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DocRob, Doctor (MD)
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My 13 yr old has been cutting herself. I did take her to our

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My 13 yr old has been cutting herself. I did take her to our family doctor and we are on a waiting list that is a year long for counselling. I have invaded her privacy, I came across her journal and yes I read it. When discussing her cutting we did ask specificly if she had any suicidal thoughts and she said no, she does however talk about it in the journal. She also has a letter written to someone named Alex upon reading it seems to be to an unborn child which she says was a miscarriage. We have talked about sex and she says she isnt ready for it yet and she is not sexually active. I dont know if I can believe her. What do I do? Having sex at 13 has serious emotional and health effects and if she wouldnt confide in me do I tell I read her diary? And that I need to know the truth?
Submitted: 2 years ago.
Category: Parenting
Expert:  DocRob replied 2 years ago.
Welcome to Just Answer. I truly hope that you will be able to benefit from my many years experience both in paediatrics, and as a father! I will aim to provide sensible, common sense help, but I need you to read and agree to the contents of this paragraph.

This conversation cannot be used as a substitute for a face to face patient-doctor consultation and is for educational purposes only. Whilst I may give suggestions for you to look at, I cannot diagnose or recommend treatment online and I cannot be held responsible for the consequences derived from the information given here, under any circumstances.

Finally, I would be very grateful if you could rate my answer when completed; I strive for level 3 or above in this but if you feel that you my advice warrant’s negative feedback, please remain in contact with me to see if we can resolve any issues before leaving the feedback. If you still feel that my answer was poor and that negative feedback is warranted, I will then fully respect your wishes.

If you continue this conversation, you are accepting these as our “terms”.

Deliberate Self Harm or DSH as it is usually referred to is a very complicated issue, and the emotional underpinnings are well beyond the scope of this sort of discussion over the internet. I am very pleased that you have some therapy in the offing; cognitive behavioral therapy (CBT) is the most beneficial in these instances and I hope that this is the "counseling" that you are referring to. Psychoanalytical can also be helpful, but there is a less decent evidence base, and it can have the negative impact of making matters worse in the short term.

I presume from your post that you have not confronted her about the contents of the diary.

The 2 separate themes that you bring up of underage sex and a potential miscarriage are indeed of massive importance. It is possible that these events (especially the latter) could be trigger points for the self harm (assuming that the self harm followed the trigger).

The difficulty we now face is what to do about it. Self harm in these instances often represents an "ego defense" of sorts, it is her minds way of avoiding confrontation with an issue that she finds too much to cope with (put very simply). Therefore, you need to tread very carefully and avoid direct confrontation. At the moment, the proverbial "cat is out of the bag" and so, whilst there will be important health consequences, the priority at the moment will be to ensure she feels a strong sense of support from her family; to know that you are there for her no matter what. Perhaps you could also mention that she could schedule an appointment with her GP (primary care doctor) without you present, so that she can discuss anything to do with sex that she may not want to broach with you. As someone who has worked in this area, that is in no way unreasonable, and is surprisingly common. At least that way you might be able to get some piece of mind that she is having her physical health needs looked after.

Finally, the issue of suicide is a difficult one: I am absolutely obliged to tell you that if you have serious concerns about her likelihood to commit suicide in the near future, you should have her assessed my a mental health professional ASAP. Whilst waiting for therapy, it may well be that she needs to start antidepressants or mood stabilizers in order to settle her mood and thoughts. These can be scary propositions but can be absolute lifesavers, literally.

I have made assumptions throughout this answer. If you would like to correct me, or ask me further questions, please do so; I would be delighted to try to help further. If you have been happy with this answer, please rate it highly (you can still ask me follow up questions!)


Customer: replied 2 years ago.


Thanks for your reply. you are right I have not told her I read it.There are some assumptions I would clarify. The cutting started before the possible miscarriage. which was dated sept 7. the cutting started when she started dating her boyfriend and they would fight and also her father and her butt heads alot,normal stuff he wants her to stay young and she wants to grow up, Dad can be very black and white which makes it hard for them to not fight. I have talked about the doctor being a resource for information on sex but she refuses as she insists she isnt going to have sex anytime soon. She has said she has stopped cutting herself but the diary says she has started doing it again. I am also concerned because her boyfriend broke up with her this morning and obviously her coping skills are not what they should be. I guess what I really want is to know how to get her to talk to someone.I talked about guidance counselors,


her aunt or my 16 yr old niece mostly when I knew she seemed depressed and I didnt feel she was talking to me. With the cutting though and because she came and told me about it I was hoping we had hit a cross roads and when things were over whelming she would confide in me and I could help her through(with professional help) now I dont know.Obviously she needs to speak to someone how do I get her to realize it better then harming herself?and actually necessary.

Expert:  DocRob replied 2 years ago.
Hi, thank you for your candid response; it really helps. It also shows just how difficult this time must be for you.
Unfortunately the question you pose is the million dollar question in this whole area of psychiatry. The only thing that we do know is that professional therapy helps, as do medications; SSRIs (eg prozac) and lithium. It will not happen overnight, and sadly, I have yet to meet anyone who can truly say that a crossroads even happens and lasts without other things in place.
You sound to be doing the right things yourself. Ensure she knows you are there to talk; and that she knows you will just listen (and not offer advice if that is what she wants). If she can get that with her counselor or the aunt etc, then encourage that. It is essential that she feel non-judged when she opens up about her self harm and emotional issues. It is also very difficult to just listen as a mother or father when it is your little girl in front of you in obvious pain.

In direct answer to your question: you cannot MAKE her realize... you can be there for her, you can let her know that alternatives are available, you can reward positive behavior.

Also, do not underestimate the power of journals. Journals are a well documented, evidence based means of controlling mood. They can help encourage insight, and they can be a more positive means of expressing the destructive thoughts of self harm.

Ultimately, I feel formal therapy will be the way forward for you, but in the meantime non-judgemental support and "just listening" may be a better way to approach things than risking butting heads ... taking the correct path will probably be both the longest and hardest if you want to achieve real, lasting improvements.

Good luck, and all the best. I am sure with a caring mother such as you, half the battle is already won... we just need to get the rest into place.

Best wishes

Rob
DocRob, Doctor (MD)
Category: Parenting
Satisfied Customers: 84
Experience: Doctor & Father
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