Should we seek a private psychiatrist for our daughter's severe anxiety?

[Pleachedpeartrees]

Hello, just so worried about my 20 year old daughter. She's had anxiety on and off from age 8. She's now worse than ever. Travelling, exams, unfamiliar places, crowds, social gatherings set her off. Panic attacks can last hours, she describes it as a stomach flipping sensation that can last hours. No particular trauma in childhood. She's tried various ssris, lots of talking therapy including cbt and emdr. Doctors only suggest increasing ssris. They won't refer her to a psychiatrist. She's not really living life and it's now making her depressed. Do I pay for a private psychiatrist, which will be thousands, or try hypnotherapy? Just running out of ideas.

Yes if you have the funds. I was discharged by the local CMHT and have had to go private for my MH issues and it has actually saved my life. There’s no greater investment imo.

Has she got up to the maximum dose of the SSRIs? My DD didn’t feel any benefit on lower doses but is much better now.

Absolutely, there is nothing OP has said that indicates ND, let alone ASD

Its classic, severe GAD and is probably now cyclical and self perpetuating because its so frightening and she is so out of control

A psychiatrist is helpful because they will prescribe different meds that GPs cannot prescribe, they should then refer back to the GP for that to continue if that is working

CBT doesnt work for things like this level of anxiety and EMDR is sometimes just offered now rather than it being for a specific event, misused really

So I would ask for the appointment for prescription assessment.

yes, that is exactly how ADHD and autism diagnoses work. Tbe traits are on a continuum and everyone, ND and NT, has some of them. The diagnostician has to decide whether they are to a clinically significant levels and are therefore badly impacting on the patient’s life eg (silly example) we all forget our keys sometimes but someone with ADHD might forget them twice a week despite
a complex system of reminders.

i was’t saying that the OP’s DD definitely or even probably is ND. I have no idea. However, the info the OP gave that she thinks rules out ND does not. My DC2 who is ND sounds like her DD.

Usually it's undiagnosed autism.

If there is no obvious cause for her anxiety then I would bet good money that she is neurodivergent, probably autistic. Research autism in girls and the way it presents.

A lot of the things that are making her anxious are negotiable. I think we sometimes assume that it is necessary to travel be in large groups be outgoing take exams and she might be internalizing this and assuming she is a failure for not being "like other people her own age". What about approaching it as if none of these things are necessary and start with baby steps and stop judging herself.

One of the features of perfectionism and conscientiisnous is that you are terrified of making a fool of yourself getting things wrong or failing and then it is a vicious downward spiral of self doubt rumination etc

I found in a similar situation what helped was to start very small. What can I do and enjoy - look at a view, pat the dog, brush my hair, make a delicious sandwich. a tiny goal out of my comfort zone every day which I don't want to do and no comparisons with anyone else.

We are wired to be members of a tribe and acutely aware of what others see us to be hence the self criticism high standards. But start letting her be "Selfish" in order to be back in that group. Value herself first for small things, minor things and build on that.

Grades aren't important if you can't leave the house. Going to the postbox smiling at someone in a queue at a shop these things work I promise. Magically the anxiety falls away.

Also sun, soil and vitamin d. Small daily interactions with humans without fail not just family.

Yes this book really does work if you follow it

Thank you for your responses so far. For context, we are a loving, close family. We talk a lot and my husband and I are very close to our children. Our son is confident and happy. I don't think family therapy is necessary, as suggested by @divinedownload. Just because all of your children are lucky enough to be 'confident and resilient' doesn't necessarily mean that anyone with a child who is struggling, has a dysfunctional or unhappy family. These things can come out of nowhere and seemingly have no trigger. My daughter had a very gentle, loving and incident free childhood and went to really nice schools. I have joined my daughter for a few therapy sessions in the past, when she was at school, to see if it might help. My daughter doesn't know why the anxiety is there. She had an upsetting break up from a boyfriend a few months ago which made everything much worse again. My husband and I have talked about it at length with her. She has had several years on and off of talking therapy as well as cbt etc, but it doesn't really seem to have helped. Her anxiety ebbs and flows and seemingly quite minor events can set it off terribly. I wondered about PANDS when she was a child as her first episode really came out of nowhere but followed on from a string of viral illnesses. It looks like panic disorder to me. It's very abstract, illogical and physical. She's almost afraid of fear itself. I've ordered the book suggested and have some links for psychiatrists that I'm going to follow up tomorrow. I watched the YouTube video which was interesting, and will share that with my daughter too. Thank you to the compassionate and helpful posters!

Perfectionism is often linked to black and white thinking and that can be linked to neurodiversity. I think challenging your worst case scenarios every single day is the best thing you can do with black and white thinking. And that starts with small things like telephone calls. Anxiety is always much higher when you wake due to cortisol so starting the day might be when anxious thoughts swarm in her brain so no pressure then, perhaps just rituals or habits short walk music meditation rather than anything concrete

Yes I think some people just have unfortunate brain chemistry, Im one of them and have to acept that I'll be on medication for life. Talking therapies for me really only have been supportive when Ive been well and only really in later life, not when I was younger, I think its limited what talking therapies can achieve when its about the chemistry. My personal view.

