PROBLEM SHARED
My teenage granddaughter has a nut allergy and is very anxious about having an attack. It has reached the point where she is avoiding doing things in case she comes into contact with someone who has eaten nuts. She won’t go to restaurants, and I am worried that as she gets older she may become more reclusive. How can we help her deal with her anxiety?
TANYA SAYS Eating is part of the social fabric of life and should be relaxed and fun, so having a food allergy can affect daily living and cause anxiety. Your granddaughter’s reaction is not unusual. Nut allergies in particular can cause a lot of worry because effects can be severe and nuts may be hidden in many foods. Parents often describe how their children’s food allergies can have a negative impact on meal planning, grocery shopping, socialising and eating out.
Research shows that children with nut allergies have higher levels of anxiety around their condition than those with type 1 diabetes. These children are more self-isolating and limited in their activities due to anxiety and this may lead to depression. The other fear is that increasingly restricted diets can lead to eating disorders.
I have worked with children who have developed food phobias, because they are too afraid to eat anywhere other than at home. The issue may cause negative ripple effects. Tensions can be rife in families where parents may be split on how protective they are of their child. The more protective and stressed a parent becomes, the more the child feels unsafe, and he or she can become paranoid.
Your granddaughter needs support to accept that she can do anything her friends do. Fatalities from food allergies are relatively rare – in fact, it is estimated that the risk of accidental death is over 100 times greater than of dying of a food allergy. Remember that it is not a disease – it is an inconvenient but manageable issue.
Given her entrenched anxiety, reassurance alone is unlikely to be enough and she needs more support to address her irrational beliefs. Avoidance due to fear reinforces the catastrophic belief as there is no experience to prove it wrong, and the more avoidance occurs, the greater the risk that anxiety begins to encroach on other situations and life becomes more restricted. This avoidance coping style requires psychological treatment that combines systematic desensitisation to what is avoided (like eating at friends’ houses or restaurants) and relaxation training to calm the panic response that drives the body and brain into crisis mode and catastrophic thinking.
With your granddaughter, get her to list her feared situations and challenge them against the worst outcome. Going from the least to most-feared situation, work up her list utilising relaxation and breathing techniques. This builds evidence to reduce fear. These are cognitive behaviour therapy (CBT) techniques. Your GP can refer you for treatment or visit bps.org.uk. A self-help guide is available at moodjuice.scot.nhs.uk/anxiety.asp.
Emergency planning and Epipen training are also important. Your granddaughter will feel empowered by knowing what she and others can do to help her in the event of anaphylaxis (a severe allergic reaction). She may have social anxiety because she feels rude towards people who are cooking for her, or embarrassed by the attention that having an allergy might bring. Help her develop the tools and confidence to speak openly about her allergy, like asking questions about food and checking ingredients. With support, she will learn that she controls her nut allergy and that it doesn’t control her.
The more protective a parent is, the more the child can feel unsafe