To think there must be something that can help DD?

A different clinical perspective may be worth considering here, especially since the nausea and vomiting now seem tightly linked to anticipation of activities she genuinely wants to attend. It may help to keep a detailed record of what happens in the hours before an episode, including thoughts, physical sensations, food, sleep, travel, and the specific event. That could give a clinician something more concrete to work with rather than simply treating it as “anxiety.”

Since sertraline is already part of her treatment, a psychiatric review could also be useful to discuss whether her current treatment is adequately addressing the anxiety pattern, rather than changing medication without guidance. A clinician experienced with autistic adults may also be able to adapt the approach around sensory needs, predictability, and anticipatory anxiety. Clearview Behavioral Health And Wellness Services PLLC offers psychiatric evaluation, medication management, psychotherapy, and telepsychiatry for anxiety and related mental health concerns, so click here, if you want to look into another professional perspective.

Most importantly, I would not frame each failed outing as another defeat for DD. If her body has learned to associate certain situations with danger and vomiting, repeatedly pushing through at full intensity may make the fear stronger. A gradual plan with very small, achievable steps could be more sustainable. Given how low she is feeling now, I’d also take her comments about there being “no point” seriously and make sure someone qualified assesses how depressed or hopeless she has become.

My DC also has CVS which is very affected by anxiety. They’ve found that a migraine med hs helped a lot more than an anti-sickness one, which wasn’t very helpful.
I hope your daughter finds a solution OP.

It must be hard for all of you.

Perhaps you could put 6-12 months of intensive effort into engaging in her activities (slowly edging away once she’s comfortable).

Life is so busy but this is a really important time for her and may shape her future. It sounds like she really needs you at the moment and maybe you can carve out some time to make it happen for her. An event in the diary once a month for example, with a view that she invited a friend along too so she doesn’t become overly dependent on you.

Bless her, life is hard and the transition from child to adult is often very tricky, especially if you already suffer from anxiety. But the answer definitely isn’t in staying indoors, it won’t get better on its own or by staying “safe” everyday. She needs to work towards getting a meaningful life for herself.

I was prescribed sertraline once and it made me feel nauseous all the time, but a delayed reaction is possible with any medication. I
would recommend asking to change her medication. I take Venlafaxine which is good for anxiety.

I had this.
It was triggered by having my first McDonald’s drive Thru for a my friend’s 11th birthday. I puked everywhere.
I suffered for years.
It then became a car phobia and then a plane phobia, then an eating in front of others disorder.
I made cooking my passion. Cars my passion and became a pilot as a hobby.
It dogged me for about 10 years but I had no external help. My mother and step father just ignored it.
Occasionally when invited to a supper at some socially important setting, I feel certain muscles twinging up until my 30s.
Good luck. Face the fear. Or get help!
I still can’t eat McDonald’s- that is no bad thing.

With her having CFS/ME is there a chance that the activities she's trying to do are outside her energy envelope. She's using up all her energy getting ready and has none left for the activity? Have a read about pacing and about post exertional malaise.

Both my teen DDs have ASD and their therapist said that ASD is essentially hyper anxiety 🤷🏼‍♀️ my eldest DD had real struggles with school but has just finished her first year at college. Both my DDs have done inner child regression work with amazing results - connecting them to original feelings while under light hypnosis. They’ve also seen a sandbox therapist which seems to have been really helpful.

I used to get terribly upset stomach every time I was in a car/bus/felt stuck anywhere like a lecture theatre. General concensus, including my own, was that I developed an anxiety about not being able to access the toilet somewhat linked to life long mild IBS- and that was about 2 decades before I got diagnosed autistic. I had therapy, learned hacks and was mostly managing. I then had my son who had horrendous milk allergy - and my mum went: “oh, that’s exactly like your colics when you were little, I wonder if it was CMPA too”….I cut out dairy for him…my car etc. stomach problems dissapeared…unless I over dose on dairy again. The point being: you can be autistic, which can drive hypervigiliance because NT world sucks, but ND is linked to a number of physical conditions that can often be kind of a niggle until something triggers them. With the nausea the way you describe it transport and/or sleep is preceding it and it started on a plane - I’d be wanting detailed ear investigations and look into vertigo or any trapped nerves in the neck (ND folks are frequently hypermobile and that comes with your body doing it’s own thing and POTS and MCAS)- she’s likely nervous about it all more now, so it looks like anxiety is all there is - but you’re not describing anything around that plane trip that was a trigger (unless it was midway through horrendous turbulence). Blood tests could’ve found an infection or similar but not any of the more likely causes of ongoing nausea.

And this could be the crux of the matter Op, she wants to remain a child because she can't face the responsibilities of adult life, therefore when it comes to doing adult socialising activities her nausea is triggered, so she doesn't have to go. Such a shame for everyone involved and particularly her, I hope she hits on the right therapy soon

I think you should ask the doctor to try a higher dose of sertraline and see if it gets worse or better. This would give a strong indication as to whether it's a reaction to the sertraline or an anxiety response. I personally think it sounds exactly like an anxiety response and that means the sertraline isn't working well enough. But another medicine could also be worth trying if your doctor will prescribe something else. Given that your DD is on the lowest dose of sertraline and could be taking four times as much, it sounds to me like she simply isn't taking enough of it to have the desired effect.

