Q. I have a step daughter who is cutting herself. She has done it twice successfully and was caught in the act the third time. She said she feels anger when she does it and that she doesn't feel the pain. It was done on her wrists and she was very angry that her mother found out. She is on Adderall for A.D.D. and was just put on Celexa. She took 2 doses of Adderall together when she attempted this last time. In the past she would chew her nails till they bled, pull her hair out, bit a hole in her lip that required stitches and was purging for three weeks in eight grade. She just turned seventeen. Her father and I do not have custody and her mother will not communicate with us. She supposedly is to see a psychiatrist once a month and a social worker once a week. She does not like the social worker and won't go back. When she cut this last time she hadn't seen a counselor for about 3 weeks. The second time she cut, she told us she intended to kill herself.

A. Cutting is a good prognosticator for medications helping. Cutters do very well on medicines with the vast majority, > 80%, having resolution of self-mutilation. Celexa is a good drug, but she will need dosages of 60-80 mg/day to treat BPD if this is what she has. Talk to her doctors about increasing the dosage. Therapy will be much more effective once the BPD is treated pharmacologically.