I stop eating. I stop speaking. I don’t leave my room. I have trouble falling asleep, and I have trouble waking up. I force myself to go without food, without contact, I force myself to sleep 12h a day to avoid them. I read obsessively. I obsess over other things in my imagination to pass the time. Migraines wrack my head as I go without food and water, laying in the darkness, sobbing. Every movement in the night keeps me awake. Im always certain something is coming from outside to kill me. Vampires, zombies, murderers, the Klan. I have constant nightmares, anxious dreams filled with confusion, guilt, grief and death. My jaw aches when I awake from grinding my teeth. I count. I count obsessively. I rarely even go to the bathroom. I wait hours sometimes so I wont be seen. I slap, punch and scratch myself. I cry, as quietly as possible. I break small objects quietly. I scream hateful words at myself in my mind. Sometimes I even say them aloud.
I imagine myself, in my psychiatry clerkship or rotation during residency, receiving these words.
I’m a senior psychology major well versed in clinical psychology (even though my main interest is neuroimaging). Those closest to me know I want to be a pediatrician.
These words come from a child, maybe 12 years old. A skinny, nervous looking child who doesn’t seem to know how to smile and answers my questions in unusually brief sentences without meeting my eyes. What would I say to her? What would I think?
My differentials line up neatly in my mind. It’s likely this child is being abused at home or somewhere else. She may also have the inkling of a personality disorder, though it’s too soon to tell. She definitely has disordered eating, I will have to ask her if she’s dysphoric. Twelve and self- harming, but she didn’t say she was suicidal. And the OCD symptoms, the counting… it’s quite a package. Her treating clinician could be looking at a long journey of unravelling complex PTSD.
But my first thought is, this child is likely being abused at home or somewhere else. She is definitely being abused at home. She said she goes without food or water. She says she doesn’t go to the bathroom for hours. She said she spends hours alone, sleeping, reading, crying, engaging in self- harm and obsessive-compulsive behaviors. She says she has untreated migraines, sleep disturbance and bruxism.
Where are her parents?
Have they not noticed these terrible signs? Do they not care? What are they doing during the hours of this child’s self- destruction?
Why is this child being neglected?
A shiver gnaws at my usual optimism as I imagine grimly what this tight-lipped kid must be hiding from me. It wasn’t easy to get her to describe the quoted portion. I know there is worse she hasn’t told. I know she hasn’t told me the reason she hides in her room.
Who brought this girl in?
The charge nurse tells me her parents brought her in. They’re sitting in the waiting area, biological mother and father.
A migraine begins twisting in my cervical vertebrae spreading its circular grip around to my temple and digging into my jaw.