Vignette 4
Rachel has been referred to a psychologist by her primary care doctor for diagnostic clarification. This
past year, Rachel has struggled with periods of extreme irritability. She tells the psychologist she will go
through periods of time lasting almost two weeks in which "everything pisses me off" and she "just has
to keep moving." She describes that, during these times, her thoughts are "out of control." Because of
her mind is constantly racing, she is unable to sleep for more than an hour at a time. She often stays
awake cleaning her house or pacing around the house. She will sometimes go out at night due to her
mood. However, on several occasions, she ends up going to bars, getting drunk, and getting into fights.
She doesn't remember the specific reasons for the fights other than already being irritated. Rachel
reports there was an incident in which she was arrested and charged due to fighting in a bar. These
mood changes seem to come out of nowhere; she describes her mood as "out of control," as she is
worried she will have one of these mood shifts again. She says that overall her mood is "normal" but
that she sometimes has "low periods" lasting a few weeks
