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Chief complaints: excessive anger out burst since child hood An attempt to commit suicide on the morning of the

day of admission. Hopi: History of excessive anger outburst since childhood. Patient says that she gets angry very soon since childhood. It is progressive in nature and currently of severe intensity.. She says she suddenly gets angry and she cannot control the anger once she gets angry upto a hour. She gets verbally abusive at that time irrespective of the place, throws anything which is around like mobiles, glass, utensils and may times she has broken most of the things. She says she cannot control and she cannot think for even a second when she gets angry most of such occasions are accompanied by impulsive acts to try and harm herself like strangulating, cutting, banging the head, pulling her hairs. If family members try to calm her down either in a calm way or using force the anger becomes more intense and prolonged. She sometimes cries / threatens or attempts for suicide/ abuses parents/ mother in law and grandmother usually of not giving enough love and care for her. Currently from past one year she has started to get physically abusive towards them frequently. Any acts of reproach following anger or feeling guilty of what she did is not present and she says they deserved it because they made her get angry and they have only made her the person she is today. Patient usually doesn't have food for one or two days properly following anger outbursts and remains to herself without interacting with any family members. Following fights with friends/ neighbours she stops speaking to them completely after such outbursts most of the times. Patient says though she cannot think clearly during that she will be well aware of herself and the surrounding during that time. She says it all started when her father left the home and shifted to some other town because of his economic crisis. she used to get angry when her friends started teasing her that her dad left the place because he could not clear his debts and that their dad gets them clothes but her dad cant she use to initially feel sad and later on started getting irritated and get angry. At home they started blaming her that her birth was a bad sign and she bought ill fate to the family and in reaction to this when she gets angry she use to be beaten by her family members. She says though her anger was more it was not of this severity or frequency And it worsened following the death of her Anna ( male caretaker who took care of her after father left to whom she was most closest to ) as she started feeling more lonely and nobody to take care of her needs anymore. and following marriage which she was not feeling but she herself cannot understand why she agreed for that marriage her anger outburst increased. Patient says that her in laws and husband ill treated her and use to physically and verbally abuse her very frequently and force her to get dowry. She use to get angry whenever they abuse her of not doing work when she had actually done it. When they try to hurt her , to protect herself and when husband use to try and interact with her after getting stunk and make sexual advances. She says she started to get very angry even at the sight of her husband as he had EMA, alcohol Dependance, gambling habit so she left husband place about one and half year back and came back to mothers place and her anger outbursts have become more at her mothers place as they dont give her freedom

and they blame and speak cheap of her because she has left her husband and staying here. Patients mother says that she had anger out bursts since childhood. On refusing to fulfil any wish would result in severe anger outbursts since childhood. When she was around 8 it was severe with excessive crying throwing things and breaking them threatening to attempt suicide. On one occasion when refused to give bit more of ghee she threw the food plate and went to terrace and was about to jump and many occasions where in anger as a child banging head against wall. As a child she was disobedient in school and at home and on trying to tell her mistakes either in calm or with forceful, way she use to get angry and never use to ask sorry or try to correct her mistake. Frequent fights wit fights were not observed till 14. One her ANNA( care taker ) passed away her anger outbursts became more severe. Mom agrees that had been accused as being ill fate when she use to get angry and destroy things she denies any correlation of her fathers economic crisis to her birth from herself or pts sisters. she says when she is angry it's difficult to control her and she will be fully conscious of what she is doing. On many occasions she starts fighting on the streets for small issues and even on the day of her marriage just for telling her to be calm on the day of marriage. She pulls her hair and throws sand or mud on her head throws things threatens of suicide even now as she did in childhood. She says her behaviour had been consistent and had worsened after marriage. Marriage was done with her permission and after marriage she started complaining of that in laws and husband are abusing her and use to get angry that they are not believing her and helping her instead telling her to adjust. Mother denied any direct demand of dowry from in laws side except they asked to return 10000 which pt father had borrowed from her father in law long back. History of feeling that everybody is trying to harm her in one way or the other since childhood. History of feeling that everything around has been plotted in such a way that she suffers. She say except anna all my family members always wanted to hurt me and blame me that I am their ill fate. Excessively accusing sisters and friends of try to plot against her that she gets bad name or scolding since childhood and often mother says her accusation were found baseless and actually it would be her fault. Patient denies any belief that people are spying on her, someone is coming to kill her but feels that black magic might be done against her from her mother in law. She admits may be she is wrong in interpreting situations immediately without thinking as something where she is victimised or plotted to make her suffer but at that time she feels so as she has experiences being victimised on many occasions before in the past. History of believing that what she says and dreams come to true since childhood. Pt illustrates many occasions where she what she dreamt had come true and also what she cursed or spoke good about someone that becomes true and says she knows that what she dreams comes true so she gets afraid when she sees any dreams and also prevents herself from.cursing someone because she thinks that will come true. On further questioning regarding her claims pt ended up saying I

