There needs to be some sort of reward or minor sainthood for parenting a profoundly anxious kid. It is not for the faint of heart. Watching your child suffer and feeling helpless to fix it has its own category. Of course, it was overwhelming for your child.
In addition, an extremely anxious child will impact an entire family. There could be school refusal, sleep problems, meltdowns, all sorts of accommodations, more attention for the anxious child relative to other children, and on and on.
What should you do?
First of all, try to figure out if your child has emetophobia. If you don’t have access or can’t seem to get a clear response from a provider, here are some checklists that might help.
Symptom checklist and assessment
Description of safety-seeking behaviors that usually accompany emetophobia
The treatment worth seeking is something called exposure and response prevention (ERP). In our experience, general talk therapy (very effective for all sorts of things) and cognitive approaches without behavioral challenges are unlikely to make much of an impact on the symptoms. Of course, there are exceptions to every rule. However, when emetophobia is a daily problem, please save yourself time and money and find someone experienced in ERP. We know from the requests and feedback we get that finding someone who is experienced in treating emetophobia can be a challenge, but it is definitely worth it.
Also, important to consider is whether or not medication is appropriate. Most parents are legitimately reluctant to try medication. We are not physicians so please keep that in mind given our remarks. If your child is generally able to function relatively normally (e.g., go to school, maintain their weight, interact with friends, get enough sleep, etc.) then your child may just need behavioral treatment. When there is a persistent major interruption in day-to-day functioning, it may be appropriate to get a medical consult. Certainly, if your child is significantly underweight then medical intervention is crucial.
Sometimes the available option is self-help. Here is a link to some good books. If you are going to try the self-help option, it will help you to think of this as a process of learning something new. That means it will require persistence and repetition. It is a matter of mastering a new skill, NOT getting fixed. If your child wants to play hockey, what is required? Think of it that way. Practice, practice, coaching, practice.
Parenting is complicated enough but with an anxious child, a whole other level of complexity is added. Here are some things to consider while you are in the process of finding and providing help for your child.
- Don’t spend a lot of energy on blame or trying to figure out why. I just can’t imagine anything really useful in assigning blame. Being full of guilt because of some hypothetical reason is not useful for this. If you need to work on that, do it, just keep it out of your interaction with your child. You may never know exactly why your child has a phobia. It is much more important to reduce the symptoms. Figuring out if it is someone’s fault or where it started won’t help resolve the symptoms, particularly for children. If you have blamed your kid by accusing them of not trying or because of some character flaw, you probably know how well that has worked. All kids need correction. They wouldn’t make it to adulthood without some scolding, fussing, and warning. What I am saying is that anxiety disorders are something different from the usual mistakes, misbehavior, and stubbornness that require correction.
- Learn what you can about anxiety. It would be nice if your child didn’t have an anxiety disorder. But if your child does, then you need to know about it. In the last few years, solid scientific information is widely available online. I recommend you look primarily at sites dedicated to anxiety disorders like iocdf.org or adaa.org. Those sites will give you a framework to evaluate other information because there is also endless rubbish available.
- If you have a partner in the household, you are probably not exactly on the same page on what to do and how to respond. You will probably not ever be on the same page. Seriously. That isn’t a pessimistic view. It is based on research. Rather than getting your partner to concede to your side, it is more productive to try to find some agreement. That requires conversation but NOT when things are escalated. If caregivers approach parenting from a directive or a collaborative position, that probably isn’t going to flip-flop. However, if you are extreme in either – push-over or hard case – then you can move to a more middle position.
- Rage and aggression are never appropriate. No eye rolling or contemptuous remarks. People may do something to avoid being shamed but the cost is just too high. Anger and frustration are protests that you don’t like the way it is! If you are mad about this in your heart, then you will be more reactive when your child’s symptoms show up. Depending on the age of your child, your opinion is more important than any other opinion in the world. With that much power, it is too easy to crush the spirit. Anger will just apply more pressure. If your car doesn’t fit in the garage, then stomping on the gas really won’t help.
- Failure to accept the reality of the anxiety can make you miserable. You will know you have not accepted it if you find yourself thinking things such as, “Why me?” “I can’t take this,” “Why are you so screwed up?” “I must be a terrible parent.” Here is the plain reality: Your child’s anxiety will mess up life for a while. If you accept this, you will experience less distress while you face a difficult process. Remember, this is anxiety. They won’t die. They won’t stop breathing. Their heart won’t burst. Your life isn’t over.
- Try to not give in to every demand that anxiety makes. It is hard to see your child afraid. It is important to gently push back. If there is a meltdown that was probably too much pressure. However, whatever was avoided, try again. Break it into steps but head in that direction. Encourage your child to face what triggers the fear. Be aware of anxiety’s favorite ploy: avoidance. Excessive anxiety must be faced. Do your best to keep your child doing the day-to-day necessities like going to school, eating enough, playing with friends, or sleeping in their own bed. If those areas are already impacted, gradually take steps toward getting back to where things need to be. It is much easier to stop safety behaviors when they first start compared to when they have been repeated frequently.
- How anxious are you? Watch out for your own catastrophic thoughts. When your child is having a meltdown, try to not match that, even if you have to fake it. Anxiety disorders are not easy to overcome but they are absolutely treatable. Don’t give up, don’t despair.
- This will take a while to work through. Just because the calendar says it is time for school, travel, or whatever, that doesn’t mean the anxiety will be fine. Adjust your expectations. There aren’t miracle cures and to use a cliché, this is a marathon, not a sprint. Think of the solution as a process, not a short-term fix.
- You might want to talk to others and get advice. You might get it without asking. Be prepared to get a lot of judgment. Most of it will be well-meaning but most people do have a clue about what this is like. Pick your confidants with some care. Sometimes, it will be all you can do to not utter the memorable phrase, “Would you please put a sock in it?” Here are some of my favorite bits of advice (please note the sarcasm): “You are just too nice, you’re an enabler.” “You should just pray about this.” “Back in my day, we would never have put up with this.” “I think your child is just manipulating you.” “I would just tell my child to suck it up.” Hearing this is just painful. I don’t care if part of it might be right. It is the psychological equivalent of responding to a car that won’t run by saying, “Have you tried the ignition?” Can we all just accept the fact that, just maybe, it is quite a bit more complicated? So yes, please have them put a sock in it. If they won’t, put some imaginary tiny socks in your ears. The truth is, people won’t understand unless they have been through it.