What Can I Do For My Daughter's Out Of Control Behavior?

QUESTION:

Dear Dr. Heller,

As an infant she was very attached to mother.  As a toddler and in elementary school she was quiet, shy, serious, easy to manage, sensitive emotions - especially when outgoing kids would dominate the teacher's attention.  In Intermediate/Junior High - same as above, had fun if comfortable, very athletic, popular, good student, willing to please, some moodiness, very mature, conscious of appearance, always well liked by teachers and dependable.  She liked being in the background, but needed to be involved or wanted.  As a Freshman and Sophomore - same as above, she started dating, made wise decisions and had high morals.  Gloominess was apparent at times.  She was  pretty and popular, but self-conscious.  Grades were slipping some.  In her Junior year she started drinking alcohol, got involved in "sexually compromising" situations, lying, sneaking out, dating boys with drug habits, listening to degrading music, shoplifting (jail), cutting, angry, loner with parents, friends became very important, caught purging, which seems to be gone now.  Senior year - Same as Junior year, rollercoastering from better to bad again.  She tried marijuana, became emotionally dependent in dating relationships, and undependable in others.  Sports/grades/school attendance were all slipping.  She became forgetful, preoccupied with "self-first", ran away in anger, didn't care about anything, had thoughts of death and low self worth even when told better.

She is going to give up an athletic scholarship and has thoughts of quitting her last senior semester of high school.  She said she makes bad decisions because she wants to, but knows better.  She makes statements that she is 18 and nothing can be done about it.  We're loving, involved, supportive parents and give quality time.  Our goal has been to be gentle but firm, and to pick our battles carefully.  Our attempts to help are looked upon as self-righteous and enrage her.  She cannot take the answer "No" without a physical and verbal fight.  Our good relationship has turned into an explosive one and her siblings are now suffering due to it.  We've read, studied, gone to a psychologist and two psychiatrists.  We got differing opinions from ADD to low self-esteem, or depression.  Prozac worked in the beginning, but results are fading.  Adderall seems to help.  She's in the process of getting a CT Scan and all blood work came back normal.  She's miserably confused - one minute in remorse and the next enraged.

Thanks.

ANSWER:

She needs her diagnoses made and comprehensively treated.  Interestingly your comment that she was "easy to manage" in her early years is a sign of ADD - the inattention type. 

The BPD seems a very strong possibility since it begins at puberty and is so strongly associated with attention deficit disorder.  Prozac "fading" usually means the BPD is present, and the individual is experiencing chronic dysphoria (anxiety, rage, depression and despair).  This requires the addition of an epilepsy medication like Tegretol

I encourage you to look at the screening test.  I also strongly recommend you look at the BPD section.