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17 yo ill health - how much can be psychological?(10 Posts)
This is a bit long winded, please bear with me! My dd has spent last few years struggling with health issues. Initially problems centred round migraines (mix of 'normal' ones with vomitting plus hemiplegic ones which were quite frightening) - this lead to medication overuse headache (from prescribed meds) which we have now overcome and migraines only occur occasionally.
When she was struggling with migraines (2-3/week), she became depressed and self harmed. Ok, we're getting through this too. She struggled to engage with counselling - psychiatrist says she has social anxiety mixed in with the depression. Prozac gave her bad side effects, especially fainting several times a day. She's now on lowest dose of sertraline and is doing well. However, with friendships I notice everything starts well then she has major fall outs, she gets angry, can't let things go, over-reacts to comments on fb etc. She was on the end of cyber bullying when she was ill so probably hasn't helped.
She has now been signed off from camhs and I am happy she is getting over depression and self harm. She has also been signed off from paediatrician with regard to migraines (not that the paediatrician was any use but that's another story).
But.... She now vomits at least once a week. Sometimes no warning, sometimes nausea. She also faints regularly, maybe once/twice per month but usually when she's nauseous or feeling ill (she seems to pick up colds, throat infections, sometimes has diarrhoea). Sometimes she can be fine after vomitting, sometimes it takes 24 hours to recover. I can't link her mental health to vomitting/fainting but perhaps there is a link.... Sometimes events coincide, sometimes they don't.
GP has checked for thyroid levels and glandular fever. I'm not sure what else is covered in standard blood tests but all was clear. Paediatricians' parting shot was to prescribe anti sickness tablets 3x a day, but dd is fed up with medication and refuses them (i can't say I blame her)...
Has anyone any advice? Where do we go from here? Do I concentrate on mental or physical health? Do I try to get her some cbt which the psychiatrist at camhs mentioned for social anxiety before signing her off? Do I push for gastroenterologist appointment or should I be looking at neurologist? Help!
have you considered autonomic dysfunction or PoTS. DD2s last paediatrician reckoned her migraines were coming from her stomach shutting down (gastroparesis); she also had a period of several months where she vomited about an hour after she ate anything - annoyingly the gastro insisted it was constipation, but eventually she did get (I think) domperidone, which is the recommended treatment for gastroparesis.
But, there is a massive link for DD between how she feels mentally and how she is physically. If she's stressed (in the run up to exam results for example) EVERYTHING is worse. When we were trying to get an initial diagnosis of PoTS, because doctors weren't listening/doing anything, her symptoms were horrific, and how she coped mentally/emotionally was described by the psychiatrist we were fast-tracked to as "extreme, but normal reactions" to how she felt she was being treated.
When DD's PoTS symptoms get worse, she has to sit down and think about why they've got worse. Is she not eating properly/doing exercise/stressing about something. We treat the symptoms, but also the root cause, and gradually thing settle down. Currently she has gut issues, but she's about to start Y13 and apply to uni, so understandable her system is under a bit of pressure, she just needs to follow her routine and take her medication.
DOn't know if that's been of any use, but as someone who's been there, done that, it is horrible PM if you want any more info about PoTS.
Thank you myvisions, I did at one point come across PoTS on google, but i never followed it through, I can't remember why. I'm going to find out a bit more - it certainly looks a possibility. I would so like to get things underway before my dd returns to college next month - she was forced to drop out last year as fainting got so bad.
Thanks again - and I'll pm if I come up with questions.
Have you considered looking into assessment for ASD? The signs are very subtle and easily missed in girls but I see that the paed mentioned social anxiety and you mention friendship difficulties, over reacting and finding it difficult to let things go.
My dd has autism and migraines and fainting feature regularly when her stress levels are high. It is always an indicator that we need to look at the big picture because she isn't always able to identify the cause of the stress for herself.
You would probably be best asking for a referral to a specialist diagnostic service details of nearest one to you can be found by contacting the NAS
Thanks Insanity. It's not something I've considered but will Have a read up .
In terms of therapy, psychoanalytic or psychodynamic therapy would be much better for exploring root causes of the issue. CBT would treat symptoms of the anxiety but if the somatic reaction is linked to psychological causes then I'm not convinced CBT would be enough. A good psychoanalytic psychotherapist who is experienced in working with young people would be best.
Gosh thanks stripytees, more research for me. Have had a quick look, sounds very interesting.
After dd fainted again on Thursday we went back to doctor who has requested more blood tests, (another) ECG, and referred her to a cardiologist (thinking about PoTS or similar).
I think we'll wait to see results of tests/referral and go from there. Then I'll look at the mental health side again and decide which direction to go.
Thanks again for advice.
I have two DDs with Asperger's and they have both experienced physical symptoms linked to anxiety.
Look specifically at girls with AS, masking and Tony Attwood.
perhaps migraines are now showing as vomiting etc. a referral to migraine clinic might help if she has not already seen someone there. they helped my sis who sounds v similar. she also has asd.
Thanks again all. I've lots to follow up if current tests/referral don't show anything.
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