Friday, 28 March 2014

Meds down, anxiety up.

I do apologise - it's been almost three weeks since my last blog post! I hate it when that happens, for some reason I feel this sense of guilt for not keeping up with it. After all, I do love blogging - the process of researching and sharing what's on my mind is something I find extremely therapeutic. But I'm trying not to be too hard on myself. The past five weeks have been extremely difficult, as I have faced this time completely medication free with little professional support. A positive, I think, but one of the toughest things I've done in a long time nonetheless. I've therefore decided this blog post will be a little jumble consisting of my experiences of coming off medication and my subsequent surge of anxiety (yuck).

Today, I am five weeks medication free. After having gradually weaned off of Sertraline for about eight weeks or so, I'm now free of the stuff completely. If you've ever been on any form of long-term medication, particularly an anti-depressant or something similar, you are probably well aware of the strenuous journey of going on it and them coming off of it - it ain't easy.

When I first completely stopped Sertraline, my emetophobia started working overtime, and I had constant worries about how I would manage, questions about if I was ready for it, etc. At first, I felt okay, thanks to weaning off gradually. My sleep pattern was a bit all over the shop at times, but it was just about tolerable if I made sure I took lots of breaks and rested when I needed to. Plus, I had the incredible support of family and friends, who would help me celebrate my achievements with tea and cake! But about two/three weeks ago now, since being completely free of Sertraline, I have undoubtedly felt the difference. It's worth nothing that personal circumstances in my life have probably heightened my anxiety anyway, but these past few weeks have almost amazed me in how different my anxiety levels have been.

Every day over the past fortnight/three weeks I have experienced AT LEAST one full blown panic attack a day. I'm not talking an anxiety attack, I'm talking I-can't-breathe-my-hands-are-sweating-I'm-going-to-die-type panic attack. A lot of the time there's no trigger, which is probably the biggest factor that upsets me. If I can't identify the source, I can't try and work towards changing my attutude towards it, right? I can recognise factors that certainly have a small impact - changes to temperature (going from a cold to a hot classroom, for example), eating too much food/not the right stuff and not getting enough sleep certainly makes me more vulnerable, but sometimes, I can be sitting at my desk, or sitting in class, and WHAM! It's like this tidal wave of nausea and "impending doom" washing over me, making me feel as though I am losing touch with all of reality. I'm no longer "Kim" in that moment, I'm just a body of nervous energy. And all I can do is run - I run out of the class, or leave my desk, and the next thing I know, I'm curled up in a ball outside, sitting on the concrete in the freezing cold as it's the only way I can "snap" back to reality. And these crippling attacks can last anywhere from 10 - 30 minutes, with the after-effects writing me off for the rest of the day. Take yesterday for example - two big attacks before 1pm that were so bad I had to come home from college and I ended up kipping for four hours (I don't sleep in the day, not ever, so I must have needed it!).

I apologise for the depressing nature of this next bit, but it's important that I'm honest with myself - this crippling, debilitating, awful experience with anxiety has left me feeling like a bit of a shell of myself to be frank about it. I'm starting to lose weight as I'm too scared to eat. I can't commit to anything "just in case" I can't manage it.

Let me give you some stats (nothing official, but everyone loves figures I guess) - my resting heart rate is around about 70 beats a minute. During a panic attack, this, for me, goes up to around 90 on average. Bearing in mind I'm not doing any physical activity during an attack, that's a big leap for me (it'll be different for everyone). It's absolutely exhausting having this two to three times a day, especially as my heart rate won't return to normal for sometimes a good couple of hours.

The worst thing is that my anxiety now feeds off my anxiety. The anticipation of another panic attack is enough to kick-start one, and no matter how hard I try and reason with myself, there's a part of my mind that just won't listen and will have a little freak out regardless. And of course those living with anxiety will know how this can trigger a low mood. I feel tearful a lot, my self-esteem is pretty darn poor, and I'm struggling to keep up with everything. Despite this, when I do try to knuckle down, my concentration and focus has gone out the window and I procrastinate. Cue Angry Kimberley. It's a vicious circle.
"Why am I finding this so tough?"
"When will this end?"
"Why can't I just get on with it?"
"Why am I such a bad person?"
I now ask myself these questions all the time, particularly during or shortly after an attack. I was fortunate enough to have an amazing friend at college with me today though during my most recent attack, who made me realise that my anxiety is also making me extremely critical of myself. As my friend said, it's only been five weeks! I've been on medication for years and five weeks isn't long enough for my system to "restore" yet. I must give it time to recover. She's right, these things can't be rushed, and all I can hold on to is those moments in between attacks and give myself more praise for those little conquerings.

