Happy Food Allergy Awareness Month!

Did you know May is also Mental Health Awareness Month? That is no coincidence in my book.

In celebration of this annual intersection, All Things Allergies is extending beyond our usual trauma-related content into another chapter of the Diagnostic and Statistical Manual of Mental Disorders – Feeding and Eating Disorders.

Research suggests that nearly 9% of the world’s population are affected by eating disorders – A category of illnesses that include anorexia nervosa, binge eating disorder, bulimia, and more. The DSM-V characterizes eating disorders as a, “Persistent disturbance of eating or eating-related behaviors that results in the altered consumption or absorption of food and that significantly impairs physical health or psychosocial functioning.” Eating disorders are among the deadliest of mental health disorders – Second only to drug overdoses. With such high risks of heritability, suicidality, and mortality, mental health professionals and eating disorder specialists around the globe work tirelessly to understand, prevent, and treat these disorders.

Yet, largely absent from disordered eating research is its intersectionality with food allergic diseases, despite the fact that dietary restrictions are strongly associated with increased incidence of eating disorders (Keski-Rahkonen & Mutselin, 2016).

Although not completely understood, Jafri (2021) hypothesizes that the required diet modifications, constant vigilance, and increased attention paid to daily food choices may contribute to the development of disturbed eating behaviors across the food allergy community. The authors stated, “A significant diagnostic feature of these eating disorders is the existence of restricted patterns of eating – Given that the cornerstone of food allergy management is this very type of diet modification, it is difficult to ignore the potential for an increased risk for dietary pathology.”

And ironically enough, it seems that the very thing that keeps us safe from the life-threatening consequences of anaphylaxis is what puts us most at risk for the development of disordered eating patterns. Sigh.

“The maladaptive or disordered dietary behaviors adopted in food allergic cohorts have evolved as a mechanism of avoiding undesirable consequences.”

Jafri, Frykasa, Bingemann, Phipatanakul, Bartnikas, & Protudjer (2021)

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Another hallmark feature of eating disorders is body image, or the collection of positive and/or negative thoughts, feelings, and behaviors that you have about your body. Body image is separate from our actual bodily physiology, but can be influenced by personality traits, cultural factors, beauty standards, social media, and medical conditions.

This can include food allergies – A study out of Sweden highlighted how a focus group of adolescents felt something was inherently wrong with their food-allergic bodies, describing themselves as “inadequate, insufficient, and deformed” (Marklund, 2007). Later research gathered similar sentiments from food-allergic adults, who expressed feeling “isolated, embarrassed, and defective” because of their chronic illness (Peniamina, 2014). Aside from the heartbreaking adjectives, researchers discovered a key commonality among the respondents – Rather than viewing their food allergies as an external illness that they had, food allergies were seen as something that they intrinsically were. Their chronic illnesses were internalized, integrated into a stable part of their self identity.

This was the missing link for Jafri (2021) and his team. The authors hypothesized that in combination with the strict dietary modifications required by a food allergy diagnosis, food allergies may be associated – in part – with eating disorder vulnerability as a consequence of disturbed body image and poor self concept. Their predictions are illustrated in the figure below.

Continued research will be integral for a deeper understanding of the link between food allergies, body image, and eating disorder vulnerability – And we aren’t the only ones advocating for it! Here’s what one research team out of Canada had to say.

“Due to the prevalence of this chronic illness and the evidence that food allergy has a significantly larger impact on quality of life than other chronic illnesses, it is interesting that there does not exist sufficient consideration for the ways the healthcare system or government programs can raise awareness for and address this concern to prevent damaging psychopathologies.

Policy makers must advocate for development of mental health services geared towards individuals with food allergies and consider the possibility that individuals with food allergies who develop patterns of disordered eating are followed in clinics that may escape the scope of practice of eating disorder specialists.”

Jafria, Frykasa, Bingemann, Phipatanakul, Bartnikas, & Protudjer (2021)

I simply could not have said it better myself.

