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YogurtParfait_US
Hi all,

Just got the report from our first psychiatrist visit for Olivia--she used a word I hadn't seen before related to Olivia. Panic attacks.

She said that based on her functioning she did not see that she was experiencing generalized anxiety. Rather, she suspects panic attacks. Her report summarized our two hour meeting, with appropriately tentative language as she discussed possibilities.

I wondered if any of you have suggestions for managing panic attacks?

This one that she is currently in the middle of was precipitated by me tucking her in, and unfolding her folded-down blankets while doing so. She started screaming that she can't sleep unless her bed is arranged a certain way ...

She's still screaming ... 20 minutes and counting ... I brought my son down to the family room to read on the sofa instead of in his own room, which is right next to hers ...

If a parent approaches her room she screams louder. She also has been running down here to scream in the family room, but I take her back upstairs ...

All suggestions/thoughts welcome ...

YP
"Hope is a wonderful thing ... but hope by itself is not enough. Hope is the reason to take action, to make a plan and then to change the plan when it isn’t working - over and over and over again if necessary." Hannah Joseph (Let's Feast Friday Reflection, "Just Keep Going," Friday, March 3rd, 2015)
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PinkMomUSA
I feel for you...not sure what to say...but I pass a great big hug your way...you must be a very patient Mom.

If I was in your shoes right now I would probably have broken down in tears...It hurts to see your child in pain.

Working on getting my d into a psychiatrist to see about depression and panic attacks..she only had one that I am aware of...we were at home...she complained of her chest hurting..over after a short while.

Take care.
PinkMom
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SiriusHertz
YP, is "panic attacks" another way of saying that her anxiety / perfectionism / OCD seems to be triggered by certain things - like messed up blankets or cards not aligned in a perfect grid? If so, I'd say it's pretty much just semantics - another way of saying what we're seeing.

In our case, and yours too I think, it's likely that the anxiety ebbs and flows; it's generally present to some degree, sometimes more, sometimes less, and sometimes it's controlled, sometimes it's beyond her ability to deal with, which results in this kind of outburst, over something that seems so minor to you and me. If the therapist wants to use "panic attack" to describe that variable anxiety level, great. 

If, however, "panic attacks" is a way to downplay the severity of the anxiety she's feeling, than it's not a good diagnosis. If the therapist means that your daughter is not at all anxious most of the time, but then suddenly has this massive, but short-lived, outburst of anxiety which then disappears completely, than it's possible she's not understanding your d. While that sounds like it describes her behavior, I'd be concerned that it oversimplifies what's really going on in her head.  "Panic attack" has been used in the past with me and my ex-wife to downplay a serious illness - as in, you don't have hypoglycemia, you're just having panic attacks (brought on, no doubt, by blood sugar levels in the low 20s; I'd be panicking too!) - so it's possible I'm reading something into it that this therapist does not mean.

As for dealing with them - no real advice other than to weather the storm and let her know you still care when she can accept hearing it. And of course take care of the rest of your family as best you can - which you're already doing. Keep your chin up! You're doing great in a bad situation, which is all you can do.
New Mexico USA | Step-Daughter dx. AN on 10th birthday (2012) | Still fighting back

The most beautiful people I've known are those who have known trials, have known struggles, have known loss, and have found their way out of the depths. - Elisabeth Kubler-Ross 

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AnnieK_USA
My young adult daughter has panic attacks every day. She doesn't take any medication for them, but just waits them out, heart beating hard, helpless to go anywhere or do anything, horribly afraid and confused, feeling like she is going to die the whole time. 

Is your D angry, or fearful, or frustrated or what?

Here is the WebMD page about panic attacks:

http://www.webmd.com/anxiety-panic/understanding-panic-attack-treatment

Daughter age 28, restrictive anorexia (RAN) age 11-18, then alternating RAN with binge eating disorder and bulimia with laxatives, is in remission from EDs for 3 years after finally finding effective individual therapy. Treatment continues for comorbid disorders of anxiety, ADD and depression. "Perseverance, secret of all triumphs." Victor Hugo
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alwaysvigilantCAN
YP are these outbursts around tactile/sensory issues? Would an Occupational therapist be able to help? You may already know all about this but here is a link that may be of benefit.