Yep, similarities to my DD too - not ND - who has CVS. Her worst episode was a school coach trip with a 4am start to France. She vomited the whole way and then many mornings before activities. Travel definitely an issue. She also used to vomit before seeing her boyfriend (that's has gone thankfully). Also before exams. Also the morning of prom! Essentially stress or even good excitement can bring it on. Unfortunately it can become a self-fulfilling prophesy where the anxiety is not the thing itself (the event, or the travel etc) but the fear that the vomiting will occur . . . and then it's a self-fulfilling prophesy. Exposure to certain triggers has helped, and has finding ways to minimise adrenaline. My DD says 'i can't let it stop me doing stuff' but it's a horrid thief of joy. I am so sorry your DD is experiencing this.

I think I would try and build her tolerance.

If 0 is staying at home and 100 is a big away event with friends, what number can she get to currently? What would the dentist or cinema look like? If they are, say, 30, what could she think of that was 40 and how might she find ways to put that additional 5% within reach? Then stabilise there, then try for 45 etc.

I agree with the therapy for trauma of travel sickness.
It seems from your OP that the vomiting started after she had been taking sertraline?
It could be the culprit.

Hmm. I’m autistic and I cannot take sertraline. It makes me throw up at the drop of a hat. Anti-sickness medications are just as bad - they make me feel like I’m about to throw up 24/7 and even dry heave.

I would stop the sertraline and anti-sickness medications. They could be causing the problem. I doubt it’s in her head or psychosomatic. The truth is that many of these drugs for NT people either don’t work or sort of work but cause serious side effects on ND people.

There are dozens of other antidepressants that would work better than sertraline. But she may not need them at all because the reason she is depressed is she keeps throwing up or feeling nauseous which means she can have no social life. Stop the vomiting and nausea and the depression will lift.

I have anxiety too btw, but I wouldn’t class fear of throwing up as anxiety as anxiety is usually fear of the very unlikely happening rather than trepidation over what has been happening every time for years.

I would also suggest new medication....possibly mirtazapine and / Pregabalin. Pregabalin is a very effective treatment for anxiety. I will get shot down in flames here but there are sometimes grounds for a short and controlled course of Valium or Xanax but you would probably have to pay for a private psychiatrist. It could be a good use of money in her case as it definitely sounds psychosomatic.

Would it help to take baby steps, build up her confidence? So instead of the plan being to go out with friends, break it down to walking to the bus stop or calling an Uber and then cancelling, or just get dressed as if she's going out.
Whatever it takes to achieve a win without triggering her anxiety. Then repeat a few times to be sure, then add another step.
Basically the idea is to show her nervous system that nothing bad happens and that she can trust herself to be capable.

But I'd you push to far too soon and trigger the nervous system she will go into flight and shut down, which is why it has to be really very tiny steps to avoid triggering her anxiety response.

Your daughter's dose of sertraline is very low. She clearly has anxiety.

I also have a daughter with anxiety and OCD who experiences diarrhoea and other digestive issues when anxious or having panic attacks. She was started on 50mg of sertraline which did basically nothing. She is now on 150mg and is a different person.

I would strongly advise returning to your doctor (or a different one if yours is unsympathetic) for a medication review. It is OK to say to them 'this doesn't seem to have worked, what do we do next'.

Plus, CBT has helped too. If you can afford it, look for CBT therapists in your area and if one isn't helping keep trying others until you find something that is.

Could you share more about how you take it? And can you drive on it? @Quartzfairy thanks

I have periods of acute anxiety and I feel incredibly nauseous. I'm not sick though. I found that sertraline made it much worse. As others have suggested perhaps different meds?

I used to get really horrible travel sickness, and found sea bands actually do help. It works on an acupressure theory.
It may be helpful as there you can consciously press down - and may help for psychosomatic- that training your mindset - if this, then I feel better. I would perhaps also look at breathing exercises, a simple is breathe in through nose, count 4, hold count 4, breathe out through mouth count 4.

Find a therapist that does EMDR.
She can still see the Hypnotherapist

But it may be trauma related

She was vomiting on a plane, which is quite traumatising

Well that is really great to hear. I suppose I'd offer the same possible advice, but with bigger steps.
So maybe she signs up to a cos-play event or a gig, something at the lower end of both price and spectacle spectrum, and same thing - radical acceptance of the vomit and the nausea, and just do it anyway. Get as far as she possibly can and however far that is, celebrate it.

I wish you both all the very, very best! 💖

Definitely rule this out as dysautonomia is common in CFS. Do antacids help at all with the nausea (gaviscon?) if so could be MCAS related and Fexofenadine helps some. When nausea becomes chronic anything and everything can set it off, a bit like someone who is prone to migraines can become sensitive to all sorts of triggers.

In any case push for a script of ONDANSETRON as a rescue medication so she can eat regularly or things could just keep getting worse if she becomes depleted in nutrients.

If it’s Pots related salt may ease it also.