Sitting round as a family navel gazing is not helpful and I wince a bit each time someone posts a problem and its either 'family therapy' or 'more therapy'. People are usuallly talked out.

Physical exercise is very good for anxiety, particularly first thing. If I could be bothered!!

Yes there is - anxiety. Although obviously there are other possible csuses. It is just something to consider, nobody is saying it definitely is that.

As it says on here, autism [and ADHD] in girls and women is often misdiagnosed as anxiety.

https://www.autismcentral.nhs.uk/guidance/diagnosis-women-and-girls

I’d consider OCD traits a form of neurodivergence. It matters in that SSRIs are anecdotally far less likely to be helpful for ND people.

You might try the Genesight test which can give some insight into which psychiatric medications are more or less likely to be effective. A friend of mine did this a few years back and was able to make a case for going straight to off-label meds without having to jump through the typical NHS hoops of trying the first, second and third line meds, having them not work / cause unwanted side effects, and then being labelled a difficult and resistant patient who can’t be helped further, etc.

Given you are wondering about PANDAS, I'd highly recommend Stepping Stones in north London, even if you have to travel a long way to get there. They are expert at untangling anxiety/OCD/ND/PANDAS. In the PANDAS community they're the go to clinic. But I'd recommend them regardless of the PANDAS piece.

We have direct experience of them and they've totally saved a child in our family who presented very similarly to your daughter.

The suspected cause in our case is PANDAS, but it has resulfed in what we all thought to be massive anxiety and a little OCD. With the clinic's help we realised that a lot of what we thought was anxiety was actually another presentation of OCD. It can take many forms, and is very sneaky.

The psychiatrist diagnosed and prescribed medication, and then referred to a psychological at the clinic who specialises in CBT with ERP. The ERP element is crucial, CBT alone will not work.

It's still an ongoing process, but child is currently back living a normal life, is happy and positive. The work now is mostly about giving them the skills for the future in case of reoccurrence.

As someone who has had anxiety all my adult life, the thing that helped the most was CBT and talking therapy (counselling). A psychiatrist would be able to deal with medication but with the anxiety itself I don’t think there’s much else they would do. Paying privately for one to one counselling and CBT would be more helpful in my opinion.
i hope you find a solution, it sounds really hard for your daughter.

You could try hypno first because it’s cheaper. I’ve known it to work. Check credentials first.

Then yes I’d pay private for a psychiatrist after that.
The Gp - would they prescribe sertraline or similar though? Just for a short time? An assessment takes ages and won’t be immediate and is very costly.

Others may have a better plan. I’m not medical.

The talk therapy was given in abundance over the years for my child. It didn’t really cut it. The sertraline definitely was life changing.

Just to say, OP, that there is a big overlap between anxiety disorders and neurodivergence. There is also a higher incidence of OCD in autistic people than in the general population.

You mentioned crowds, unfamiliar places, travelling as setting off the panic attacks. Many ND people have issues with these situations.

So it mightn’t be that the ‘symptoms’ aren’t there, just that they’re not being recognised…possibly? Obviously I can’t know, but just mentioning it in case it helps you at all.

DS is autistic and has a brilliant sense of humour and absolutely no issues with recognising sarcasm btw. When he was on the pathway to being diagnosed I tended to look at lists of traits and dismiss asd as a possibility because of various things like that. But he is autistic and it became clearer the more we learned.

I’d see a psychiatrist, to answer your question.

So glad it worked out well for you @PurpleLovecats. I was one of the posters pushing you to go private (I’ve NC since then). I was worried when you disappeared from MN

Thanks. I think it’s shocking that i couldn’t get the help on the nhs and am still fighting their misdiagnosis. I’m back on antipsychotic medication and feel so much better.

As the parent of an anxious, unhappy teen the answers to this thread show exactly how difficult it is to know what to do when dealing with our DC. Everyone means well and everyone has a different answer. I’d say go to the psychiatrist. My DD has been completely resistant to any talking therapy - she does them but they don’t seem to have an impact on her at all.

How is her diet and general health. Does she have any gut symptoms/any signs of any kind of chronic inflammation like asthma or allergies.

Unexplained anxiety can be part of an inflammation response. This is a fairly new area of research though.

What would the purpose of the private psychiatry be @Pleachedpeartrees

I assume to consider other medications than SSRIs?

Or is this for more clarity on a diagnosis of a mental illness?

She’s had lots of therapy but did she really engage and do the home tasks and make changes to her life?
How helpful was the EMDR?

Reading your posts about a very anxious, high achieving YP where therapy hasn’t been successful, I’m thinking she’s possibly neurodiverse too.
There seems to be a lot of social difficulties and issues around transitions and stress. Difficulties in regulating emotions.
Also, the onset was relatively young for an anxiety disorder.

I wonder if a clinical psychologist may be more helpful in formulating what is going on for her.

How is her diet and general health. Does she have any gut symptoms/any signs of any kind of chronic inflammation like asthma or allergies.
Unexplained anxiety can be part of an inflammation response. This is a fairly new area of research though.

That’s interesting @GingerIsland!
I’ll google anyway but are there any references of note that you’re aware of on this subject?
My DS has asd and severe anxiety as well as asthma and allergies. I had previously heard that those with asd are more likely to have atopic conditions than the general population, but that’s all I know.