12 year old DD emetophobia/ocd/anxiety- increase in meds for sudden on set panic attacks

[BleachedWail]

My dd had a terrible year 6 due to onset of extreme emetophobia which stopped her eating and drinking. Camhs became involved as CBT had no impact
and she became a different child almost overnight once she started Sertraline. She’s been almost completely her old self since last summer and had a brilliant start to her senior school life, which we couldn’t have even imagined this time last year. However over the last fortnight she’s had a resurgence of symptoms and started to have a number of panic attacks each day, particularly after eating (but not exclusively). She’s agreed to start group CBT therapy and her psychiatrist has increased her sertraline to 75 mg from 50mg (4 days in) but we are seeing no relief for her as yet (it was starting to ease things for her by about now when she first started the medication last year).

I suffer from anxiety myself and I’m trying not to let my mind race to a place where the meds won’t work any more and we can’t help her.

Has anyone trod a similar path?

Thank you

No emetophobia, but DD16 has OCD and panic attacks and has been on fluoxetine (similar to sertraline) for a couple of years.

The meds have helped, but overall, CBT has been really important. It's a long road, and obviously it's not easy, but she does need the CBT imo.

DD was also prescribed betablockers to take occasionally if she had a panic attack just before an important event (e.g. GCSE exams). Might this be something that might help your DD? In the end, DD has hardly ever used them, but I think it's psychologically helpful to her to know they're there, iyswim.

Finally: DD also has autism. It might be worth considering whether this could be a factor for your DD as well (the comorbidity with OCD is massive, so it's a statistically significant possibility). Your DD is hitting the age when autistic girls, who may have successfully masked up till then, often hit a wall and start to have more problems. Obviously this may not be the case with your DD. But it's worth keeping in mind.

All the best of luck to you both.

Also, even at 75mg, her dose of sertraline is not that high (according to a quick google, the max dose for adults seems to be 200mg). Obviously age can be a factor, but the nhs website mentions that sometimes even kids can be on 200mg.

The dosage of SSRIs for OCD generally needs to be higher than it is for depression etc. DD has been on the max adult dose of fluoxetine since she was 15.

Thank you, I appreciate you taking the time to respond.

Did your daughter struggle to engage with the CBT? We found with the first course she is (pre medication) she said all the right things in the sessions and understood the theory as a concept but was unable to take it to heart or put it into practice.

It wouldn’t have crossed my mind until this last 12 months that she could be classed as autistic, but I realise I know very little and I watching her go through this makes me look back on my own anxieties in a different light.

I think DD found the CBT really hard (and still does, after almost 2 years) - it has led to a lot of improvement, though.

I don't think she struggled in exactly the same way that your daughter struggled.

What DD was/is doing (the session frequency has reduced now) was a specific type of CBT: ERP therapy (Exposure and Response Prevention). I think this is really key. ERP therapy is the treatment of choice for OCD. Generalised CBT has not been shown to be nearly as effective.

The OCD-UK website has a lot more info about this, and about what to look for in a therapist. Of course the whole thing is even harder if you're looking for somebody who works with under-18s.

I know this may not be very useful info to be giving you, because CAMHS is so poor that it's hard to get ANY therapy out of them, never mind effective therapy!!

Yes, I would never have considered that my daughter at that age might have autism, either. Even though her brother already had a diagnosis, so it should have been on my radar! But of course that doesn't mean that the same would be true for your daughter. I thought it was worth mentioning because it might be an additional cause of stress for her which she may not even be aware of herself. My own experience is that a teenage girl with OCD can be incredibly adept at hiding things and trying to appear "normal". One of the really nasty aspects of OCD is that it seems to drive the sufferers to try to hide it.

Once again I really do wish you all the best. I'm so sorry this is happening to you and your daughter.

Just to say: DD's therapy once on medication was a lot more effective than before she started medication. The ERP tasks can be very hard and upsetting, and the medication gave her enough detachment to be able to do the tasks without panicking so much.

Thank you, that gives me something constructive to look into

I know this may not be very useful info to be giving you, because CAMHS is so poor that it's hard to get ANY therapy out of them, never mind effective therapy!!

This isn't always true... it depends where you live. In London, around South/West Yorkshire and most of the Midlands, there are some very good CAMHS services, because they support training for diverse therapists. If CBT hasn't helped emetophobia, there may be a deep cause that long-term child psychotherapy would help with, but you need to ask the care coordinator or psychiatrist.

Not sure why they think group CBT would work, ic individual didn't...

I'm a clinical psychologist and I'd recommend EMDR as a treatment for emetophobia, not CBT. This is my personal opinion however.

We have found CAMHs helpful as a service and the psychiatrist they provided has been lovely. I get the feeling they have to exhaust CBT first as an option… it’s probably also easier and cheaper than other therapies… I’m not sure… so far the medication increase hasn’t helped much and the panic attacks are persisting at night.

I have read good things about EMDR but it seems tricky to access for kids, even privately. She started to be impacted after her sister had a sickness bug so I wondered if it would be helpful

Could it be hormone related, given her age?

I’ve wondered if this sudden resurgence following 12 months free of symptoms on the Sertraline is hormone related, she’s not really showing any signs of puberty yet though