A 12-year-old female pati...

A 12-year-old female patient was hospitalized in a paediatric psychiatric hospital in 2016 after presenting with a plan and intent for suicidal ideation (SI). At three years of age, she was diagnosed with Alagille syndrome, associated with multiple cardiac and hepatic issues and dysmorphic facies. She had a family history of her mother being diagnosed with Alagille syndrome. She visited many physicians each year due to her anxiety and depression. She was cyber-bullied and bullied at her school. She developed depressive thoughts after reading derogatory comments on her social media. On admission to the present psychiatric institute, she complained about guilt and worthlessness, poor energy, anhedonia, and passive SI for at least one month, with intermittent SI for the last two months. She committed self-injurious behaviour by cutting her upper legs and bilateral wrists over the last year. She restricted her caloric intake and endorsed self-inducing vomiting as she believed of being overweight. She also experienced verbal abuse from her father, witnessed drug abuse as a child, and was of low socioeconomic status. Her mental status examination revealed that she had poor eye contact, a depressed mood, decreased concentration, and poor insight and judgement.