Sending you strength YP.
5 years in active recovery; With many, many days of full nutrition and closed loopholes, insight, life experiences and brain maturity we are slowly loosening the safety net
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YogurtParfait_US
Sirius,

The psychiatrist did give a diagnosis of anxiety disorder-NOS (which Olivia already had from a psychologist), so I didn't feel she was dismissing anxiety as a general issue. She also noted anxious behaviors during the interview--acceptable but not optimal eye contact, obvious discomfort when "mean voice" was raised, etc. I see your point that it is, perhaps, a word choice issue--what I call a tantrum, she called a panic attack.

BTW, Olivia finally calmed down enough to talk in a normal way (to ask if I would come and tuck her in without yelling), but when I tried to put her to bed she was thrashing with compulsive exercise. I asked her to calm her body to sleep, and she wouldn't. I had to say that we can't have houseguests come and stay if she won't go to bed normally like she does every night. So she did, but she wouldn't use a blanket (she said "I have to be cold"--clearly the disorder talking). I put the blanket on her after she fell asleep, which happened pretty quickly.

Poor kid. The only good outcome on this one is that she is sleeping without the perfectly folded blankets that my re-arranging of triggered the panic ...

Thanks for the insights!!! Parenting an anxious kid is no picnic, that's for sure!

YP
"Hope is a wonderful thing ... but hope by itself is not enough. Hope is the reason to take action, to make a plan and then to change the plan when it isn’t working - over and over and over again if necessary." Hannah Joseph (Let's Feast Friday Reflection, "Just Keep Going," Friday, March 3rd, 2015)
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YogurtParfait_US
Always--no, never sensory. Usually related to being reprimanded or asked to do something differently. Tonight related to violating a ritual that I wasn't aware of--"must sleep with blankets turned down just so"--it is possible that the ritual just started during our vacation ... she has been upset about bed arrangements before, but never has had a tantrum over it ...

Annie--angry, fearful, frustrated ... I don't know, but I know she is upset by being corrected. She is quite a perfectionist ...

YP
"Hope is a wonderful thing ... but hope by itself is not enough. Hope is the reason to take action, to make a plan and then to change the plan when it isn’t working - over and over and over again if necessary." Hannah Joseph (Let's Feast Friday Reflection, "Just Keep Going," Friday, March 3rd, 2015)
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AnnieK_USA
According to WebMD, these are the symptoms of panic attack. Does this look like what your daughter is experiencing? My D has most of these.

http://www.webmd.com/anxiety-panic/default.htm

"Panic attacks involve sudden feelings of terror that strike without warning. These episodes can occur at any time, even during sleep. A person experiencing a panic attack may believe that he or she is having a heart attack or that death is imminent. The fear and terror that a person experiences during a panic attack are not in proportion to the true situation and may be unrelated to what is happening around them. Most people with panic attacks experience several of the following symptoms:
  • "Racing" heart
  • Feeling weak, faint, or dizzy
  • Tingling or numbness in the hands and fingers
  • Sense of terror, or impending doom or death
  • Feeling sweaty or having chills
  • Chest pains
  • Breathing difficulties
  • Feeling a loss of control"
Daughter age 28, restrictive anorexia (RAN) age 11-18, then alternating RAN with binge eating disorder and bulimia with laxatives, is in remission from EDs for 3 years after finally finding effective individual therapy. Treatment continues for comorbid disorders of anxiety, ADD and depression. "Perseverance, secret of all triumphs." Victor Hugo
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YogurtParfait_US
Yes, "panic attack" doesn't quite seem to fit--maybe two apply?? Though I don't feel her feelings, so am not sure ...

YP
"Hope is a wonderful thing ... but hope by itself is not enough. Hope is the reason to take action, to make a plan and then to change the plan when it isn’t working - over and over and over again if necessary." Hannah Joseph (Let's Feast Friday Reflection, "Just Keep Going," Friday, March 3rd, 2015)
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IdgieThreadgood7USA
Sounds like anxiety related OCD like behavior to me. Another form of distress intolerance. I think it's very much like refeeding in its response. My ds perfectistic traits and what I refered to when she was young as worry wart. Never overwhelming until Ed evolved. It seemed at least in our case that the anxiety worsened when Ed behavior was dimished. Not all of a sudden but gradually. I wonder if this is something people talked about plugging the behavioral holes in recovery. Olivia is young but I think at some point coachng her to recognize these behaviors early before they reach panic state would be the goal.
It's funny but I think I remember small OCD like behaviors in children who outgrow them like socks have to just do or shoes come on and off 100 times Certain tactile things like tags in clothing etc. it's like a spectrum Why it evolves in some is such a perplexing question. Can subtle diet changes be a trigger too?
"Sometimes you just have to be your own hero"
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YogurtParfait_US
I think it is--it occurred to me in the middle of the night that she might have had to have her blankets folded "just so" to prevent something horrible happening (like me dying) or something like that, and it might have been triggered by our return home from vacation ... 

