement, request a review. Also, you will benefit by having some talking therapy if you have not already had it. You can request your GP or self- refer to the local IAPT service (Improving Access to Psychological Therapies). You will be seeing a therapist with whom you can discuss further about your concerns and they will feedback into the system about any recommendations. If at anytime you are not able to cope or manage the situation, speak to a trusted family member/friend and contact emergency services.