And do you know what? Following that conversation with her today, I had my shortest panic attack in the past couple of weeks. Even though I had to jump up and run out the classroom and touch walls (don't ask, it's the only thing that grounds me sometimes!), the whole thing lasted about 30 minutes. I then endured the rest of my Sociology class - that's just not even been possible for me recently following an attack. So today, I'm going to hold on to that. I'm going to accept that today, I did bloody well and no one can say anything to make me feel different. 

Anxiety is hard. REALLY hard. I've learnt recently how it can devastate lives, how it can stop you from functioning, from living at all. It's so scary, and unless you've experienced it, you won't understand the amount of fear, shame and exhaustion that it entails.

But if you're reading this, and like me you feel as though sometimes you ARE your anxiety, and that there is nothing else to your life, then you're wrong, you are so wrong. There is hope. I'm not saying there's an overnight cure.  For most of us with anxiety, it's deep-rooted in such a way that digging it all up means things have to get worse before they get better. But we must hold on to those things that seem so small, as they mean so much. Today, my one positive is that I only had one full blown panic attack and a couple of mild anxiety attacks. For some people, that's not progress, but to me, it means the absolute world.

Please, if you are suffering from the effects of anxiety, don't do it alone. There is help and support available to you, and you are not alone. Anxiety makes you feel as though the whole world is against you some days, as though you're the only one feeling this, the only one going through it, but you're not. There are millions of people who do, and we must fight this together.

Please, stay strong. 

Further Information and Support

Mind - Anxiety and Panic Attacks
Anxiety UK
YoungMinds - Anxiety in Children and Young People


Wednesday, 5 March 2014

UK National Emetophobia Awareness Day 2014

Today is the first ever UK National Emetophobia Awareness Day - yippee!

Unfortunately, I only found out about this yesterday, otherwise I would have pushed it a heck of a lot more on Facebook and Twitter, however, with it being the first ever day of its kind, I hope that more people will be made aware as time goes on.

I've decided that as an 'emetophobe' myself, posting a blog today was almost a necessity for me. Despite the fact I have about a 101 things I need to be doing right now (only a tiny exaggeration), it's important that more people are educated and made aware of this potentially debilitating phobia. 

Before I continue, please note that this blog post does use words which some may find potentially triggering. Always look after yourself first and foremost.

What is emetophobia?

Emetophobia is the intense fear of feeling or physically being sick and/or of other people around you feeling/being sick. There are also several 'subcategories' which you might come across upon researching emetophobia, such as the fear of being sick in public or the fear of being nauseated. 

Despite the fact that emetophobia is not commonly diagnosed, it is an extremely common anxiety disorder. Statistics vary, but most suggest it is between the 5th and 6th most common phobia. It tends to be much more common in women than in men. It can occur at any age, but many adults with emetophobia tend to report having experience symptoms of this phobia for as long as they can remember. 

What causes emetophobia?

There are many different reasons as to what the cause of emetophobia is. Most commonly, it can be linked back to a negative experience which involved vomiting. It might be that you were a child who was unwell quite often, or you may have had a bad bout of food poisoning. Perhaps you witnessed someone you care about being particularly unwell.  This snippet from sums up the psychology behind it quite nicely (although it does tend to talk about it just in relation to a childhood experiences, the concept still applies I think): 

When a traumatic scene is witnessed as a young child (between the age of 1 to 6 years old in my experience) the subconscious mind as the body's 'protector' works out the best way to prevent the incident repeating itself. The way this works in practice is that the subconscious attaches negative emotions or feelings to vomiting and in future this teaches the person to steer away from 'dangerous' situations. Whilst the subconscious is doing all this 'protection', the conscious mind is struggling to find out where this irrational behaviour is coming from.
Rikard (2011) also theorised that emetophobia may come about as a secondary response to a negative situaition (in one presentation, Rikard uses the example of someone vomiting during a severe storm, and results in the individual associating the frightening events of the storm with the act of vomiting).

Evidence tends to suggest as well that if you have grown up with your parents or guardians living with emetophobia (or a similar fear or certain anxiety disorders), you are more likely to suffer from it yourself.

