SIL's health anxiety

[AnnieAmelia]

SIL has a long history of health anxiety and Covid has pushed it through the roof. It's dominating her life.

The problem is that she's getting very anxious about what other family members are doing and asking them to modify their behaviour. We are modifying some things, and lying / not telling her about others.

She's now wanting to control my mother (her MIL)'s contact with her grandchildren.

She has risk assessed her own mother's contact with grandchildren and is happy for her mother to see her grandchildren, but wants to reduce my mother's contact with her grandchildren.

My mother is unhappy but SIL has been so distressed lately that she doesn't want to risk exacerbating things.

Mostly it seems to be about control - she's happy to meet her friends in Cafe A (because she's risk assessed it) but doesn't want other people meeting their friends in other Cafe B or C which she hasn't risk assessed.

Her own social life isn't reduced (because she risk-assesses) but she wants other people to reduce their social life.

An example of something we've kept quiet is that DH and I attended a funeral. It was in a large church, there was social distancing, everyone did a LFT first, everyone had to sign in for tracing, everyone was masked. But SIL doesn't think anyone should be attending funerals. So we have pretended we didn't go.

While we were at the funeral she was shopping in a shopping mall, which she had risk assessed as safe. It makes no sense that a socially distanced funeral is most risky than spending a couple of hours in a shopping mall, but SIL isn't making sense.

My mother is upset, but feels she has to comply in case my SIL's mental health worsens.

Does anyone have any experience of this sort of situation?

I wouldn't pander to her at all, that won't help her. Is her spouse your brother/sister? What part are they playing in all this?

Her spouse is my brother. He's walking on eggshells in case he triggers her in any way. The health anxiety started long before Covid and so he's been careful round her for a long time.

At the moment I'm trapped between my mother and my daughter, both of whom are upset about my SIL trying to control their relationship.

Slightly different as I have ocd rather than health anxiety but I agree about not pandering to her. My DH did in the beginning but ultimately nothing is ever good enough.
She needs professional help.

Cross post. I 'dealt' with ocd for 7 years on my own, DH getting increasingly frustrated with me and modifying his behaviour so I wasn't triggered. Ultimately I wish he'd sat me down and said this needs to stop and helped actively to find a therapist.
Does she acknowledge her health anxiety at all?

They've been trying to access professional help to no avail. Over the years she's had three different NHS talking therapy referrals (one was for a year of fortnightly sessions) and it seems there is nothing left that might work that she hasn't tried.

She also went private for (I think) monthly counselling for over a year, but I think that was a decade ago.

She's had a couple of brief NHS in-patient admissions, again years ago, but found being an in-patient incredibly distressing, and she and my brother want to avoids that.

So everybody is focussing on keeping her happy.

Do you know what type of talking therapy she had?

I don't know what sort of talking therapy. I know she's had both 1-to-1 and group therapy. Also, I don't think it was specifically for her health anxiety - she's anxious about other things as well, which have impacted on her life.

She acknowledges other anxieties more than the health anxiety. As far as Covid is concerned, I don't think she acknowledges that her response is "health anxiety." She has been focussing on stories of people who have been double jabbed and had the booster and still died.

We are all fully vaccinated btw. And none of us is taking risks, though all of us are trying to get on with our lives as normally as possible. What she's identifying as "risky behaviour" is stuff like going to a socially distanced funeral. In fact, I did a lot of my Christmas shopping on line to avoid crowded shops, whereas she'd risk assessed shopping as safe.

She sounds very controlling. I know she can't help it, but it sounds as though controlling people around her is a way of coping. What would actually happen if you were firm with her and told her that you had done your risk assessments and that the situation was safe?

Is she trying to reduce your mother's contact with your children, or her own? If it's yours, I don't think you should be pandering to this.

No idea what would happen, but it wouldn't be pleasant.

She's self-harmed, broken things and threatened suicide in the past.

She has a lot of migraines etc. Out of the last four times I was supposed to meet my brother, he had to cancel on three of them because she was too ill with a migraine etc to be left alone.

I wonder if she should explore CBT privately, she can start with the other anxieties then move onto the health anxieties.
I couldn't acknowledge my ocd at first because I could always find a justification for my behaviour which I guess is what she's doing. Then things that DH thought would trigger me didn't.
My ocd is focused mainly on contamination so if I do for example a cleaning job I know I'v carried out it 'correctly' vs DH who might touch various things during the process thus contaminating them. Your SIL is probably thinking if I go shopping I'll wear my mask, keep my distance, wash my hands etc therefore safe. With you she'll be thinking oh did Annie wear her mask the whole time, hug anyone, share buffet food therefore deeming it unsafe. Obviously it's all irrational.
The real turning point for me came when I realised my behaviour would certainly impact my DC. It's not fair for your child to miss out on seeing grandparents. You'll feel cruel triggering your SIL but you can't let her mental health impact the wider family.

