Please help - calming a near-suicidal, highly distressed 16 yo daughter....

[cyclotherapy]

Hi.... Any advice you can give would be amazing... we have run out of ideas....

We have been with her 24/7 for the last 8 weeks - she's been put on Fluoxetine by CAMHS psychiatrist, but sadly without any impact though I know she is likely to up the dose when we see her next week. We keep all doors and windows locked, which DD finds reassuring.

This is the fourth time she has been like this since she was 9. Each time a bit different, each time "wearing off" after 4-12 weeks, although she would say nothing changes, the same dark highly-critical voices in her head, just she is able to manage them better and engage in life while they are in the shadows.

These last 8 weeks have been a mix of extreme distress and watching American sitcoms for hours on end.

I love the wisdom of Mumsnet ... so many wonderful people, bringing such amazing life experience and knowledge to bear....

Answering other posts I've not yet responded to ....

lljkk bipolar? Don't know enough but seems unlikely - although she was a bit hyper at the end of last term preceding this crash, this is the first time there has been an up and then a down... and we suspect the up may have been in reaction to the Elvanse... DH says this is basically speed, so we are looking into this a bit more.... any other reason why you think it might be bipolar? The other times the triggers were a stressful year (age 9), hospitalisation/pain (age 11), psychotherapy (age 13), and not sure what now (age 16)... but definitely this time it did feel a bit like crash and burn...

My suggestion is probably small fry compared to what you are going through, but I find something called yoga nidra very helpful in managing my anxiety. My attacks are usually shorter than your daughter’s but they do push the voices and lower my chest pain.

When things are bad I find one I like, and use it over and over. Rather than losing its power I find it like a touch stone. Although I use a pod cast, you can buy books of scripts so you could read to her if it’s your voice she craves.

So much to think about ....

teenytiny I hadn't heard of yoga nidra and like the sound of that.... she is drawn towards mindfulness but finds it tough to do... though

mummy sparkle we struggle most when she is in the depths, not knowing how to calm or reach her.... the frightened child, cowering in the corner

neonyellow yes agree - need to look at whole package - not yet sexually active (she had boyfriend in good few months age 15, but life got dark and she told him she wasn't well enough - made me so sad, they were so lovely together and laughed so much), drinks a bit but really only cider and beer.....And I hadn't thought of the Pill - to investigate...

jacko - she loves Fawlty Towers! We are definitely selective in our viewing - Modern Families current favourite... something that is easy and funny and kind (ish!)

thunderous - our ACT psychologist recommend looking at a dialectical book so Ive just ordered...

unlurk and mayhem and fawlty and pompom cat yes we've been thinking of things through a toddlers eyes - really good idea ... I think I should dig out some of her favourite children's books. Sadly she can't remember us reading to her except for a couple of times - we did masses! I adore children's books... So we have done lots of reminiscing and playing patacake and silly under the duvet games ... but I hadn't thought of children's books. Going to have a rummage now....

Betty it makes me want to cry - she truly has taken the best bits of DH and me.... she is intelligent and talented and if she just knew it the world is her oyster...she can do pretty much anything as is both arty and sciencey, gently sporty, into drama and dance, loves creative writing and does beautiful cartoons.... loads really.... and is very very funny, and ridiculously kind and generous, so a much nicer person than me!

Bombardier thank you.... I really hope she does... so often we feel we are failing her, and also that unintentionally we have created this disorder (whatever it is) within her....

Damson interesting... and good to know that snuggling and endless talking is part of the ADHD picture, it is relatively new to us so we are learning the ropes... though no clear "witching hours" or otherwise. Interestingly she can see when the Elvanse kicks it, but isn't clear when it wears off. She did find the ADHD diagnosis a huge relief as it explained so much of why she felt different, and she felt she had found "her community" reading stories on the internet.

unweaved age 13 DD did wonder if she had Borderline Personality Disorder, having discovered a description on the internet... and reading descriptions it did sound very like her... although an educational psychologist friend told us it is rarely diagnosed before late 20s because so much is in flux before then and unclear

Does she have a current diagnosis, apart from ADHD?

@cyclotherapy

I was diagnosed with BPD at 16 in 2007, after a history of serious trauma and abuse. Yes, in theory they're not supposed to diagnose until the adult personality is fully formed but in practice it is very obvious that someone has it, especially if they had a difficult childhood. The cycles of overwhelming emotion/regression/voices are a bit of a red flag for BPD which is why I suggested the DBT and mindfulness stuff.
However, I am not suggesting that she has it. Tbh, with the ADHD stuff and the potential issue of PTSD it sounds like that should be looked at in a bit more detail before diagnosing her with a PD. Some of the BPD workbooks could really help her though.