What are the symptoms?

Symptoms will vary depending on the intensity of the fear and to what scale it has an impact on an individuals life. Here are some symptoms/behaviours which I've gathered from the internet and from personal experience:
  • Avoiding people who have been sick, sometimes for days or weeks at a time
  • Avoiding certain foods (the most common ones tend to be meat or hand prepared and uncooked foods such as salads and sandwiches)
  • Safety behaviours such as carrying anti-emetics (medication to prevent vomiting), hand sanitisers, mints/chewing gum, a plastic bag "just in case", tissues to open door handles, etc. 
  • For some women, they feel unable to have children due to fear of morning sickness
  • Avoiding doctors surgeries/hospitals
  • Feeling extremely anxious about long trips, for fear or not being able to 'get out' in case you're ill or in case someone near you is ill (may also avoid public transport for same reason)
  • Some individuals may become housebound through fear of contamination
  • Feeling anxious and/or panicked as soon as someone mentions anything about being or feeling unwell, often resulting in you being overly alert and almost 'listening out' for it
  • Excessive cleanliness 
  • Avoiding watching certain films and TV programmes 
  • Being unable to write or look at the words "vomit" or "nausea" for example, and feeling panicked when you do
  • Nightmares about vomiting
This is most definitely not an exhaustive list but I hope it gives just a small insight as to what an individuals with emetophobia might experience.

What impact does this have on an individuals life?

  • Women may avoid having children
  • 'Emetophobes' may avoid certain jobs and careers, and may struggle to hold down employment especially if they have a high number of sick days
  • Individuals may become housebound and socially withdraw
  • They may not receive the support they need through misdiagnosis - many people with emetophobia have been wrongly diagnosed with anorexia nervosa (due to the little amount of food they may intake through fear of contamination or nausea from too much food) or socal phobia, for example. 
  • Secondary mental illnesses may become apparent such as depression, especially if an individual feels that are not able to look after a loved one or a child when they're ill for example.
  • The constant anxiety can be extremely tiring, as many individuals with emetophobia are on constant high alert. This can result in a variety of other health conditions such as IBS, which then actually feed the emetophobia even more.
What are the treatments?

Emetophobia is often treated in ways similar to other anxiety disorders. It could involve CBT (cognitive-behavioural therapy) or gradual exposure therapy. This must be managed with the individual being in control of their treatment though, as understandably, those with emetophobia are unlikely to want to 'face their fears' and be exposed to vomit, no matter how gradual it may be. Evidence does suggest that this type of treatment DOES work though, so ensure you have a good therapist that you feel confident to practice this with.

Many people have also said that hypnotherapy can help with symptoms, but it can be an expensive form of treatment.

There are a growing number of self-help resources as well. Rob Kelly, the man behind the UK National Emetophobia Awareness Day, has an extremely popular self-help programme for emetophobia called Thrive. You can find out more about this programme by clicking here. (I hope to try this programme myself soon as the testimonials look incredible!) 

There may also be the option of medication for some people, and whilst this will not cure the emetophobia, it may help with someone of the physical sensations of the related anxiety.

Where can I go to find out more information and get help? 

Anxiety UK- A great information source, and if you join as a member, you get access to discounted therapies. Also have a downloadable fact sheet for a small cost.

Emetophobia Help - Anna Christie is a registered counsellor who has also recovered from emetophobia. Based in Canada, she is also able to offer therapy to anyone in the world via Skype.

International Emetophobia Society - Claimed to be the Internet's largest online forum for those with emetophobia, it's a great place to meet and speak with fellow emetophobes for information, support and advice.

Thrive Programme - The self-help programme mentioned earlier, put together by Rob Kelly.

My Story

I have a good idea of when my emetophobia started - I can't remember my exact age, possibly around seven or so, and my grandad got food poisoning. There were other things in my life happening at the time which I believe, in conjunction with my grandad falling ill, mixed up some associations in my brain and I was left with the fear of sick. My grandad is one of the strongest people you'll ever meet. He's covered in tattoos, and tanned from working outside for years and years. Seeing him fall so ill must have been incredibly traumatising for me, but at the time, I didn't realise that. As a little girl, all I saw was how just a piece of food had made him incredibly unwell and I was petrified by this. If it did THAT to him, what the heck could it do to little old me?

