A 27-year-old man is referred by his therapist for medication evaluation with a longstanding history of emotional volatility. He describes intense anger reactions lasting 2-4 hours that are consistently triggered by perceived slights or rejection from romantic partners, followed by desperate attempts to prevent abandonment including excessive texting and threatening self-harm. He reports chronic feelings of inner emptiness and an unstable sense of identity, noting that he frequently changes career goals, friend groups, and personal values. He acknowledges multiple episodes of cutting his forearms during relationship conflicts. His sleep pattern is consistently 7-8 hours per night regardless of mood state, and his energy level does not significantly fluctuate. He reports persistent low mood with a PHQ-9 score of 16. Prior records from two previous psychiatric evaluations show one provider diagnosed bipolar II disorder and another diagnosed borderline personality disorder.