Today we’re going to talk about panic attacks, and how to get someone through a panic attack when they have an eating disorder. I’ll share some thoughts about how to view panic attacks and a powerful technique for soothing your child when they have a panic attack.
My daughter has an eating disorder and I need to know how to handle her panic attacks. They often happen around eating or going to her treatment appointments, but they can happen at any time, like when we’re meeting friends or I ask her to clean her room.
Sometimes I think she’s faking it. It’s like she’s putting on these shows to get out of doing whatever I want her to do. And nothing I say seems to help when they’re happening. It’s almost as if she’s not actually there.
They keep getting worse and I’m exhausted and frustrated. What should I do?
This sounds really hard, and I understand where you’re coming from. The first thing to know is that anxiety disorders are associated with eating disorders, and panic attacks are a type of anxiety disorder.
So it’s not uncommon to see panic attacks alongside an eating disorder. Luckily, anxiety is a really manageable condition. In fact, it’s considered one of the most treatable mental disorders because we have a lot of research and experience working with it.
Now, that doesn’t make it easy, but I just want to start by saying that I know it’s hard to have a child who has panic attacks, but there is hope they can get better.
It may get worse before it gets better
It’s not unusual to see panic attacks actually getting a little worse during eating disorder treatment. Why? Well, eating disorders are coping mechanisms. They are something a person adopts to help them navigate stress. So when a child is in treatment for an eating disorder, what they’re learning is adaptive and healthy coping behaviors that they can use when stress shows up.
But in the meantime, they’re being asked to face stress head-on without their eating disorder as a coping mechanism. And that is really hard. This is why we might see an increase in anxiety and panic during treatment.
The truth about panic attacks
So let’s think about how you can get through these panic attacks with her and minimize the emotional fallout and any damage from panic attacks. The first thing I need to let you know is that I know that panic attacks seem really outrageous compared to the stimulus or the situation.
By definition, a panic attack is an overreaction to whatever the situation is. But they are still real. A panic attack is a physiological response to a stimulus. That means they’re not in our control, they’re not a choice. It’s not something that your child is doing on purpose. It’s real.
Panic attacks, like all behaviors, are a form of communication.
Listening to behavior
While we would love our kids to sit down calmly over a cup of tea and say, gosh, you know, this is really upsetting to me and I’d like you to help me solve my problem. And we may have some kids who do that. But more often what we see is when a kid’s struggling with stress and anxiety, we see them communicate with us through their behavior.
This is why I think it’s helpful to look at eating disorders and panic attacks as communication.
What do we need to learn from this and what can we do to help our child get through this?
Let’s think about it this way. If you translate the panic attack as “she’s doing this for attention” or “she’s faking it,” then you’ll respond one way.
On the other hand, if you translate the panic attack as “she is having a hard time, she really needs my help,” you will respond a different way.
How we translate our kid’s behavior, how we think about it in terms of communication, and what it’s trying to tell us, really changes how we respond.
I know a lot of people translate panic attacks or any negative behavior as manipulative or controlling. It can certainly look like that. And there may be aspects of that going on.
But at the heart of that behavior, our children are trying to tell us that they need our help. And I think it’s really helpful if we remember that and keep that in mind, even when their worst or most challenging behavior comes to the forefront.
I suggest you try and translate the panic attack this way: she’s not giving you a hard time, she’s having a hard time. And you can help.
Getting through a panic attack
Let’s go through an example of how you can help someone get through a panic attack. Let’s say you’re getting ready to leave to meet with friends. You made the plans days ago. You told her about it. Everything seemed fine. Now it’s time to go.
But she’s not dressed yet. So you ask her to get dressed, which seems like a perfectly reasonable request. But she hears you and she starts shaking and crying and yelling that she can’t go.
She falls to the floor dramatically. She’s flailing around. And your first reaction may be to roll your eyes. I get it. You have been through this a bunch of times. It is frustrating and exhausting.
Next, you might do the most reasonable thing you can think of. You offer her advice and recommendations like, “come on, Honey, just get dressed,” or “do you want to wear jeans or leggings?” or, once you get really frustrated, you might start to remind her “you promised me you would go, why are you making this so hard?”