She's trying to control my mother's contact with my university aged children.

Obviously she already controls my mother's contact with her own similarly aged children.

I'm making her sound awful, but so long as everyone is agreeing with her, and she is the centre of attention, she can be brilliant company. Very much the life-and-soul, vivacious and generous.

Quite honestly, if talking therapy hasn't worked three times, she may need medication. It worked wonders for me when I was in a spiral of anxiety.

She is on medication, has been for years/ decades, though I don't know what medication, or for what aspect of her mental health i.e. whether for anxiety or depression.

She had a diagnosis of histrionic personality disorder at one point, though I think that diagnosis has changed. I don't know what her current diagnosis is.

Oh dear. This does sound really challenging then- I'm sorry you are all having to cope with this.

I could ignore some of it, but I am currently stuck between my mother and daughter, both of whom are upset, but Mum says she can't risk upsetting SIL, and if that means my daughter is upset, so be it.

I was wondering if anyone had experience and knew how bad it could be if we defied SIL.

I really appreciate your advice, ocd1, that pandering isn't helping SIL either and that we can't let SIL's mental health impact the wider family.

If she's self harmed in the past you should probably work on the assumption that she may do it again. How distressed is she at the thought of 'risky' family meets? It's disappointing she's not received more help than she has. On the NHS website there's a number you can call for urgent help/advice. I'd suggest your brother calls it later today to discuss with a professional.

As someone else with a severe anxiety disorder (I have BDD and BDD by proxy so understand how it manifests and feels when your anxiety disorder is projected onto others) agree with OCD1 that "pandering" like all the the other compulsions that come with some anxiety disorders doesn't help, they just feed it and make it worse.

However blanket stopping all the compulsive behaviours (and by that I mean the behaviours she is asking others to do to help manage her anxiety) all at once while she is this unwell with no support could trigger a serious mental health episode.

I find with mine, and I have lots of strategies to get mine under control when it's triggered, I have to wean myself off the compulsions gradually while employing my other strategies. Including the compulsions that affect the people around me or I am asking them to do or my anxiety and suicidal ideation goes through the roof and is unmanageable.

She really needs some specific and specialised therapy to help her find strategies that will work. A lot of the CBT offered under the NHS is non specific and delivered by CBT therapists which personally I have not found helpful at all.

I found it more helpful looking into specific therapies for my condition. For example in your SIL's case, a health anxiety specific clinical psychologist.

I was considering paying to see the UKs leading expert in BDD but actually in doing the research and reading some of his books I've managed to get my BDD under control through the techniques I've learnt just doing that.

Another therapy she could try if CBT does not work for her is EMDR. Used mainly for PTSD, there have been some good results with anxiety disorders.

Also she needs to try different or more medication if her current meds are not working.

With BDD for example current recommendation is high dose SSRIs (more than a GP could prescribe she would need a psychiatrist). Not sure if this is recommended for health anxiety or not.

SSRIs also didn't work for me at all I take Mirtazapine which is very effective (for me). And works well in combination with my other strategies. I need to take the highest dose at 45mg a day.

I have severe health anxiety and Covid's definitely made it worse. I've really limited my social life but my husband and kids do what they want because I can't expose them to my anxieties in that way.

There's anxiety and then there's being controlling and abusive and she sounds like the latter.

I don't think her social life is much different to what it was pre-Covid. She "risk-assesses" her activities as safe.

I think ocd1 is spot on with "Your SIL is probably thinking if I go shopping I'll wear my mask, keep my distance, wash my hands etc therefore safe. With you she'll be thinking oh did Annie wear her mask the whole time, hug anyone, share buffet food therefore deeming it unsafe. Obviously it's all irrational."

But her risk assessments aren't always logical, so I would usually fail them (e.g. bigger, busier shops with automatic doors are safer than smaller, quieter shops which don't have automatic doors. She's been going to a very busy Starbucks to pick up coffee, I think because it has automatic doors. I would think twice about going there.)

We've been keeping the peace by smiling and nodding, but I'm increasingly annoyed at having to pretend that the irrational is rational.

Get her to watch some of these;

www.youtube.com/c/TimBoxMindCoach/videos

As your children are adults, why does your SIL even need to know who they are meeting? Just carry on as normal, & don't tell her.

Sorry but I think this is all very unfair of her, so she gets to do what she wants but gets to restrict everyone else, and threatens to self harm or attempt suicide if you don't concede to her demands.

And have just seen the Starbucks comment! That's absolutely ridiculous!