Q: I have two daughters aged 19 and 15. The elder one is in 1st year engineering and is quite normal in all respects. Both are very free and frank with me and all aspects of male and female body structure, hormonal function were explained to them in a very casual and friendly atmosphere. My second daughter attained puberty at the age of 14 years. What saps my whole energy is her highly rebellious attitude to conform to any of the ordinary social norms and wanting 100% attention of all the family members all the time. I am a working mother and I cannot give that much time. Her father was also at home for full 4 years just to meet her emotional needs but it did not bring any change in her behaviour and temperament. Furthermore, she is against telling these facts to any friend or doctor. As a 5 year old child she used to prick her nails for hours on end. At the age of 10, she used to prick between her eye brows with her finger nails and it used to bleed at times. She said that she has a sensation of creeping insects under the skin at that point. We sought doctors help but nothing really came out of it. Till a year back she used to hit her toe nails against the wall before going to bed saying that she gets an itching sensation in her nails. Any attempt to counsel her by her sister or me ends up in a fight. What worries me most is her recalcitrant nature. Paradoxically, she is a very scared kid who cannot see a road accident and is scared of staying alone. She does not like any of her class mates and never allows her sister or me to spend time with our friends just to draw attention towards her. Once I dared to tell a gynaecologist (whom I used to take her for irregular periods) and she kicked up a big row on return from the doctor. Under these circumstances I am neither able to take medical help nor help of any friend. Her father feels that in course of time she would be alright and is against taking medical help. Her tantrums, fantasy of becoming a boy and misbehaviour coupled with her bad score card are sapping all my energy. Even little things like taking food at regular times and asking her to manage her own affairs leads to avoidable confrontations upsetting everybody. Added to all these problems is her passion for money which made her lie to us a couple of times. I brushed it aside as a teenage problem but now it is going out of control and I am deeply worried about her. Please advise.

A:Your concern is justified and appropriate. It does seem from your report that your daughter has a significant problem, which may well be either developmental problem with or without a personality problem requiring attention, and or a psychiatric problem with adolescent onset. Such behaviour does occur in some adolescents for brief periods as part of the growing up adjustment problems, but it seems to me that your daughters problem is certainly more serious and long lasting to be considered as part of the growing up problem. So, the need for professional consultation and help is clear,and this should be done as soon as possible. The problem of getting her to agree to professional help or consultation is a real one, as is the case with such problems. Essentially, it will have to be first agreed upon in the family that professional help is required. Once that has been done, the persuasion of the person concerned will have to be done in a firm and consistent manner by all concerned which may well take time and effort. It will be good to remember that such efforts at motivating people for help seeking can be arduous and difficult, and will have to be persistent, without losing hope. All this is easier said than done, but there aren't too many options but to do make this effort. Sometimes, in moments or periods of weakness and/or in a crisis situation, motivating such persons for help can become easier. Once the professional consultation is agreed upon and sought,the skill of the clinician can be helpful in retaining the person in treatment. The nature of treatment which will be suitable and the effectiveness of the treatment can be judged only after a few consultations. As such, all things considered, the road ahead is not going to be very smooth. The opinions and the advice provided above may not seem very positive or encouraging, but it is necessary to face the realistic prospect of helping your daughter. It is also quite possible that the task of helping her may be easier than it seems now.