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Hello and thank you for using JustAnswer. I am very sorry that your son is having these issues, I can understand how distressing this can be for you. As you know, I cannot officially diagnose your son without a face to face evaluation, but I can speculate as to the possible cause for his behavioral issues. I would like to ask a few questions to get a good idea of what is going on:
1. Does your son have rapid mood swings between depression, anxiety, and anger?
2. Does he suffer from panic attacks or nightmares?
3. Is he sociable or likable? Or does he appear awkward in front of others?
4. With the rage issues, does he attack others or damage property?
5. Can he maintain a level of focus or does he appear easily distracted most of the time?
Thank you for your response. Given the age range of when these symptoms started I would say that a preliminary diagnosis of both ADHD and a Traumatic Disorder (similar symptoms to PTSD but not caused by fear of death, injury, or sexual abuse) would be most likely. ADHD can account for being easily distracted and the anger issues that you pointed out that occur nearly every day, while a Traumatic Disorder would account for the mood swings, panic attacks, and being a recluse unless he was comfortable with the person. Usually given your son's age, I would perform objective assessments like a Personality Inventory and an ADHD psychological test to confirm my suspicions given that he would be diagnosed so late.
A diagnosis of Borderline Personality Disorder (BPD) would be possible, but because the age of onset was so young (as you stated it started in 6th or 7th grade) I would not make this a primary possibility since personality disorders tend to manifest in late adolescence. Another possibility is that your son may have had a Traumatic Disorder growing up, given how his father treated him, which can account for some of the symptoms and had an Oppositional Defiant Disorder (ODD) which can account for the rage, outbursts, and possibly defying authority. Now ODD can lead to BPD later in life and as you said his symptoms got worse, so BPD would be a rule out.
Your son displays a unique behavioral set that have worsened and evolved over time, so right now I would say Traumatic Disorder and ADHD as a primary diagnosis, but a rule out of BPD should be made as well given. I hope this makes sense and please let me know if you have any questions or concerns as I am happy to assist you.
For ADHD, it is a neurobiological disorder that only responds to medications. Psychostimulants like Adderall, Vyvanse, or Ritalin are considered the best, ***** ***** are highly addictive as well. There is an alternative for this though in the form of a non-stimulant medication called Strattera which can also be very effective. The Traumatic Disorder could be treated with either or both Cognitive Behavioral Therapy (CBT) or an antidepressant medication...usually the combination approach is considered the most effective though.
As for BPD, this disorder is life long and responds to both medications and Dialectical Behavioral Therapy (DBT). Treatment with BPD is very difficult and because it cannot be cured the use of antidepressants, mood stabilizers, benzodiazepines, and/or atypical antipsychotics is necessary with the use of this specific form of therapy.
Well you mentioned that counseling has not been helpful, so I think a 6 month trial on the medications would be beneficial to see if he responds well to the medication regimen. Psychotropic medication unfortunately is a trial and error approach though as it is not an exact science so finding the right dose and medication for him can be frustrating. I truly wish your son all the best and I hope that his symptoms will lessen very soon.
*Please do not forget to leave a positive rating at the top of the page so that I can get credit for helping you. Thank you, ***** ***** appreciate it.