YP


"Hope is a wonderful thing ... but hope by itself is not enough. Hope is the reason to take action, to make a plan and then to change the plan when it isn’t working - over and over and over again if necessary." Hannah Joseph (Let's Feast Friday Reflection, "Just Keep Going," Friday, March 3rd, 2015)
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IdgieThreadgood7USA
YP, the 1st OCD like behavior we say in our d came long before Ed behaviors occurred.
She was 10 years old and talked about wanting us to live forever and never die. A pretty standard young child realization and then my best friend, my age with a daughter a year younger than Cody, died. Cody was devastated as were we all. But she could not go to bed at night until she recited a mantra. It was recited very quickly and could not be interrupted or she would start over. She believed it would keep us safe. She was very anxious. Over time it waned and faded but she did develop other phobias, didn't want to cross the street,feared movie theaters, made is check to make sure the front door was locked. I think it was the beginning of her harm avoidance behaviors. For what it's worth, I think the predisposition is there and events in the environment pull the trigger. They can be awful things like the World Trade Center or newtown shootings or they can seemingly small things. Once it happens , the brain remembers. I think interrupting the response in a small methodical manor like the OT someone spoke if with OCD behaviors could be helpful. I think the response becomes like a PTSD like experience.
"Sometimes you just have to be your own hero"
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sarabandeUSA
Best book ever for parenting anxious children: 
Parenting Your Anxious Child with Mindfulness and Acceptance: A Powerful New Approach to Overcoming Fear, Panic, and Worry Using Acceptance and Commitment Therapy by Christopher McCurry, PhD

Here's an excerpt: 

Successfully treating an anxiety disorder means more than eliminating or even reducing the anxiety symptoms.  A successful approach requires addressing both the inner world of your child’s thoughts and feelings and the outer world of your child’s anxious behaviors—as well as how these inner and outer worlds invite you to engage, for better or for worse, in the anxiety dance.  This book will help you understand the nature of that dance: why you and your child must do it together, and how you can create a new dance to effectively solve problems and promote your child’s growth when anxiety shows up.

----
And here's really wonderful guided meditations you can download and listen with your daughter -- I'm sure a young child would enjoy even though it's says "teens" and there's a guided body-scan meditation:   Mindfulness for Teens: Meditation Practice to Reduce Stress and Promote Well-Being by Gina Biegel

Gina Biegel's website on mindfulness:  http://www.stressedteens.com/

mom to teen daughter in remission/recovery; treatment included UCSD's multi-family program and FBT with EXRP & ACT
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sarabandeUSA
You can't do much during an attack, but keep her safe and remind her to breathe and hold her if she'll let you.  My suggestions below are based on the how to help her better understand her panic attacks during calm moments.  These are ideas to do not during an attack.  In the moment of the attack, it's best not to try to control how she feels or you feel -- the more you or her struggle to stop the the panic and fear of an attack, the more you will struggle.  It's a big cycle. Reasurring her that she knows that these attacks go away is helpful, that she's experienced them going away is helpful.  The productive work you can do is not during an attack but in calm teachable moments.

I also think it's really helpful for parents to discuss the concept of "thoughts" and "feelings" and how they're produced by our super powerful brains, so kids can better understand that thoughts and feelings aren't "real."  Humans need to be flexible enough to decide how they want to engage with their thoughts, feelings, and bodily sensations, so they don't get pushed around by them or controlled by them.  This is pretty easy to discuss with young kids, and it helps by explaining to them how we have lots of thoughts all the time and how we decide to deal with them. This helps kids see how thoughts are different from behaviors.  Our behaviors are based on our values, this is how we choose what we do each day (or what to avoid). 

This discussion can also help parents "show" how they will keep the child safe during these highly anxious moments -- it's part of the learning a new anxiety dance with the child that McCurry talks about.