You sound like an utterly amazing mum and the love you have for your daughter sings out in your posts. I have lived with a serious mental illness all my life and have had many episodes of acute suicidal distress. The key things I need in those times are to be listened to, to be believed and have my level of distress and emotion validated, to be approached with kindness and compassion and gentleness. It sounds like you provide this in those bleakest moments and because of that you are all surviving them, despite them being so unimaginably tough. One thing I have that helps is a self soothing box which I made when I was doing well. The aim is to provide a sense of soothing for multiple senses. I have a particular Playlist of music that I find comforting, loads of different materials to touch so both very soft fur but also things like elastic bands to twang. I have bits of paper with my reasons to live written on. I have my favorite chocolate bar and also different smells that I find soothing. I'm sorry if this seems patronising or something you have already tried but I have round it to be cathartic.

My other suggestion would be to Google hearing voices network. It's a survivor lead organization that supports recovery from mental distress. I think they do some stuff for young people. And they don't make judgements on whether or not it's 'psychosis.'

Sending so much love to you. I can only imagine what you must be going through. Although I would do anything to not have had this struggle in my life, it is not all bleak. Experiencing the extremes that I have has taught me a great deal, given me lots of opportunities and I think made me a more forgiving person. X

Handhold for you OP, this sounds so distressing, best wishes to you, your DH and your DD.

iloveannierose What a beautiful idea! It may sound mad but we haven't thought of that... it feels like such a lovely thing to do... when she is feeling better, and we are in a period of calm, we will do that... and perhaps start gathering things for it now. Already, I can see it is not all bleakness - my DD already has the most extraordinary power of forgiveness and ability to see things through other people's eyes, and a level of compassion for others

uweaved how very thoughtful - and I will look at some of those workbooks....I agree, we are in no rush for a diagnosis but keen to find whatever helps.... especially since it's only 2 more years before she is an adult and I suspect we will have much less influence, and certainly less closeness and ability to help.... and of course, we want to send her into the world as resilient as she can be

sealsong no other diagnosis beyond ADHD.... when an inpatient they ended up with "adjustment disorder" but were clear this was a bit of a catch all because they hadn't been able to come up with anything else..... and when we explored this, it sounded very like PTSD, which hasn't been actually diagnosed but we believe she does have

yawning thank you.....

Hugs

OP, you sound like a wonderful, caring mother, and your DD is lucky to have you by her side.

What about using a relaxing, restful piece of music as an 'anchor' during her dark episodes? It's something we practiced when I did hypnobirthing - you learn to associate the music with being relaxed (playing it at night when you're all safe, calm, and warm in bed for example) and then listen to it again when you need to recreate the feeling. We also did a 'shoulder anchor' technique where your birthing partner resting a gentle hand on the shoulder calmed you. If you google it you might be able to find a script you can adapt to your DDs situation.

Hang in there, both of you. This too shall pass.

Apologies if it’s been mentioned already/ ruled out by CAMHS, but a lot of what you describe sounds very similar to many of my students with autistic spectrum conditions. The feelings of personal responsibility, the lack of ability to regulate intense emotions, heightened anxiety and distress and self-injurious behaviors are all quite typical. Presentation of ASC in girls is often more complex to recognise/ diagnose- particularly girls who cope well academically.
I wish you all the best, it sounds like you’re doing an amazing job I’m very difficult circumstances

"she was a super-alert baby (probably the ADHD?), very difficult to settle and needing little sleep."

That was a big issue with DS, he didn't sleep through a night till he was almost two. We were told (later on at a parenting course) it's more appearing to not need much sleep but in fact needing more as their brains are so very active. It can be exhausting not being able to switch off and finding those ways can help (so yoga might be helpful for that).

If she's finding online helpful, How To ADHD on YouTube and Twitter does an ace blog. I really like her.

Hi OP, you sound lovely and so supportive.

I don't know if this is helpful to share, but I suffered similar issues to your daughter - right down to the ADHD diagnosis. That was probably the beginning of getting better for me although it took years. As I'm sure you're finding out, ADHD in girls tends to manifest very differently to ADHD in boys. In girls it seems to result in the kind of mental strain which is affecting your daughter. For me, treating the ADHD eventually allowed me to start being kinder to myself. Realizing my brain didn't work like other people's and eventually realizing I had been mentally beating myself up for 15+ years for not being "normal" allowed me to get better. It took time, meds, and learning lots of coping strategies. I hope your daughter can find a way through too - your help and love will surely be giving her the best chance.

Poor girl and you. You sound like a lovely family.
A couple of suggestions...
Does she have asthma and take montelukast tablets? These can have lots of neuropsychiatric side effects like you describe. As can quite a few other meds. I would read the patient information leaflets of anything she is taking.
Secondly have you tried a weighted blanket? These are really comforting for people suffering from anxiety. You can buy them online or make them really easily with polypropylene pellets x

How are you both this morning @cyclotherapy , I was thinking of you overnight

I so sorry that your dad is experiencing this. As an adult I am finding much help for childhood trauma through long term Gestalt psychotherapy. It sounds as if your dd wouldn't manage this at the moment but it might be something to think about once she is more stable on medication.
When she is in her worst moments, could you try singing to her?