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Up next in this All Things Allergies eating disorder series is an investigation into disordered eating patterns as an Invisible Consequence of Anaphylaxis. I’ll share my personal experiences with disordered eating after an allergic reaction, and discuss how the recent acknowledgement of Avoidant Restrictive Food Intake Disorder (AFRID) by the American Psychiatric Association may pertain the food allergy community.

Disclaimer: This post is intended for educational purposes only, and should not be substituted for medical or professional advice. Please contact a licensed medical or mental health professional with further inquires.

Exploring the physiological + psychological similarities between anaphylaxis + panic attacks, and how the perceived gap in professional literature may perpetuate somatic trauma responses in the food allergy community.

“We have learned that trauma is not just an event that took place sometime in the past; it is also the imprint left by that experience on mind, brain, and body. This imprint has ongoing consequences for how the human organism manages to survive in the present. Trauma results in a fundamental reorganization of the way mind and brain manage perceptions. It changes not only how we think and what we think about, but also our very capacity to think.” 

The Body Keeps The Score, Bessel van Der Kolk

Introduction

In April of 2021, I openly shared my personal battle with mental health in a blog post titled, Invisible Consequences of Anaphylaxis. Honoring my mission to normalize mental illness in the food allergy community, I am leaning into the academia in order to illuminate a perceived gap in psychological literature + research.

As a licensed mental health counselor + clinical psychology doctoral student, I apologize in advance for any scientific jargon throughout this read. But let me geek out for a bit! Understanding the physiological mechanisms behind my somatic trauma responses brought an important sense of awareness + acceptance to my own personal mental health concerns – An understanding that I hope to be able to share with you, too.

Fight or Flight Response

Before we get ahead of ourselves – Let’s get down to basics.

Many of you have likely heard of our body’s natural defense system. The Fight or Flight Response is our body’s innate acute stress response activated by the sympathetic nervous system. When we find ourselves in physical or emotional danger, research suggests that our body has four options…

• Fight = Imagine being pulled into a strangers car. Just like every defense class has preached, fighting off your attacker gives you the best chance at survival.
• Flight = Perhaps a toddler wanders towards a busy street… Your instincts kick into high gear and you bolt to pick them up.
• Freeze = A burglar enters your home and there’s no exit in sight? You hide quietly in the closet without making a peep.
• Fawn / Appease = To avoid any further conflict, you comply with the demands of an attacker.

The natural instinct of the human body to defend itself against harm happens without conscious thought. The human body responds instantaneously and automatically to danger by bypassing the prefrontal cortex (The part of our brains that plan, organize, and makes decision). In other words, the Fight or Flight Response is involuntary – We rely on our innate reflexes to protect us.

In order to muster up the strength + stamina needed to survive an emergency situation, the adrenal glands flood the body with hormones, such as epinephrine, norepinephrine, and cortisol. The triggering of our internal alarm system through the release of these chemicals gives the body the necessary energy + alertness to ward off danger. The adrenaline circulating throughout the bloodstream quickly results in physiological changes, including…

• Increase Heart Rate
• Quick, Shallow Breathing
• Digestion Slows / GI Disturbances
• Nausea
• Dilated Pupils
• Tensed Muscles
• Sweaty Palms
• Auditory Exclusion / Temporary Hearing Loss
• Dizziness

If you have experienced these sensations before (Maybe at a Halloween haunted house, or when you couldn’t find your parent at the grocery store) – Good. Your body is working exactly the way it is supposed to.

Panic Attacks

The Diagnostic and Statistical Manual of Mental Disorders defines a panic attack as, “An abrupt surge in intense fear or intense discomfort that reaches a peak within minutes” (APA, 2013, p. 214).

Panic attacks biologically operate through the same Fight or Flight response system, but occur without the presence of actual or threatened danger. Researchers have identified two types of panic attacks – Expected panic attacks that result from a specific trigger (Public speaking, air travel, interviews, etc) and unexpected panic attacks that occur without an obvious trigger (Nocturnal panic attacks).