Here's some ideas that I've used and shared with other parents -- first, I wouldn't leave her alone while she's having a panic attack, she needs to feel shes safe even if you're on the other side of the door:

1.  describing thoughts, feelings, bodily sensations as stories in our brains, not real

2.  asking child to label these different scary thoughts or rituals or obsessions can help child gain a little distance from the thought, so the thought isn't so real and scary (for example child could say out loud, "I'm feeling that silly red pajama story again")

3.  fun experiment: gather timer, paper and pencil and ask child to write down every thought they have in a 2 minute period, you can do this too, and see what they say -- idea is to show that we have thousands of thoughts (bits of data) per day -- you could even ask child to act out some of the goofy thoughts to show how silly it would be if we acted on all these thoughts all the time...  further pointing out how we can be flexible and act with our values despite the crazy thoughts are brain produces all the time

4.  create entirely new "ritual" for the old one in order to develop a new pathway, so brain focuses on a new, healthy, safe one

5.  find silly ways to "poke holes" in the logic of the current obsessive ritual, such as if a child was afraid of wearing red pajamas because it reminded her of blood and death, and then you notice that she has on red nail polish, and you say "oh look you sometimes wear red nail polish to bed and nothing bad happens")  -- this disconnect creates a little distance and the brain has to make sense of the disconnect and in the process the ritual lessens its grip just a little on the child.

6.  more advanced exercise:  talk to child about values by asking her what’s important to her, what she likes about herself, what makes her unique – she could make a fancy drawing for her bedroom of her values with words and pictures to remind her of what’s important when she’s afraid or anxious.

7.  teach her some deep breathing strategies so you can use during a future attack.  practice, practice, practice.

8.  develop a code word to use before an attack or during to help you both focus on the strategies you designed and practiced frequently (maybe daily for a month).
mom to teen daughter in remission/recovery; treatment included UCSD's multi-family program and FBT with EXRP & ACT
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YogurtParfait_US
Sarabande, Amoma, Ern4ever,

Thank you! This is all very useful!

xox,
YP
"Hope is a wonderful thing ... but hope by itself is not enough. Hope is the reason to take action, to make a plan and then to change the plan when it isn’t working - over and over and over again if necessary." Hannah Joseph (Let's Feast Friday Reflection, "Just Keep Going," Friday, March 3rd, 2015)
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sarabandeUSA
I just found this nice list of mindfulness activities for young children -- I think these are in the McCurry book too: http://www.actonpurpose.com.au/Mindfulness-activities-for-young-children.pdf

And this comic book about ACT for young people "I just want to be...me: building resilience in young people":  http://www.actonpurpose.com.au/ExtractIJustWantToBeMe.pdf

found it all here: http://www.actonpurpose.com.au/index.html

not sure what I think about the comic book, but the breathing exercises in first handout are good...
mom to teen daughter in remission/recovery; treatment included UCSD's multi-family program and FBT with EXRP & ACT
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marilyn
YP, I agree with those that this is different from a panic attack.  I've had just one or two in my life.  The main one was during a plane flight where there was turbulence.  I literally could not feel or move my feet.  Then, the same thing happened to my hands.  It was terrifying.  A flight attendant came with a paper bag and told me to take slow, deep breaths using the bag.

This sounds more like OCD to me, as several others have said (the blanket having to be folded just so).  The ideas of mindfulness activities, guided relaxation, soothing music, maybe gentle massage -- these all sound like good things to try.

I might try (at least once) pushing through the screaming, and telling her calmly something like:  "I'm here to help you relax.  What can I do to help you relax?  Everything is going to be okay.  We're going to figure this out together."  Just brainstorming!
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YogurtParfait_US
Thank you so much!! I appreciate all of the insights!

YP
"Hope is a wonderful thing ... but hope by itself is not enough. Hope is the reason to take action, to make a plan and then to change the plan when it isn’t working - over and over and over again if necessary." Hannah Joseph (Let's Feast Friday Reflection, "Just Keep Going," Friday, March 3rd, 2015)
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sarabandeUSA
Just a few more thoughts, then I'll shut up, really...
OCD rituals and compulsions can be the fuel to trigger a panic attack. Fear, panic, scary bodily sensations, compulsions can be all wrapped up together. I think it’s important to understand how OCD and anxiety are linked – rituals and compulsions are done to avoid feeling the anxiety, in an attempt to lower the anxiety, but of course, that never works, so the person continues to do the habit, which then becomes a ritual, and there’s the cycle. This is how restriction and avoidance works in anorexia: as an attempt to avoid strong feelings, to not feel high anxiety, so refeeding is EXRP -- the exposure to food and phobia, and the response prevention is being required to eat so as to “not avoid, not restrict.”
 
