To think there must be something that can help DD?

[Owwdi]

Sorry for the shameless post for traffic, but things are a bit desperate.

DD is 22 and has ASD. She has always suffered with anxiety but it was manageable. She takes sertraline to help with it.

She doesn’t have many friends or what you’d call a buzzing social life, but she does have a few friends who are into similar things as her, they are scattered around the country though rather than living locally.

Just over a year ago she went to Japan with one of her friends and got really sick on the plane. She’s always suffered with travel sickness but this was the first time she was ever sick on a plane. Then for the next week (half of their holiday) she was too nauseous to go out or eat much at all, and spent that time stuck in their room. I managed to get her friend to take her to an international clinic where they gave her an anti sickness injection and some pills, and she managed to get out and about for the second week.

Since then, she has been feeling nauseous a lot. She’s been to the doctor and it doesn’t seem like there’s anything physically wrong, and both the doctor and DD agree that it’s a psychological issue.

It’s really getting in the way of her life. We’ve been paying privately for therapy for her for the last 4 months with a therapist who uses various methods including hypnotherapy. I’d say her general outlook and mood, and desire to get out and about has improved, but the feeling sick remains.

Day to day she seems ok now, but it’s literally every time there is something she really wants to do, eg a concert or convention, she’ll end up vomiting too much to be able to go. It’s happened several times now in the last year, she’ll travel to London to her friend’s place, feel ok, then the morning they need to go and do something, she starts vomiting. She’s just on her way back now after another failed attempt at having a social life and she’s feeling broken and like there’s no point in trying anymore. It’s hard to argue with her at this stage, I’ve been encouraging her to keep trying and believe that she can do it, but without fail she starts throwing up and isn’t able to go.

Even times that don’t involve travelling, like recently it was her birthday and her friends came to stay here, they were planning on going out, but DD woke up in the morning and started throwing up.

BTW she doesn’t drink or do any drugs, so there’s no way that’s an element to causing sickness.

She can’t go on like this. GP doesn’t seem helpful. Private therapy doesn’t seem helpful. I’m not sure what to do next, but she’s so low and what kind of a life is it if she can’t do anything fun without being sick?

There are some NHS services that offer neuro-gastroenterology, probably horrendous waits but your GP should be able to refer your DD on to one under Right to Choose if they list out everything that has been tried and the extent of the problem. Neuro-gastro depts combine medical investigations with access to psychology.
There is a cyclical vomiting syndrome charity in the UK and in America. CV appears to have some link with ASD. I know you are not describing exactly CV but there will be potential overlaps. SSRIs like Sertraline are not first line meds for CV, there are others that would be chosen first and as pp said, migraine treatment may be looked at.
EMDR therapy could be a good call too if this is from the initial trauma of the incident happening while trapped on a plane in front of others with no escape. While gut directed hypnotherapy has some good clinical evidence for some functional gut problems, it is not a NICE recommended treatment for trauma or panic disorder.
Edited to add: if she is going to therapy in order to try not feel sick, this is likely the wrong focus. An appropriate therapy would be supporting her to accept and not fear the vomiting despite how awful it is for her (which eventually does usually have the secondary gain of noticing the feelings less and them coming on less but not always)

That sounds like everyone’s given up trying though. A lot changes in a year. Just because the volunteering didn’t work out then, doesn’t mean it couldn’t now. Perhaps she wasn’t in the right place mentally, or the right placement.

I would look for jobs or voluntary work around her hobbies. Even if it’s one morning a week.

People need purpose, structure and meaning in their lives. At the moment, she’s got a very small world which is going to exacerbate her anxiety. She needs incremental and gentle exposure to life outside her house.

Will she socialise with you? If you went to a convention together, would she be sick? Im wondering if you could tag along to a few things (with her friend) initially so she can get over the hurdle.

If you see you are no closer to an improvement - I would suggest a change in therapist -
with anxiety disorders, the most change happens in therapy within the first few months -
therapy that is not illiciting change is ineffective -
seek a CBT therapist - but one registered with BABCP - not one saying they are CBT trained -
and they need to be able to tailor treatment for ND - not a standard approach - keep looking xx

No she hasn’t been tested for that, and that’s really interesting, I’ll mention that to the doctor.

Yes it does now, although before she was having therapy she felt nauseous all the time.

Since she’s been having therapy she’s been a lot better on a normal day. Doesn’t feel sick when she’s just at home, and able to go to low key things without feeling sick (eg a dentist appointment or a cinema trip). It’s just when it’s things she’s really looking forward to that it happens.

Thank you, I’ll ask the doctor about this. I was initially trying to find an EMDR therapist months ago but there’s very few within travelling distance and none of those replied to me, or if they did they weren’t taking on new clients.

Has she had a stool test for H.pylori?

It’s tricky because she does need a lot of hand holding, but she has no interest in doing any of the things I do day to day, most of my activities are dog related and she hates dogs. And I have very limited time and energy to do things with her, she’s quite specific about the kinds of things she wants to do and none of them are nearby! I think if I did go with her to things it would help, but I’m not sure I’d be able to do it regularly enough to get her out of the cycle she’s in.

Personally I’d say she has improved a lot, she’s generally a lot chirpier, has been taking herself out on little outings (things like the cinema), thinking about the future. But the main problem for her is the being sick, and that’s no better, so in her head the therapy isn’t working.

Have you put her on an antacid? I am not denying its psychological but when someone starts vomiting violently or continuously for a while the acid in their throat can make their throat scratchy and sensitive to gagging and produce vomiting again very easily. Their gag reflex brcomes more sensitive and the whole cycle very rapidly begins again. I would suggest putting her on what is here marketed as prilosec so that next time she vomits its less traumatic for her throat. I slso think she needs EMDR to resolve the original trauma of the terror of novelty being associated with shame and vomiting on the plane.

I'd think the GP would prescribe an anti-emetic, ie Ondansetron, and exposure therapy would be the in order along with anti-anxiety meds per the situation. 🤔

DS1 had this around age 12-14 although it was mainly related to school and medical appointments.

Rescue remedy did help him a lot. I think the fact it's pretty much placebo is actually helpful when the issue is psychosomatic. I have wondered whether he needs to be on anxiety medication though. It seems to come and go and increase during times where he feels an excess of pressure.

One of my friends found a lot of help in good CBT for emetophobia and associated agoraphobia.

I have said it comes and goes - he is 17 now and it has been present again over the last year. He isn't always physically sick but sometimes he is. Often it's more of a sensation that he will be sick or have an upset stomach.

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.

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! 💖

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

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.

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?

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

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.

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.

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 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.