According to the American Psychiatric Association (2013), at least four of the following symptoms must be identifiable to be considered a panic attack…

• Palpitations, Pounding Heart, or Accelerated Heart Rate
• Sweating
• Trembling or Shaking
• Sensations of Shortness of Breath or Smothering
• Feelings of Choking
• Chest Pain or Discomfort
• Nausea or Abdominal Distress
• Feeling Dizzy, Unsteady, Light-Headed, or Faint
• Chills or Heat Sensations
• Paresthesias (Numbness or Tingling Sensations)
• Derealization (Feelings of Unreality) or Depersonalization (Being Detached from Oneself)
• Fear of Losing Control or “Going Crazy”
• Fear of Dying

According the Diagnostic and Statistical Manual of Mental Disorders, approximately 11.2% of adults in the United States will experience a panic attack in any given year (APA, 2013, p. 215). Studying that subset of the population, researchers were able to find predisposing factors that make individuals more likely to experience panic attacks throughout their lives. For example, children with neurotic or anxiety sensitive temperaments are at higher risk for panic attacks later in life (APA, 2013, p. 216).

Panic attacks can be also be a, “Direct physiological consequence of another medical condition,” including cardiopulmonary conditions like asthma (APA, 2013, p. 213). Most notably for the food allergy community, Panic Disorder (F41.0) has often been found to be co-morbid with both asthma and irritable bowel syndrome (APA, 2013, p. 214).

Anaphylaxis

Unfortunately, we are all too familiar with this one.

Anaphylaxis is a, “Severe and potentially life threatening allergic reaction… which can occur within seconds or minutes of exposure to something you are allergic to” (Mayo Clinic, 2021). According to the Cleveland Clinic (2021), the activation of mast cells and basophils during anaphylactic shock releases specific mediators that may eventually result in…

• Shortness of Breath
• Difficulty Swallowing
• Swelling
• Chest Tightness
• Hives / Rash
• Wheezing
• Clammy Skin
• Increased Heart Rate
• Low Blood Pressure
• Dizziness
• Nausea
• Vomiting
• Diarrhea
• Feelings of Doom

Sound familiar?

The bolded anaphylactic symptoms above represent the identically described symptoms in the definitions of the fight or flight response + panic attacks from earlier in this post.

The eerily similar physical symptoms that accompany our natural stress response make distinguishing an anaphylactic reaction from a panic attack incredibly challenging – Particularly for the traumatized brain.

Trauma

The American Psychiatric Association (2013) defines a traumatic event as, “Exposure to actual or threatened death, serious injury, or sexual violence” through direct experience of the traumatic event, witnessing the event in person, repeated exposure to adverse details of the event, or learning that the traumatic event has occurred to a loved one (APA, 2013).

Some of the more commonly recongizable examples of traumatic events include physical assault, severe motor vehicle accidents, natural disasters, and exposure to war.

Although seemingly less researched across the psychological landscape, certain medical incidents are also considered traumatic events. Clear as day on page 274 of the the Diagnostic and Statistical Manual of Mental Disorders, the American Psychiatric Association distinctly states, “Medical incidents that qualify as traumatic events include sudden, catastrophic events… [such as] anaphylactic shock” (APA, 2013, p. 274).

*DISCLAIMER: Not every traumatic event (Ex. Anaphylactic shock) results in a diagnosable disorder. Please seek consultation from your doctor or a licensed mental health professional for more information.

The Trauma Response

“Being frightened means that you live in a body that is always on guard.”

The Body Keeps The Score, Bessel van Der Kolk

Although our natural Fight or Flight Response is designed to activate in response to actual danger, a traumatized brain can trigger warning signals even when no such threat is actually present. Because it struggles to differentiate between safe and unsafe situations, the traumatized brain defaults to preparing for battle – A body that has been hurt in the past is continuously on high alert to prevent it from happening again.

Deep within our temporal lobes, a hypersensitive amygdala (The fear center of our brains associated with emotion and memory) inside of a traumatized brain prematurely initiates the acute stress response, regardless of whether or not the body is in actual danger. Remember – the Fight or Flight Response happens automatically + unconsciously by bypassing the prefrontal cortex. The amygdala is not seeking out approval from our conscious awareness that knows we are safe – Instead, the amygdala is part of the traumatized brain that is eager to defend itself.

