Brief Answer:
Certainly not typical case of bipolar

Detailed Answer:
Good afternoon. My name is Dr. Saghafi. I am a neurologist in XXXXXXX OH.

I wholeheartedly disagree with the PA who called her probable bipolar. Self mutilation and very near antisocial personality traits (threatening to harm family members) is anything but bipolar. However, the PA's recommendation of depakote is on the right track....but obviously for the wrong reasons. However, I would be extremely careful on dosing because pediatric patients have different metabolic patterns than adults. You need guidance from a professional though certainly the dose she's on seems inadequate for her condition.

As a neurologist I always recommend getting a full neurological workup first before stating unequivocally a patient has purely psychiatric disorders. Especially, if you're telling us that she has had off center behaviors since age 2. There are specific inborn errors of metabolism which result in patients self mutilating themselves. This is an actual disease process due to an enzyme deficiency and should not be mistaken for a primary psychiatric or psychopathic disorder. The fact that her father had similar signs and symptoms makes it even the more likely that whatever she has as a diagnosis is genetically based. She may also benefit from an imaging study such as PET scan or functional MRI.

Also, I don't believe her behavior has much to do with PTSD as one colleague suggested since the young age at which she began exhibiting problems was long before she would've experienced those family losses.

Have you reached out to the teachers in school? She must have an IEP and her primary school teacher may have some tips on how to control her behavior if you'd ask them. She also may be under the vigilance of the school psychologist who may have some thoughts as to a diagnosis.

However, I do believe that she is best seen and treated (as others have said) by a pediatric PSYCHIATRIST.

Here is a thought that strikes me as I am sitting here thinking about her problem. Many children (including those with borderline IQ's and personality disorders) get a lot of mileage out of something called equine therapy. Ever here of it? Using horses for therapeutic impressions on children. It's done with autistic kids, kids with language disorders, and kids with behavioral and violent reactive disorders. It also goes under the name: HIPPOTHERAPY.

Here, check this link out: http://www.americanhippotherapyassociation.org/

I've also pulled a few contact numbers of people in Illinois who might be able to answer questions for you:

HorseFeathers Therapeutic Riding, NFP , YYYY@YYYY
http://horsefeatherscenter.org      
Lake Forest, IL

BraveHearts at the Bergmann Centre , YYYY@YYYY
Poplar Grove, IL

Midwest Center for Children’s Development
YYYY@YYYY
http://www.mccdtherapy.com      Crystal Lake, IL


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