Are you enabling your child’s anxiety? Read these stories about Baruch and Rachel and their families’ efforts to deal with their anxiety.
Baruch, 10 years old, had recently seen a boy throw up in school. Baruch started to fear that he too might get sick during school hours and throw up. Every day, he attempted to convince his parents to allow him to stay home. His mother Rivka would get him out the door by reassuring him that she was absolutely certain that he would not throw up and that if he got nervous during the day he could call home. Invariably, Boruch would call home a couple of times during the day, because he didn’t feel confident that the food he ate during snack time and lunch would stay in his stomach. Rivka would again reassure him on the phone that she was absolutely certain that he would make it through the day without throwing up.
Eventually, Boruch started to fear that he would throw up at a friend’s house. Rivka helped him by arranging for his friends to come over to their house instead. Baruch expressed an interest in going to camp in the summer but was afraid of throwing up in camp. Rivka soothed him by saying that camp was not so important and that if he didn’t go to camp, she would do fun activities with him every day. Baruch felt relieved and stayed home during his summer vacation and had a wonderful time with his mother. Through this entire period Baruch never actually threw up, but he was nevertheless consumed with the fear that he might.
Emetophobia (fear of vomiting) is a not-uncommon phobia, and Rivka is a well-meaning and caring parent, who tried her best to help her child cope with his anxiety. She did this by offering constant reassurance and helping Baruch avoid anxiety-provoking situations. Unbeknownst to her, though, she probably fueled his anxiety disorder and placed roadblocks on his path to recovery.
This might seem illogical. Wasn’t Rivka doing her utmost to alleviate her child’s anxiety? Yes, she was. But her strategies were effective only in the short term and were detrimental in the long term. Let us first understand the nature of anxiety disorders and then we will see the problem with Rivka’s approach.
What Is Anxiety?
Anxiety is an unpleasant feeling of uneasiness or apprehension relating to uncertainty. Anxiety comes in many forms. One can be anxious about past events (“Did I turn off the stove?”), about the present (“What are people over there thinking about me?”) or the future (“Will eating this food give me cancer?”). Anxious feelings can potentially be beneficial. For example, fear of getting a poor grade can be a strong motivator to study. However, anxiety can also present itself as a disorder that is detrimental to one’s life, especially in a situation where the anxiety relates to a remote danger that feels to the anxiety sufferer like a real possibility.
A person can have generalized anxiety, or he can have anxiety relating to something specific, which is called a specific phobia. For example, someone who suffers from a fear of crossing bridges (gephyrophobia) may fear that the bridge will collapse while he is on it. His life is greatly affected by not being able to travel over bridges (unless he is a nomad living in a desert). Similarly, Baruch’s phobia of throwing up in public has prevented him from visiting friends and going to camp.
What is at the heart of an anxiety disorder? Why would someone be afraid of the exceedingly remote possibility of a bridge falling down while he is on it? This is a very difficult question to answer. But this much is clear: A person with an anxiety disorder has a brain that has a difficulty differentiating between an actual risk and a remote risk. How does one train his brain to realize its mistake? By crossing the bridge! The more he crosses the bridge, the more his brain realizes that bridge-crossing is not as dangerous as it seems. But if you avoid the bridge, you are telling your brain that bridge-crossing is indeed a risky venture that should be avoided.
Reassurance and Avoidance
If you are a parent of a child with an anxiety disorder, you are in a position to either encourage your child to face his anxiety or to reinforce the anxiety. We can now understand that two surefire ways that a parent can maintain and reinforce a child’s anxiety disorder are constant reassurance and accommodating avoidance. Rivka was “guilty” on both counts.
Baruch truly feared that he would throw up in school. This exaggeration of danger made him feel that throwing up was a real and dreadful possibility. Rivka’s daily reassurance gave him the ability to get through his day, but in the process it maintained Baruch’s perception that his fear was legitimate. How would Baruch ever be able to overcome his fears if he was addicted to reassurance-seeking as a coping strategy? Of course, we can all benefit from reassurance every now and then, but when reassurance is the crutch that gets us through the day, every day, then we are sinking in the quicksand of anxiety.
Avoidance aggravates the anxiety, since each time sufferers avoid the anxiety-provoking situation, they are sending themselves a message that this is indeed a scary situation. When the family accommodates the anxiety, this message is further reinforced. Rivka accommodated Baruch’s anxiety by assisting him in avoiding situations that made him anxious. Although her motives were noble, the long-term effects could be damaging, as Baruch’s anxiety will only increase.
Not all anxiety is a disorder, especially if it is age appropriate. It is normal for infants and toddlers to have anxiety relating to loud noises, strangers, and separation from parents. It is normal for preschoolers to have anxiety concerning monsters, the dark, thunder, and floods. Throughout life, there are normal anxieties. However, it is not typical for a healthy ten-year old to be paralyzed by a fear that he will throw up in public.
Normal parenting strategies are appropriate for children who have normal anxieties. But when a child has an anxiety disorder, it will very likely require the intervention of a mental health professional with an expertise in childhood anxiety, who will work with the child and his parents to help them develop appropriate strategies in dealing with and eventually overcoming the anxiety.
Rachel’s Struggle with Contamination OCD
This concept can be further illustrated through Rachel’s story. Rachel was a 14-year-old girl who was very concerned with germs. She had obsessive thoughts about catching a disease from germs around the house. In an attempt to alleviate her obsessive thoughts, she felt compelled to “decontaminate” her bedroom, clothing, and food. The combination of the “O” (obsessive thoughts) and the “C” (compulsive response) means that Rachel suffered from OCD, another type of anxiety disorder. She was unable to do all the decontamination on her own, so she nagged and yelled about the germs that her family spread all over the house until her entire family got in the habit of helping her with her decontamination rituals. Her parents made sure to purchase a hand soap that Rachel felt was powerful enough to kill the germs, all food preparation was done wearing plastic gloves, no one entered her room without using a hand sanitizer that was kept on a little table next to the door and the dryer had to run for over an hour per load so the heat would kill any germs, just to name a few.
Rachel’s family perpetuated her OCD. Rachel’s compulsive rituals increased due to the high level of family accommodation. Furthermore, Rachel’s motivation to go for professional help was greatly diminished since her family was making it somewhat easy for her to live with her OCD. In all likelihood, Rachel’s entire family is going to need to be involved with her psychotherapist in order to learn how to be supportive of Rachel as a person, but not to be supportive of her disorder.
The take-home lesson is that when anxiety develops into a clinical disorder, the well-meaning strategies that family and loved ones employ to alleviate the suffering are often counterproductive. Guidance from a competent professional is frequently necessary to guide the whole family onto a path of recovery.
Rabbi Hauptman is Director of Relief of Baltimore, a mental health referral service. Contact him at email@example.com or at 410-448-8356. This article was reviewed by Dr. Ariella Abraham Psy.D. who specializes in Cognitive-Behavioral Therapy for anxiety and depression. Contact her at 845-709-3291.