D.I.D....

Yeah @outlander. She does find social settings exhausting.

Turns out she's got a bacterial secondary infection. (Sinusitis) So she is genuinely unwell, and is now on medication to clear that up. She so often goes to doctors or the hospital with "aliments" which either test negative, or are reported as being much worse than medical examinations would suggest they are, so it's hard to tell when she really is sick. She seems to be unconsciously reliant on other people caring for her, which is very difficult to balance.

@outlander, she certainly has anxiety. A psychiatrist has diagnosed Factitious Disorder, which is pretty much somatic (psychological not physical in origin) pain and illness at an unconscious level. i.e. she has no self insight into what's happening, and genuinely believes the pain or illness is physical. She even really experiences the pain/illness, but it's like the signal is working in reverse, with it originating in her brain and being felt in her body, rather than bodily pain sending the signal to her brain.

Yeah @outlander, it sounds like yours is much more connected to anxiety. Being able to see what's happening is such a big help towards dealing with it. And that's a big part of why we're not seeing improvement with our Older Daughter. Until she can see what's happening, it's not possible to do anything much in the way of therapy. CBT for example involves "cognition".

Something I've found is that anxiety definitely increases the perception of pain. Things that might not be too awful normally gets caught up in a kind of feedback loop, not helped by the automatic tensing up that happens under stress. And yeah, another thing with our girl is that she frequently seems to overstate her pain levels. The level of pain (out of 10) that she says she's feeling doesn't match up with how she's reacting. I don't think I could carry on a conversation of any sort while experiencing 8-10/10 pain, let alone an unrelated conversation about how her latest craft project is progressing. That's sort of "having trouble speaking" level pain??

@outlander, I can't see ACT working because she feels like too many things are outsie of her control, including and especially her SH behaviour.

I could see the possibilities with EMDR, but again, there's a lot of things that she would class as traumatic, so going that way would be a very very long process and traumatic in itself. Maybe down the track, but I don't know if she'd handle it at present.

We're all in the uncomfortable position of really not knowing how to move forward unless she starts to take ownership and control of herself, even in small ways.

DBT might be closer to the mark.

Hubby's taking Older Daughter into hospital. SH while dissociating again. 😞

The psych nurse vetoed an ambulance... which as such I agree with. It's not right tying up ambulances when there's others needing it more, and I suspect that they're trying to dissuade her from constantly turning up at hospital with minor illnesses or self inflicted injuries. We try very hard to talk her out of both ourselves. But Hubby's tired, and she hasn't got any private transport available. Her brother hasn't passed his P's yet, and I don't want her behind a wheel. I could see that getting very dangerous. She does have enough cash on her for a taxi home, so at least we should be in bed at a normal-ish time.

I can't see her restricting her "emergencies" to daytime hours when there's public transport, and if Hubby has taken his nighttime medication, he's not safe to drive, and I don't have a licence. So if refusing to send out an ambulance becomes the usual protocol, this could get "interesting" in all the wrong ways. They have in the past paid for a taxi for her to come in instead, but apparently didn't offer that either this time.