don't know sir but this is my experience and I know it's truth. She did not claim that she has some abnormal or supernatural power but just believes that her dreams and words becomes true. Excessive belief in black magic and explaining that her mother in law had done black magic to get her married to her son and also did black magic to make her marriage fail so that she can get another girl with dowry. History of difficulty in maintaining social relationships since childhood As history obtained by mother Though pt avoids interaction with mother and grandmother she interacts actively with other relatives neighbours and friends and even with strangers. Since childhood she gets close to people very quickly and later after few weeks for any small issue especially if they try to tell her what's right or wrong she gets very angry and scolds them that they all are in one group blaming her and abuses them excessively and stops interacting with them. She says that she was not interested in making friends on asking why she replied she was just not interested and her classmates were all use to blame her and dint like her, even those friends she made she fought with them after few weeks and stop interacting. At present she has no friends of her age group and not in touch with any from school days. Mother says she gets shocked to see the over intimacy and affection she shows with strangers or neighbours and most occasions acts as though they are more close to her than the family members and if asked she replies that family members don't care for her and so she is close to people who care for her. she is tolerant to some extent and interacts with sisters and their kids but once gets irritated for any small issue she will abuse them. History of believing that people both known and unknown are referring to her and speaking since last 1.5 years when her family members talk any female she knows that they are talking about her and she gets angry and starts yelling at them and even after family members telling that they were not talking about her issue she would not believe it. Pt agrees that may be only some occasions they might be talking about someone else but at that point of time she cannot calm herself down and she would be convinced that they are talking about her and reacts to it with anger. Even on some occasions when watching television she thinks they are telecasting about her in some indirect way and gets irritated, when she sees strangers also she feels that they are talking anoint her but won't react to it. On further questioning to explain her belief she says that may be they are not talking about her but she feels so on some occasions. Pt says she doesn't think before doing things when she is angry and she just do what she feels like at that time since childhood and though later in thinks and feels she should think and act she cannot control anger and acting impulsively .. She has attempted self harm/ suicide on many occasions when angry and on most occasions in presence of relatives and another impulsive acts are throwing and breaking things History of excessive lying and having secret conversation with guy/guys from past one and half year is given by mother. Mother first got to know about her affair 4 months after marriage when she tried to meet her ? X bf which the exact relation between them nit revealed by the patient to anyone. Mother says the problem in marriage started after her husband and in