The body and the brain are no longer in sync; Our external reality is not matching our internal experience – That’s thanks to trauma.

Linked on my Amazon Storefront, The Body Keeps The Score by Bessel van Der Kolk beautifully articulates how the traumatized brain + body live in a constant state of hyperarousal. His novel was a fundamental piece in the acknowledgment and acceptance of my own mental health journey.

Anxiety, or Anaphylaxis?

“Okay, Alyssa. It’s clear you have done your homework. But what does this actually mean for the food allergy community?” I’m glad you asked.

Picture this. You are safely eating a home-cooked meal in the comfort of your own kitchen. Your ingredient labels were triple checked + there is no risk of cross contamination when preparing food in your own pans. Bite by bite of your dinner goes down fine until… Is that a lump in my throat? Now that you say it – my stomach feels a little nauseous, too. It escalates as you become aware of your short, shallow breaths. Your heart pounds as your chest tightens. Sweaty hands search for an auto injector. The sensation of choking on a swelling throat reminds you of the emergency room visit after your first allergic reaction. But these anaphylaxis symptoms – Difficulty breathing, increased heart rate, chest tightness, dizziness, sweating, nausea, vomiting – directly mirror those of anxiety. In your hyper vigilant state, it feels impossible to differentiate. But you are not in anaphylactic shock – You are panicking.

It is common for the general public to confuse panic symptoms with a more severe medical emergency, like heart attacks, asphyxiation, or even being on the brink of death; That is anxiety talking. However, throughout the food allergy community, this issue is exacerbated for those who have previously suffered a traumatic anaphylactic reaction, given the distinct similarities between the trauma + the somatic trauma response. Although our acute stress response is initially unconsciously activated, it is consciously perpetuated by continued anxiety + fear about the sudden distressing physical symptoms.

Because what happens when you panic about panicking? You panic.

Personal Experience

“Being traumatized means continuing to organize your life as if the trauma were still going on – unchanged and immutable – as every new encounter or event is contaminated by the past.”

The Body Keeps The Score, Bessel van Der Kolk

My food-induced panic attacks were initiated after an anaphylactic reaction in June 2014. My traumatized brain + body gathered the troops to fend off non-existing threats at almost every meal. The rapid heart rate, short shallow breaths, clammy skin, and nausea I anxiously sat through at the dinner table was practically indistinguishable from those same sensations I had felt headed to the emergency room with an anaphylactic reaction. Refusing to be vulnerable to another threat, my survival instincts were locked into overdrive. Allergen or not, danger or not, my physical body was perpetually ready to fight.

A mental health provider once powerfully validated the juxtaposition between my debilitating internal experience and my seemingly collected external appearance; Acknowledging the pure exhaustion of living inside of a traumatized body. Family + friends struggled to comprehend my persistent anxiety when there was not a visible reason to sound my internal alarms system. But my disconnected mind and body blindly refused to let its guard down + involuntarily suffered the physical fight or flight sensations on a day to day basis.

Despite it all – there is help. After years of trauma informed cognitive behavioral therapy, prescription antidepressant medication, and continued self care + compassion, redefining my sense of safety has allowed me to better manage panic attacks, fainting spells, and anxious thoughts.

Beyond the scientific review of the physiological + psychological impacts of anaphylaxis in this article, my blog post The Invisible Consequences of Anaphylaxis instead intimately explores my personal mental health recovery journey + continued relationship with food anxiety.

Our Community

Through it all, the All Things Allergies community reminds me that I am not alone. The young girl who grew up suffering from mysterious fits of anxiety now reads comforting message after message of similar stories from her followers.

For years, I endured panic attacks without the vocabulary to label them. For longer, I was blind to the invisible consequences of anaphylaxis that perpetuated my somatic trauma responses. Although an explanation would not have been a cure, the capacity to make sense of my symptoms would have jumpstarted my mental health recovery journey.

So, if I can help normalize + verbalize this experience for just one other allergy kid, then I am very proud to be becoming the very woman that I needed as a little girl.

