When she was in Primary 5, Olivia (not her real name) fought with her classmate and, in a fit of anger, injured the latter's back.

"My parents were shocked. They thought I was gentle," she said.

But the fights continued. She bullied her classmates, threw chairs at her teachers and clashed with her mother at home. She also fought with a classmate and broke the latter's nose and tailbone.

The school counsellor asked if she had depression. Olivia said: "I hated her so I threw a chair at her and walked off."

Even then, her parents did not see the need to get psychiatric help for her. Her housewife mother said she and her husband, a senior manager, thought it was just the behaviour of a naughty child.

Olivia, an only child who is now 15, said: "Whenever I fought, my dad would say, 'Oh, I also got into fights when I was your age'.

"He tried to help me look at how things had unravelled but he didn't see that it was my emotions that I couldn't control."

He also did not see that Olivia was undergoing so much stress that she even thought of killing herself.

TROUBLE FITTING IN

"In Secondary 2, I hated myself. I wondered why I was often angry," said Olivia, who comes across as bright and articulate.

Academic pressure was not an issue. Her parents do not push her and she is one of the best students in school. Lessons did get boring at times but it was social integration at school that bothered her more.

Her classmates spread rumours about her, saying she was dangerous because of the fights she had been in. She said: "They ran away whenever I was near. I hated myself because everyone hated me."

She longed to fit in and would pressure herself to study late into the night, believing that getting good results would lead to acceptance by her schoolmates.

DISTURBING PROBLEMS

Last year, while dining out, Olivia's parents became worried when she did not return from the toilet after more than five minutes.

Her mum looked for her but it was too late. "When she came out of the toilet, her arm was bleeding," recalled her mother.

Olivia had cut herself. She had started cutting herself at 14 but had hidden the scars with hairbands on her wrists and long-sleeved tops.

Her casual revelation of her self-harming ways last year stunned her mother, who said: "One day, while I was cooking, she showed me the scars on her arms."

There was yet another problem.

Olivia said: "In August last year, I started to hear voices in my head that told me I was worthless, useless, disrespectful, irresponsible and not worthy to be alive."

She saw a psychiatrist who asked her to stay out of school temporarily to avoid the stress triggers there. She was diagnosed with major depressive disorder and found to have anxiety and a history of post-traumatic stress disorder.

Olivia developed suicidal thoughts and was admitted to hospital a few times late last year for high suicidal tendencies.

She said: "I was sitting on ledges, wanting to hang myself and overdose on everything. If I saw a nail, I'd want to push it into my arm."

The seeds of her troubles were sown from young.

She said: "People in my extended family hated my mum. They said she's stupid and since I'm her child, I am also stupid."

Her mum, tearing up, said her mother-in-law felt she was only a diploma holder and unworthy of her husband, who has a master's.

This year, Olivia started consulting Associate Professor John Wong, head of the National University Hospital's psychological medicine department, and is continuing her treatment there. She has improved and is taking less medication, said her mother.

Olivia returned to secondary school this year, but her classmates started spreading rumours that depression was contagious.

Depression is often misunderstood. It is an illness that may require long-term treatment, but many people see it is as something that one can simply snap out of.

Her teacher was no exception. Olivia said: "She told me, 'Mental illness is just an excuse for bad behaviour'."

Joyce Teo