Some other thoughts that might be helpful. It could be important to let her know that you are seeing and hearing her anguish, you can see just how awful traumatic feelings from the past are for her. Equally important is to say that those feelings, although awful, are not all of her and that it might not be helpful for her to get so totally lost in them. Remind her of the other things she is that are not those feelings ( eg her talents, great aspects of her personality, things she loves to do etc - they are all part of her) . It could be good to do all of this in the first instance, at a point when she is not at her worst and is most able to take it in.
The task for you would be to acknowledge just how awful and terrifying and unfair the feelings are ( and you may need to do lots of this) but keep it in balance with all the other things she is that are not traumatic feelings.
If you think she would be receptive to it, you could explain that getting totally lost in the feelings isn't helpful because it can just end up as being retraumatising and make things worse, but that of course it is important to acknowledge how awful those feelings are, without getting lost in them.
Disclaimer: I am no therapist but this is just what I have found helpful.
It sounds as if, when she had psychotherapy before, for whatever reason she did not get enough support to acknowledge the feelings without getting lost in them. It is a tricky balance!

cyclotherapy so sorry that you are going through this. Just wanted to add that if she is drawn to mindfulness, have you heard of the app headspace? It makes mindfulness and meditation very accessible. There are 10 free sessions and then you can sign up for about £7 per month. It has hugely helped my husband with anxiety and depression. There's a kids section that focuses on things like "calm", "sleep" etc and there are different meditations for different age groups. Wishing you all the best.

for you and your DD. I’ve had EMDR and it changed my life - there is hope. I was hospital for a while and we were taught techniques to get through the worst suicidal/anxious/can’t bear moments: try something that will sharply decrease temperature, eg cool pack or iced water, burst of physical activity eg star jumps, and paced breathing (eg breathe in for five, hold for four, out for seven, hold for four, repeat). For the moments that are more steadily sad, I agree with the headspace recommendation, it’s very grounding - also gentle yoga (try yoga with Adrienne videos on YouTube, some are five mins), baths if she likes them, classic children’s books...
Also recommend for you reading Depression the Curse of the Strong, I found it helped with my understanding.

Can I suggest horse therapy? It has been proved to be hugely helpful with a range of physiological issues. I'm not talking about riding - just being with horses in a no pressure environment.

Here's a link - www.counselling-directory.org.uk/equine-assisted-therapy.html

Your love shines out of your words. I wish you and and daughter a safe future.

Hello and thank you all of your wonderful messages of love and handholds and flowers... they mean so much and have really lifted me when feeling very bleak.

I'm sorry not to have been in touch earlier - all of us were awake until 6.30 am after my last post which totally scuppered me....and some very tough times since, living from hour to hour... but little glimmers of hope.

She was up for having Granny for supper and a DVD - her first social encounter in 9 weeks ... and she went for a short walk with the dog. Both she found very scary and isn't up for going for a walk again but is for Granny coming back in a week or so. Serious progress!

helloviroids Wow!!! I would love to know more about your EMDR - it is our great hope! First session went really well but sadly not another for a couple of weeks as psychologist had a family bereavement. How many sessions did you have? Did any make you temporarily worse? How long before it started to make a difference? And what did you think helped... well anything really would be great to know. Do PM me if easier. AND BRILLIANT practical advice for those darkest moments: we'll see if DD is up for any - I suspect the temperature one at first. Any others they suggested?

sarahlou I do like the idea of horse therapy and am going to take a look at that after we see how the EMDR does

quilliam I love the idea of anchors and am going to explore music she already has a very positive association with

Vivi Interesting ... we've always thought not autistic because she has such a strong understanding of how people think and picks up superfast on mannerisms etc... but other things do shine out, especially her very black and white view of the world...

DamsonGin that's really interesting and going to look at those when she is a little better and ready to reengage with the ADHD world

Motherofbears thank you - really inspiring to think she could have as positive an outcome as yours

Youdancing no other meds at the mo but wow, I like the sound of weighted blankets - I hadn't heard of them before but as a babe we had to swaddle her really tightly to help her go to sleep ... going to try one as soon as it is cooler and think it could be very comforting moving forward - rather hot at the mo with all windows locked!

educatin Yes I do sing to her - many of the nonsense songs I made up for her when she was tiny! Following your post, Ive integrated more of her being more than her negative feelings in a much more gentle way than we were doing and it definitely helps. Gestalt has always intrigued me ... one to think about post EMDR

Hope I had forgotten about Headspace - a friend mentioned it a while back... Ill take a look, thank you

Thank you so much every one... seriously wonderful helpful and reassuring advice.