And that approach can make a lot of sense. If you’re working with someone who’s mildly stressed, your advice and recommendations can help them sort of re-center and find their way forward.
But when someone’s having a panic attack, their nervous system is dysregulated.
Calming the nervous system
What that means is that their prefrontal cortex, which is where we make executive decisions like how to put on pants and walk out the door, that executive system, is not online. When we’re having a panic attack, we are operating from our primitive brains.
And until her nervous system calms down, she can’t engage her prefrontal cortex. She can’t hear your reasonable and logical suggestions and requests. She’s also unlikely to get out of the house.
The biggest mistake I see parents make when kids are panicking is trying to use words and logic to get them to stop freaking out. Because when your kid’s having a panic attack, your first goal is not to convince her to get pants on or to try and reason with her about anything.
Your first goal is to help her settle her nervous system.
How to settle her nervous system
As her parent, you have a really, really powerful tool in your toolbox to help settle her nervous system. You’ve probably heard of the five senses of taste, touch, smell, sight, and sound, and possibly you’ve heard of the sixth sense called neuroception. That’s our ability to sense other people’s energy.
I know this might sound a bit strange, but this is a huge discovery in neuroscience in the past 10 years.
Today we can actually do brain scans and we can see that as human beings, we are finely tuned in to other human beings’ feelings and emotional states. And there is nobody with whom we are more closely tied from a neuroception standpoint than our parents.
What that means is that the best way to calm her nervous system when she’s having a panic attack is to calm your nervous system way down.
Calm yourself and you’ll calm her
You can try taking a few deep breaths. Stand or sit firmly on the floor, grounding yourself from your head down to the ground. There are a bunch of mindfulness techniques that you can use to try and get your nervous system into a calm place.
Once you feel a little calmer, try to get to your child’s level. If she’s on the floor, sit near her on the floor. Then you can help tap into her neuroception and connect with her by thinking soothing things.
I know this might sound a little strange, but you need to send calming energy from your body to hers.
Most likely you’re going to want to speak things out loud. And I get that. But I challenge you to feel soothing, pleasant, calming things deep in your body while you’re near your child. I can tell you from personal experience that this works wonders when you have a child who is freaking out.
Now, since we tend to be really verbal people, it can help to kind of have some direction. So I would sit near her and if she’s open to it, I would try to touch her hand really gently because again, they’re in their primitive brain when they’re having a panic attack so we can reach out to them through their senses. And touch can be a really soothing, calming sense that we can tap into. So you can gently touch her hand and say in a very calm, soothing tone of voice, “you’re safe. I’m here.”
Alternate that soothing phrase with your body’s energy communication. So you say one thing out loud, “you’re safe. I’m here.”
And then you say it in your body, “you’re safe. I’m here.” Try to let go of time and any goal while you’re doing this process. She needs to actually feel safe in your energy.
Try not to check your watch or look at someone else. Just stay right there with her. In that space, your calm and steady presence will soothe her nervous system. She will start to calm down.
What happens next
Once she’s calmed down from that panic attack, she may be able to move forward with what you wanted her to do, which is get some pants on and go out to dinner. She also might not.
What I’ve presented here is a technique for managing a panic attack when it happens, just getting through that panic attack. And that is really important. It’s the first step to managing and helping our kids learn to manage their panic and anxiety.
Once you’ve learned and mastered this soothing technique, then there are more steps you can use to move forward after a panic attack. These will help her to move on and hopefully get some pants on and move out the door.
You can also learn techniques to recognize that a panic attack might be coming and head it off before it escalates. But that’s the next step. So for now, just doing this much will mean that you can feel good about your behavior during her panic attack.
You can know that you did the very best you could in that moment. Your child is actively healing from an eating disorder. And sometimes our goal is just to get through these hard times. Sometimes we just need to get through this so we can get them to the next appointment, so that we can get them to the next meal and keep them as calm and safe in our presence as possible.
With consistent work towards this, things will get easier.
Viola, I hope life will get easier for both of you when you practice this technique of soothing her panic attacks. I know how hard this is and I hope this helps.
You can listen to this article as a podcast. Check it out and subscribe using your favorite podcast player.