I don’t think labeling these high anxiety events matters much because the parenting strategies are all the same (like the ones I describe in a previous post here). Preventing the ritual and compulsion would be a good place to start (possibly by creating a new healthier habit). Also helping the child ride out the emotional wave of high anxiety and using breathing strategies to help her ride it out. I like Nancy Zucker’s use of the wave as a metaphor – you can tell your daughter that while she rides the anxiety wave, you’ll be waiting for her on the beach, and you’ll keep her safe while she’s surfing (you could come up with a great, fun story about surfing--the safe kind of surfing--ha, ha).

The goal is to show her that anxiety isn’t necessarily bad, it’s her body’s warning system, and she will need to learn how to live with anxiety, like all other humans – you can tell her that her body’s warning system is just more powerful or finely tuned than other people’s – turn it into a positive, seriously.   The danger of anxiety (for parents and kids) is ignoring it or hoping it will go away or trying to make it go away...

Walter Kaye during the multi-family program at UCSD told us that these AN character traits are actually great for adults and for certain careers – it’s our job to help our children make sense of these, learn to live with them, and use them in positive ways – I think it’s so powerful to know that these anxieties can be seen as strengths. 

YP, I'll be curious to know what works for you and your daughter, keep us posted.
mom to teen daughter in remission/recovery; treatment included UCSD's multi-family program and FBT with EXRP & ACT
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YogurtParfait_US
Thanks, sarabande.

The night of the explosion and lengthy tantrum over me mussing the covers was the night before last.

Last night, I was putting her to bed. Covers were messy. She smoothed them out and lay on top. She said, "I am going to sleep on top because I should be cold." I used a bit of advice given here and said, "Those mean voice thoughts are just stories. None of them are true."

Then, I said, "For a girl sleeping under messy covers, and I will come and sleep with you part-way through the night.

She snuggled/rolled up in her covers and went to sleep. I joined her in the middle of the night ...

YP


"Hope is a wonderful thing ... but hope by itself is not enough. Hope is the reason to take action, to make a plan and then to change the plan when it isn’t working - over and over and over again if necessary." Hannah Joseph (Let's Feast Friday Reflection, "Just Keep Going," Friday, March 3rd, 2015)
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IdgieThreadgood7USA
YP, you rock mama. Your loving calm demeanor has obviously found a solution Hugs to you!
"Sometimes you just have to be your own hero"
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mec
YP,

The only time in my life I had panic attacks was over 10 years ago when I was taking over 100 mgs of Medrol (steroids) due to inflammation and I literally was out of my conscious loving mind. I had about 3 severe panic attacks where I literally felt my throat close up on me and I couldn't breathe, my heart was pounding in my chest and everything started reeling around me. I felt as if I was dying. Finally, one dr was right there in the midst of one of these attacks and he looked in my throat and told me that it wasn't closing, checked my vitals and told me that I was fine. He taught me how to breathe for relaxation but the best thing is that he immediately cut my steroid dose in half.  He said the those that the previous Dr had put me on would end up killing me, not the inflammation.

I never had another panic attack and even though mine was chemically induced it was still as real as one produced by an anxiety disorder. I feel for anyone who suffers from them. It is the scariest and most disconcerting feeling because you feel as if you are dying or that you can't breathe, that your chest is tight or that you are going to faint. It is just awful!
21 year old daughter who was DX with RAN at 9 years old. The work of recovery is ongoing. 
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SeminarLady
My daughter had two major panic attacks in her life - one at her age 6 birthday party sleep-over and 2nd was when she was first in her second IP for ED and they pushed her to join groups. She was so not ready for groups - she had the panic attack and the treatment staff called me and told me that she was hyperventilating, she complained of not being able to breathe and they rushed her to ER. Maria and others describe those 'panic' symptoms well.

YP, what you describe sounds more like OCD or anxiety rather than full blown panic attacks.

Hugs!
Cathy V.
Southern California
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sarabandeUSA
YP, I'm so glad the "thoughts are like untrue stories" strategy worked!  Great job!

Here's another book about OCD treatment for young children using EXRP that might be helpful (Jennifer Freeman has written a therapist's guide and a parent's workbook).
mom to teen daughter in remission/recovery; treatment included UCSD's multi-family program and FBT with EXRP & ACT
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