lawsuit to know that she had met him.. For the next 4 months husband was not talking to her and afterwards she promised that she won't do it again anything like that and that guy was just a friend. Then mother in law started accusing her of not of good nature and frequent fights broke out and husband started drinking everyday and stopped coming to home. Patient says that he accused her that she is fat not good looking and she looks like devil and he use to go to her only for sex when he is drunk and she use to get angry and not cooperate. Mother gives history she was very stubborn and just like at home she use to make small issues big with husband and never tried to or made an attempt to build the relationship. She was accused of not taking care of husband like giving food or in daily activities by the husband and in law and also for not doing any household work at home as she don't know cooking and never tried to learn cooking and use to sit and watch movies not interacting with any one in the family. So when mother in law or husband try to tell her mistakes in which ever means she use to get abusive and inform her mother that they are abusing for dowry. Abusive both verbal and on one or two occasion physical between pt and her mother in law. On one occasion mother in law allegedly try to burn her with boiling ragi preparation but no burn marks are present and pt says because her face was wet the hot ragi preparation just slipped off the face without causing any burn marks. She left husbands place about one and half years back and never returned and no interest shown by husband to take her back. After coming back to mothers place on one occasion the guy who was staying opposite to her house had complained that she is writing love letters to him and messages him but on asking she denied and later that guy was evacuated from the locality ....she was sent to tailoring classes even there she was seen to be calling from booth and ? Meeting some guy after which she was stopped from gng to tailoring class. About few months back pt was caught messaging to two or three different numbers at night or whenever she gets access to mobile with contents like chinnu gm gn and other dearly content etc which the details not given by the mother and even at this occasion she refused to give Ny details whom she was messaging and on restricting her for these behaviours her anger outburst increased. On her repeated request she was allowed to go to work at her Aunts place from past one month and where she had phone access and family members received complaints that she was frequently seen using phone and so on the morning of the day of admission when she was about to leave to work her father mother aunt and grandma prevented her from going to work she started yelling outside of the house of depriving of hers freedom came inside home and threw things around. She attempted to cut her hand with the knife. Pt says she was not doing to threaten them she felt there is of no use leaving when she has no freedom and wanted to end her life but family members prevented her from doing so. Pt doesn't express any remorse regarding the act and now she feels that what she did was wrong but in the abuse of parents and that anger what she did was correct. Patient gives history of feeling hopelessness since 7 years only on occasions of fights and quarrels and during that patient gets repeated ideas that there is no use living as she is a burden to everyone and nobody cares for her and it's better to commit suicide and these ideas persist for one or two days following which it subsides if there are no more fights. During this phase she controls from acting out and on occasion she and of methods but doesn't execute. Mother says her threats

of suicide are numerous and attempts of self harm following fights are almost common since 1.5 years especially. History of feeling sadness since 7 years following fights which subsides in half to one day if she is left alone. No history of pervasive feeling of sadness or lack of interest in any activities Pt says that sadness is more than happiness in her life because there are fights very frequently at her house and if left to herself she will be relaxed reading books and watching television and she won't feel any sadness. History of mood swings since childhood Increased since 7 years progressively worsening moderate to severe intensity. Gets sad for trivia, issue excessively angry or happy for trivial issues interlaced with normal mood. Appetite : decreased since one and half years because every time she comes to eat family members will talk about issues which she feels they are talking about her either she gets angry or feels they are talking because she is burden and eating food and living in their Money so she won't feel like eating Sleep: normal sleeps at 10 wakes at 5 to go to work since one month before that she use to sleep till 8 or 9 in the morning. No night terrors or night mares Bowel and bladder: normal and regular No history of lack of interest in pleasurable activities / decreased energy and easy fatiguability. No history of lack of concentration Pt says she is hopeful that her life gets better in coming future and has and to earn her own money and stand on her feet and be happy in life. No history of pessimistic views about future. No history of excessive unreasonable happiness reported either by mother or pt/ excessive activity No history suggestive of grandiose ideas / excessive spending No history of talking to self or smiling to self No history excessive apprehension with palpitations sweating etc / phobias No history of hearing or seeing things not seen by others. No history suggestive of delusions of control No history suggestive of bizarre delusion no history of any substance abuse or dependance no features of binge eating or dieting No history suggestive of derealisation or depersonalisation No history of head injury/ loss of consciousness / involuntary bladder and bowel movements