Amnesia, dissociative disorders and delirium Quiz: Ace Your Exams

A 35-year-old person presents to the psychiatrist for evaluation of emotional instability. The patient reports, “No one seems good enough for me. I’ve tried and tried with all the people in my life, but they all seem the same. I picked a fight with one last night and almost stabbed them in the eye with a toothpick.” Shortly thereafter, the patient pivots and assumes a different tone of voice when stating that a friend of theirs wouldn’t have so many problems with dating if the friend simply stopped drinking and exercised more, adding, “As I say, a sound mind makes a sound body and vice-versa.” The patient has a history of polysubstance use, somatic symptom disorder, and epilepsy for which they take levetiracetam. The patient was sexually abused by their parent as a child into their teenage years and coped by using marijuana heavily. Vital signs are within normal limits. Physical exam reveals a disheveled person in no acute distress. Several healed scars are noted on the forearms bilaterally. Blood alcohol level is undetectable, and the urine drug screen is negative. Blood levetiracetam level is currently therapeutic. Which of the following is the strongest risk factor predisposing this patient to this clinical condition?