Posted by jay on May 1, 2002, at 21:00:33
In reply to Help - 12yr old caught cutting!, posted by cmcdougall on May 1, 2002, at 12:53:55
Carly,
My god, I am sorry you have to deal with this, but it's sad as more and more kids are presenting psychiatric problems on levels never experienced. I don't want to act like I am something *special*, but I am a social worker who deals with both pre and post adolescent psychiatric issues, and sad to say your case is very common. That doesn't mean it is ever acceptable, though.
I've checked through the literature in regards to OCD and Paxil, and am a bit confused on this one because she was on SRI monotherapy before, but maybe the doctor is trying to treat the Dx of the anxiety component of the OCD. The reality is, though, Paxil has not stood strong as itself in relieving anxiety symptoms. Bringing cutting into the picture adds major complications, as I have not seen a lot of data involving Paxil efficacy and self-harm in kids. The fact is, it usually takes a trial of a number of medications to find the one that works best, but sadly time is what we don't have. For a co-existing anxiety disorder, I don't see why Paxil monotherapy would be used. Either a newer anti-convulsant/mood-stabilizer or/and an atypical antipsychotic seem to be used in similar cases I have seen in conjunction with an SRI or Anafranil. Many Pdocs I know see OCD as an extension of a major anxiety disorder, and even it's effects such as self harm. The problem is the SRI's as monotherapy in these cases have scant evidence to back up their efficacy. Benzos aren't usually used because they induce disinhibition, but again, I have seen them be of some use in *certain* and very scrutinized and managed situations.
Most of all though, and this is something you and your stepdaughters Mom can work to do, is possibly initiate some type of formal therapy work. It sounds like Dad needs to get his stuff together to, and he *has* to face this, even if he doesn't like it. Even just a supportive "family dynamic" therapy can be very helpful, but this is something you will want to look at as long term maintenance therapy. It *won't* relieve your daughters symptoms asap as medications will. Combined treatment in this area, from my experience and from the literature, seems to have the most efficacy. Also, don't forget to check out Dr. Bob's resources on treatment of children.
Also, on another note, I don't mean to be blunt, but tell your husband and his ex they have to get over their own problems, period, as their daughters life is at risk. It is as plain and simple as that. If they need their own help and support systems, fine, but they are not what is at risk here.
I can toss you my email addy if you feel the need to talk more. But, please keep posting, and I and others will do our best to help.
Best wishes...hopes are with you
Jay
> Dear Babblers,
>
> I just spent the last two hours hyper-focused on writing a very detailed letter about the subject line - my 12 yr old stepdaughter. Wouldn't you know it, right before submission I was kicked off line! I can't be bothered re-doing the whole thing so here is a summary.
>
> 12 yr old, healthy female, not yet menstruating, treated for OCD w/ Luvox 100mg/2xday for the past year. This child had touching/counting rituals that severely impacted her daily activities (strong history of OCD on both sides of family). The Luvox seemed to be keeping the symptoms manageable. The child experiences a lot of anxiety at school because she tries so hard to hide the OCD. Add that to the "normal" troubles of being a girl in 6th grade, and you can just imagine what this innocent is suffering.
>
> Recently "Girlie" wanted to try out for the drill/dance team. Her mom encouraged it, thinking it would help her fit in if she made it. I secretly prayed she wouldn't make the team, thinking (upon reflection of my own 6th grade experiences) that fitting in with that group would just create additional stress.
>
> Her mom stated that during try-outs, she had never seen Girlie so animated - eyes darting back and forth, etc., however she made the team. Later that week, after a fight w/ her "best friend", Girlie sliced her upper arm w/ a pair of scissors! She tried to blame the cuts on the dog, but when pressed admitted what she had done. Girlie described an immediate feeling of relief and calm after cutting. She claims this is the first time, but I wonder...
>
> Pdoc (child specialist) was called immediately and is switching Girlie from Luvox to Paxil. I do not know the downward titration schedule of the Luvox, but I warned her mother that there could be withdrawal symptoms. Anyone out there know what they might be?
>
> Girlie is now taking 30mg Paxil per day. Her OCD symptoms seem to be spiraling out of control right now. Non-stop touching/tapping and counting, running up and down the stairs, etc. Sunday night, Girlie said she wanted to kill herself! Her mom thinks the thought of being in school and having to work SOOOO hard to hide her disorder are too much to bear right now. I think thats probably right. Girlie has an appt w/ pdoc later this week. He wants to rule out BP - may add a mood stabilizer. I have not noticed any BP behaviors, but as the "wicked" stepmother I only see Girlie every other weekend.
>
> I know some of you are cutters and OCD sufferers. Please, please help me to help this innocent baby and her mom. There is a lot of bad blood between my husband (Girlie's daddy) and Girlie's mom. They do not communicate at all, and I know this stresses the poor kid out even more. I have a fairly good relationship w/ the mom, and she will listen to what advice I can pass along.
>
> Thanks in advance.
>
> Love and luck,
> Carly
poster:jay
thread:104638
URL: http://www.dr-bob.org/babble/20020425/msgs/104692.html