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Q. My daughter behaves very differently and does not like to discuss her problem. Please help.

Answered by
Dr. Anuj Khandelwal
and medically reviewed by Dr. Vinodhini. J
This is a premium question & answer published on Aug 01, 2020 and last reviewed on: Aug 26, 2020

Hello doctor,

My daughter is 17 years old. I do not know whether she is mentally sick or not. But I observe the following characteristics for the past two years.

She is getting her menstruation twice a month. Her mood is turbulent, she will laugh but get angry shortly. She cannot sit in one place even in school. The teacher used to take class but she sit in different places. She cannot pass from her grade 6 to the next grade for the past three years and will not give attention to learning. She has not done her homework or any assignments on her own. She is naughty in the classroom.

She cannot sit in one place at home also and she will go anywhere without informing the parents and come after two days. We parents do not know her address. She is highly interested in sittting with street boys and sleeps with them. She always does what she feels as right and lie too much. She is careless about her life and I guess she loves sex.

She is not afraid to go somewhere in the midnight and live with street boys. When parents ask her about the problem she is not willing to talk with them. Sometimes she helps the family by doing some work. Please advise.

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Hello,

Welcome to icliniq.com.

Some of your symptoms suggest hyperactivity, inattention, oppositional and defiant behavior, hypersexual, and high risk behaviors. Along with this, there are some menstrual problems.


The Probable causes:

Genetics along with environmental factors are responsible for such behaviors and problems. Adverse childhood experiences along with parenting troubles and clash between parents can cause such personality traits.
Also I suspect some hormonal imbalance and thyroid problems which needs evaluation.

Investigations to be done:

CBC (complete blood count). Complete thyroid profile. FSH (follicle stimulating hormone), LH (luteinizing hormone), serum testosterone levels. Serum copper levels,and MRI brain.

Differential diagnosis:

Borderline personality disorder. Nymphomania
ADHD (attention defecit hyperactivity disease) with conduct problems. Mental and behavioral disturbances in a case of hyperthyroidism.

Probable diagnosis:

Borderline personality disorder.

Treatment plan:

Tablet Axepta (Atomoxetine Hydrochloride) 18 mg 1-0-1, Risdone (Risperidone) 1 mg 0-0-1
for 10 days. REBT (rational emotive behavior therapy) and DBT (dialectical behavior therapy) counseling sessions.

Preventive measures:

Avoid any substance abuse if any. Avoid getting into any confrontation for now.

Regarding follow up:

After 10 days.


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