Future Directions

Despite the American Psychiatric Association’s clear recognition of anaphylactic shock as a traumatic medical event, the intersectionality between food allergies and mental health is lacking the proper diagnostic tools, well funded research efforts, and evidence based intervention protocols to effectively treat patients with co-occuring allergies and mental health disorders. So, when my dissertation chair matching process comes along this fall, I intend to propose this perceived gap in psychological literature as my area of focus throughout my doctoral education. Anxiety, or Anaphylaxis? is just the beginning.

Hey professor, if you are reading this blog post, can it count as extra credit?!

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Mental Health Resources

You are not alone. Please see my blog post, The Invisible Consequences of Anaphylaxis, for additional mental health resources, publications, and help lines.

Disclaimer

This post is intended for educational purposes only, and should not be substituted for medical or professional advice. Please contact a licensed medical or mental health professional with further inquires.

References

American Psychological Association (2013). Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. American Psychiatric Association Publishing: Washington, DC.

Cleveland Clinic (2021). Anaphylaxis. Retrieved from https://my.clevelandclinic.org/health/diseases/8619-anaphylaxis

Mayo Clinic (2021). Anaphylaxis. Retrieved from https://www.mayoclinic.org/diseases-conditions/anaphylaxis/symptoms-causes/syc-20351468

Van Der Kolk, B. (2014). The Body Keeps The Score: Brain, Mind, and Body in the Healing of Trauma. New York, New York: Penguin Books.

After receiving my negative skin + blood tests from Chicago Family Allergy and Asthma, I was given the “all clear” to food challenge tree nuts, seafood, and legumes at home for the very first time. Given my undetectable IgE levels, Dr. Katie Tanner felt confident in conducting my taste tests outside of their Lincoln Park office. But the girl with a history of severe anxiety, traumatic stress, and anaphylactic reactions was in no such hurry to suddenly pick up an almond joy on her way home. Yesterday I was avoiding tree nuts like the plague… But today you want me to eat one and just see what happens?!

In the food allergy community, we rally around our commonalities – But each of us are the experts of our own respective journeys. So as an exercise in self compassion, I have chosen to take an individualized approach to this process. With more than twenty years of associating tree nuts with danger + disaster, it has been in my best interest to move at pace that feel right for me. So, with consultation from both my allergist and therapist, I created a personalized exposure hierarchy to gradually introduce previously restricted allergens into my everyday life.

Exposure Therapy

According to the American Psychological Association, exposure therapy is a “psychological treatment that was developed to help people confront their fears.” This intervention is often used to treat phobias, post traumatic stress, obsessive compulsive tendencies, and other anxiety related disorders. One variation of exposure therapy is graded exposure – A technique where psychologists help “construct an exposure fear hierarchy, in which feared objects, activities or situations are ranked according to difficulty. They begin with mildly or moderately difficult exposures, then progress to harder ones.” Graded exposure therapies minimize distress by slowly habituating clients towards their desired goal with progressive, but manageable steps.

Following these same principles, we created an exposure hierarchy to manage food anxiety in preparation for my first food challenge. We designed the hierarchy to begin with the least challenging exercise (Being near previous allergens), then move towards my most challenging feat (Incorporating previous allergens into my regular diet). We avoid labeling the inaugural tasks as “easier” because each phase presents with its own expected anxiety. In fact, the purpose of this therapeutic intervention is to gradually minimize that exact experienced arousal by steadily increasing stress tolerance.

(See Mom and Dad?! These psychology degrees are definitely paying off!)

In preparation for my upcoming food challenges, my homework assignment outside of the therapy room has been to actively engage in lower tier exposure activities. Below, I have provided examples for each prong of the exposure latter, moving from least difficult to most difficult.

