Dear Annalisa

My daughter is 20 and for about 10 years has suffered from a terror of being sick; in particular, when I am not nearby.  She keeps this terror a secret and organises her life around avoiding situations where she might be sick or, more generally, be too far away from me. Hence she avoids travelling to countries that are too far away, although she would love to go. 

I am fairly sure this anxiety started at a time of stress in our family generally, but I hoped it would fade away naturally. As she reaches an age where she will be living away from home as a student (albeit that she has picked a university close enough to home that she could reach me if she was sick), I realise she needs to face this problem, as it is holding her back from being able to enjoy life, and unless she finds some helpful coping strategies, this will be debilitating. 

I have suggested it would be helpful to talk to somebody, but she refuses. Her fear seems to have a connection with an occasion when I was on the phone, unaware that she was being sick and her father, my husband, did not tell me what was happening. It was certainly at a period of insecurity, and my daughter’s personality is such that she finds the idea of change extremely frightening.

I should add that most people see a kind, empathetic, beautiful, healthy, funny, clever, outgoing woman. They have no idea about her anxious side. Is there anything I can do to help her?

Anon, via email

As you have said, this isn’t just about your daughter’s sickness phobia, it is also about her fear of being separated from you. Often with fears expressed in children (your daughter was a child when this first presented), it is not only about what they fear will happen to them, but what will happen to you, the parent, if they are – as in this case – not with you. And I’m wondering here what your daughter fears will happen to you if she leaves you for too long?

Clinical psychologist Emma Citron, of the British Psychological Society (www.bps.org.uk), who specialises in phobias, agrees. “Does she feel there is a need to be close to you over and above the phobia?” Citron also wonders about your daughter’s relationship with her father.

We could postulate for ages about the causes, but what to do now? “When the phobia is this much part of life,” says Citron, “it’s hard to change without help. Her anxiety levels are too high.” She recommends cognitive behavioural therapy (as did another specialist I spoke to), so I would recommend a trip to the GP to look into this (or go privately). But how do you get your daughter there?

Citron feels you must overcome your own fear of confronting your daughter (because you are enabling her phobias). “You have a right to gently – but firmly – confront her and have that conversation about what you think needs to happen.” Citron thinks you needed to say something like: “This has really gone on too long. I can’t sit and watch this happen and enable this dysfunctional behaviour. You can get help with it.” Then explain how. She will probably not listen, but you need to revisit this the next day, and the next, and not retreat and let this go on.

If your daughter still won’t seek help, after several attempts at trying to convince her, think of an ultimatum that you can stick to. But don’t begin with that, as I think it will overload her anxiety levels.

As an ultimatum, Citron advises saying something like: “I’m no longer prepared to have you living here.”

Many a mother would, understandably, find this difficult and use it as a last resort and you may need support from a counsellor with knowledge of phobias and dysfunctional interaction within families.

I think you also need to realise the part you are playing in your daughter’s phobia and be confident. You can tackle this situation to enable her to do it. I really think a key in resolving the problem is your daughter realising that you will be OK without her, and vice versa.

Because you are right, this is an extreme manifestation of a phobia that will curtail her life if it’s not addressed. But the good news is that once she has proper support, she can certainly reduce the problem to a manageable level, even if she isn’t cured.

First published in the Guardian: http://www.guardian.co.uk/lifeandstyle/2012/dec/29/phobia-being-sick-annalisa-barbieri?INTCMP=SRCH.