Q: My 15 yr. old daughter has been becoming more and more miserable at school. She spent the last four months of last school year on “Hospital School” with a diagnosis of “Severe Anxiety Disorder/Social Phobia.”
She was miserable, as she so much just wants to be “NORMAL”. She is very
smart, (4.12 GPA-missing school ALL THE TIME!) cute, has no obvious problems.
Today was the first day back to school after vacation and last night was terrible. She was hysterical, sobbing, etc. After talking with her
for a few hours she said, “If I could just get over the vomiting thing, everything would be so much better. Mom, not a minute goes by when I don’t think about it. It is controlling my life. I can’t ride busses. I look at everyone to determine if they seem like they may throw up, my whole life is controlled by this!”
Now I have known about her “Vomit thing”. She has a twin brother and, even at 10 months of age, if he would throw up, she would become hysterical. Unfortunately, he was prone to carsickness. I can remember them sitting in their car seats in the back seat, him smiling as he threw up and her screaming her head off. This calmed down over the years (or so I thought) but she would refuse to go anywhere with him on long car trips. Not until last night, though, did I realize what a huge issue this has become.
After reading several websites about emetophobia, I am 100% sure she
is suffering from this and all her “social anxiety” disorder problems are
secondary to the emetophobia. She is very comfortable in non-school type
functions. She is active in the community theater, for example, that is a collection of people of all ages, not very many children or even teens. I always thought this was because older people weren’t as socially threatening. That made sense to me. When I asked her about this last night she said, “Older people aren’t as socially threatening, true, but they also aren’t as prone to just throw up.”
After coming to the above conclusion, I felt some relief. I’m thinking that a specific phobia may be easier to treat than a full-blown social anxiety disorder?? I do know that the “vomit thing” is going to result in a full-blown breakdown if something isn’t done.
Now, I have been paying for cognitive therapy for the past year and a
half. (She has no insurance. I have six developmentally disabled foster
children, they have MediCal, and my own children don’t qualify as I make too much money!!) Three different therapists have seen her. This “Vomit
thing” has never been an issue.
I am in the country in N. Calif. The closest major medical centers are three hours away. Please help me. I am willing to do anything to help her get over
this. I saw something on TV once about a “crash” therapy program for
specific phobias. This one was on spiders. I believe the therapy was several hours daily for about a week. Do you know anything about this type of therapy’s success rate? Any suggestions will be greatly appreciated.
A: I can’t, of course, venture a diagnosis on the basis of a letter but I have a hunch that this isn’t emetophobia (which is usually the fear of vomiting yourself, not of seeing others vomit). Anxiety disorders take many forms. One of them is obsessive-compulsive disorder (OCD). Most people are familiar with the forms of OCD that are observable. These involve checking, cleaning, and ordering. But there is another form that isn’t visible to others. For some people, the primary symptom of OCD is a continuous loop of an unwanted, intrusive, disagreeable thought that replays over and over and over and over. It’s like the needle getting stuck on an old fashioned record player. Some people call it a hiccup in the brain. Many people afflicted with this form of OCD find a ritual or a counter-thought that helps them dislodge the bad thought. I know from experience with some patients that the thought can go on for days until either it disappears as inexplicably as it started or the ritual or counter-thought does the trick.
In fairness to the therapists who have already tried to help your daughter, a therapist can only work with what he or she is told. When this kind of OCD starts at a very young age, kids often don’t realize that it’s not normal to have such intrusive, uncomfortable thoughts and so don’t think to talk about it. As one teen told me when I asked him why he hadn’t shared the information years before he finally did, “I thought everyone had bad thoughts and I was just a wuss because it bothered me.”
Now that she has told you what is going on, it may be that you are at a turning point in being able to get your daughter the help she needs. You do need to consult with a professional to make a differential diagnosis. It’s still possible that she is dealing with a phobia. I’m only going on a hunch, never having talked to or seen your daugther.
If it is OCD, there are medicines that can help. You will need to find a psychiatrist who has experience with OCD as well as other anxiety disorders. (I’m unfamiliar with California prescribing privileges. There may be others besides MDs who can prescribe.) Ask your primary care doctor for a referral. Cognitive behavioral therapy might also be useful if it is combined with medicine and if it is targeted at managing the unwanted thoughts. Exposure therapy, in some instances, can also be helpful, as can hypnosis. Best results usually come from a combination of medicine and therapy of some kind to help the patient get some sense of control.
I hope this turns out to be helpful. Your daughter sounds like a terrific kid with many talents. It’s remarkable that she has accomplished so much in spite of the distress caused by the thoughts. She’s lucky indeed to have such a supportive and caring Mom to help her through.
I wish you both well.
Dr. Marie