Growing up, I became more and more concious of people around me becoming unwell. If my sisters were ill, I would try and count down the hours until I thought I'd be 'out of the woods.' I remember the last time I was sick extremely well, but my phobia actually stops me from being able to share that experience. Just thinking about it for some reason makes my heart beat that little bit faster, and I worry that I'd be talking it up. Yes, to some that might seem a silly concept, but for me it is oh so very real. But I remember everything about that day. I remember the date, what I was wearing, what I had been doing that morning, what had happened that week. I remember the actual 'experience' and I want to cry just thinking about it, it frightens me that much.

I remember little things when I was in primary school - things like making sure there was a good enough gap in front of where I was sitting cross-legged in the hall between me and the person in front, in case I did the Deed. I even recall a time where I tried to make excuses to not have my meningitus vaccination because I was so scared of falling ill. Throughout high school, I'd go most of the day without eating as after all, they don't have refigerators at schools for packed lunches. Whilst I was at school, I didn't have to worry about cooking so much. I'd often get my mum or dad to check my food, and see if it was cooked, but I mostly went on their word and ate whatever was put in front of me.

As I've gotten older, my phobia has become worse, and I think I understand the reason for this.  When I left school, I had more time and freedom to explore the wonders of the internet. As an adult, I've learnt about the wonders of anti-emetics. I can even buy them online, it's that easy. I've educated myself on incubation periods, methods of contamination, and what does and does not kill norovirus.

I can't begin to describe how debiliating this phobia is for me. It means I'm pretty much tee-total, and if I do ever drink, I have to be feeling extremely confident that in the past week I've not put myself at risk of contamination, because if there is any risk, I won't drink alcohol in case I need to take an anti-emetic. This means my social life has suffered immensely over the years, especially as I'm only 22 years old (I've never even been tipsy let alone drunk).

If I don't have my hand sanitiser on me, I won't eat, even if I have already washed my hands with water so hot (for twenty seconds) that steam is coming off of them. I struggle to eat out in restaurants, and will only ever go for somelike like beef or pasta. Other meats are mostly out of the question (unless they're smoked) along with salads and sandwiches. 

The thought of having children is something that plays havoc on my mind. I love children, I've always wanted children, but I struggle with the fact that I am likely to have morning sickness and I'm even more petrified of the fact that I won't be able to look after my children when they inevitably catch a tummy bug or something.

My emetophobia heightens in the Winter months. Cue a lot of hibernation and sitting and waiting for the latest Public Health England reports on norovirus activity in the past week to be published. Give me a cold any day, but if you've had a stomach bug, I won't see you for at least a week. It's nothing personal, I swear, but for a few days of avoiding you, it's easier than having no sleep due to panic and feeling even worse because I can't eat 'just in case.'

Whilst the warmer months do tend to generally mean there is a decrease in the reported levels of norovirus and other tummy bugs, this phobia lives with me every day. I think about it every hour, of every day, without fault. Heck, I sometimes even dream about it. I am constantly concerned about contamination and every time someone even just mentions feeling off or the fact that their cousin from South America visited six weeks ago had a mild upset stomach just frightens the life out of me. I will think about it over and over and over again, until I end up getting myself in such a state that I end up crying my eyes out due to the unwanted anticipation of potentially falling ill.

The stranger thing that I have come to recognise about my phobia though is that I don't know how I feel about being recovered from it. Yes, that sounds daft, but I think it's become such an entrenched part of me that changing it would actually not only be incredibly difficult, but I am frightened of not having that safety net. I suppose the point of overcoming such a fear though would mean that I obviously wouldn't feel that way eventually, but for now, it's me and it's who I am.

So if you ever speak to someone who has a fear of being sick, please don't be judgemental. It's easy to respond with 'well just make yourself sick, then you'll be fine' or 'but no one LIKES to be sick' but please remember the impact of your words. Those with emetophobia can feel incredibly isolated and alone, and comments like these only build on stigma and ignorance through lack of understanding.

The one thing us emetophobes must hold on for is hope. We must remember that recovery IS possible, and this debilitating condition can be treated. Even in the darkest of moments, hold on to that tiny little ray of hope, because it is that that keeps us moving in the right direction, no matter how small the steps are.

Sources - Emetophobia 
Anxiety UK - Emetophobia 
Mental Healthy - Emetophobia: the fear of vomiting 
OCD UK - Emetophobia
Steve Rikard - Emetophobia causes and cures (SlideShare) 
Wikipedia - Emetophobia