Lacey is an attractive young woman but seems to be unable to maintain a stable sense of self-worth and self-esteem. Her confidence in her ability to "hold on to men" is at low ebb, having just parted ways with "the love of her life". In the last year alone she confesses to having had six "serious relationships".

Why did they end? "Irreconcilable differences". The commencement of each affair was "a dream come true" and the men were all and one "Prince Charming". But then she invariably found herself in the stormy throes of fights over seeming trifles. She tried to "hang on there", but the more she invested in the relationships, the more distant and "vicious" her partners became. Finally, they abandoned her, claiming that they are being "suffocated by her clinging and drama queen antics."

"No one messes with me. I stand my ground, you get my meaning?" She admits that she verbally assaulted previous boyfriends. What made her so angry? She can't remember now, but it must have been something really big because, "by nature, I calm and composed."

As she recounts these sad exploits, she alternates between boastful swagger and self-chastising, biting criticism of her own traits and conduct. Her affect swings in the confines of a single therapy session, between exuberant and fantastic optimism and unbridled gloom.

One minute she can conquer the world, careless and "free at last" ("It's their loss. I would have made the perfect wife had they known how to treat me right") - the next instant, she hyperventilates with unsuppressed anxiety, bordering on a panic attack ("I am not getting younger, you know - who would want me when I am forty and penniless?")

Lacey likes to "live dangerously, on the edge." She does drugs occasionally - "not a habit, just for recreation, maybe 2 or 3 times a week, a little wine, a little weed". She reports having gotten 2 DUIs in the past year. "I am more careful now; they won't catch me again." She is a shopaholic and often finds herself mired in debts. She went through three personal bankruptcies in her short life and blames the credit card companies for doling out their wares "like so many pushers." She also binges on food, especially when she is stressed or depressed which seems to occur quite often.

Lacey has had 7 jobs in the past year; she generally cannot keep a job for longer than a month, either by her choice or her employer. " I don't think I was meant to work."

She sought therapy because she is having intrusive thoughts about killing herself. Her suicidal ideation often manifests in minor acts of self-injury and self-mutilation (she shows me a pair of pale, patched wrists, more scratched than slashed).

What is the primary diagnosis? What are all of the secondary diagnoses?