QUESTION:

My four-year old granddaughter bites herself on the arm when she becomes very frustrated or angry. Could this be an early indication of BPD self-mutilation? Either way, what can we do for her?

DR. HELLER'S ANSWER:

No, the BPD doesn't start until puberty. The two most likely diagnoses are depression, particularly with psychotic features and OCD. I generally try Prozac followed by Risperdal for individuals like this, and the results are usually dramatic.

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