I'm going out on a limb, but noticing your comment about having sleep problems for a couple of decades, maybe sleep apnea...or...something else in the realm of neurological, which has now begun affecting your mood. Same with the self-abuse. If you can't make a convincing case for your psychiatrist or primary care doctor to send you for neurological testing or to see a psychoneuroendocrinologist(a psychiatrist who focuses on the endocrine system/thyroid, adrenals, pituitary, etc.)discuss this with your family and have them carry the ball, since chasing down doctors is quite stressful. The psychiatrist might be correct, but most(in my experiences)aren't House. They, like doctors in other specialties, aren't curious or interested in challenging cases. It's easier to write a script for one or more drugs and send you on your way. Don't accept this diagnosis as the final word. That doctor could have made a bad call.