1. Being Comfortable Around Foods (Least Difficult)

• Friends + Family Order Previous Allergens at Restaurants
• Sit by Peers in Class Eating Previous Allergens
• Purchase Allergens at Store to Bring into Food Challenges

2. Cross Contamination

• Consume Foods That Poses Cross Contamination Risk to Previous Allergens
  • Starbucks = Almond Milk
  • Sweetgreen = Cashews
  • Do Rite Donuts = Pistachios
  • RPM Seafood = Shellfish
  • Mezza Grill = Chickpeas
  • LINDOR Truffles = “May Contain Tree Nuts”

3. Food Challenge

• Schedule Food Challenge @ Chicago Family Allergy and Asthma
• Attend Brief Therapy Check-In During Food Challenge
• Utilize Meditation, Relaxation, and Breathing Skills to Differentiate Between Anaphylaxis Symptoms and Anxiety Symptoms

4. Incorporate into Diet (Most Difficult)

• Recommend by Allergist, Consume Previous Allergens on Regular Basis to Maintain Tolerance
• Purposely Eat Previous Allergens Every 1-2 Weeks
• Once Proven to be Safe, Build Up Courage to Eat these Foods Away from Home
  • Use Almond Milk in Coffee
  • Hippeas Chickpea Puffs
  • Order Pine Nut Pesto at Dinner

Allergen Hierarchy

Not all allergies are created equally; My food anxiety has seemingly associated more fear with some allergens than others. For example, almonds and hazelnuts feel more intimidating to food challenge than walnuts or pistachios – Despite there being no meaningful difference between the nuts. In fact, the thought of food challenging any tree nut produces significantly more apprehension than legumes or seafood.

Following suit, these allergens fall into a exposure hierarchy of their own. Chickpeas were purposely scheduled for my first challenge to reduce overall uneasiness about trying a previously restricted food in general. Similarly, before my in office food challenge of almonds (most difficult), I will be conducting an at home challenge of walnuts (less difficult). Taking my first bites of almond should hopefully feel less alarming if its not the first nut I have ever eaten.

Next Steps

On Saturday October 9th, I will challenge my first tree nut in the comfort of my childhood home. Just two weeks after testing walnuts, I chosen to host my almond food challenge in the safety of Chicago Family Allergy + Asthma on Friday October 22nd. Stay tuned for updates, because as always, the Hivey League will get a front row seat as I steadily move towards the peak of my exposure hierarchy.

The emotions that I have associated with previous allergens will certainly take time to unlearn, but research in the field of psychology has highlighted the effectiveness of behavioral interventions for extinguishing anxieties similar to mine. Despite close to twenty years of paralyzing food anxiety, I am hopeful – Because being scared means you are about to do something really, really brave.

DISCLAIMER: The content of this post is for educational purposes only, and should not be substituted for medical, psychological, or professional advice. Please consult with your doctor or a licensed mental health professional for more information.

The Reaction

During the summer of 2014, as a 17-year-old incoming senior in high school, I took a walk with friends to a local ice cream shop that would unknowingly change the course of my life forever. Half of a brownie flurry later, I was reaching for a bottle of Benadryl in our medicine cabinet as my stomach swirled. The walls seemed to be caving in on me as I laid on the bathroom floor with my parents by my side. Unwilling to change out of my favorite pajamas, we set off for the emergency room as I sat petrified in the backseat.

One IV of steroids and hours later, I checked out of the emergency room with an “all clear” from the doctor. Although my visual symptoms of nausea and hives were gone, the invisible consequences of my anaphylactic reaction remained untreated. The lasting impact of the chilling event was forever ingrained in my brain.

Aftermath

From that June afternoon onward, I struggled to eat. Every meal ended with a silent dash away from the dinner table, sure I was having another reaction. So convinced one night at the local movie theater, I left the film halfway through after breaking down in tears in the bathroom. At varsity swim practice, I became extremely troubled by workouts that limited our breathing. Instead of celebrating my senior season, I was counting down the days until the sport I once loved was over. I washed my hands until they bled, and hyper vigilantly sanitized surfaces that could be a cross contamination risk. Most intrusively, I was repeatedly lightheaded in unfamiliar situations, and began to have a Vasovagal Syncope episode whenever I was emotionally distressed. Similar to when someone becomes faint at the sight of needles, I would experience severe drops in blood pressure and pass out during school, at doctors appointments, and even in the grocery store.

What was happening to me? I did not have the words, nor experience, to describe what I was feeling. The confident, independent young lady I once was suddenly could not even enjoy a home cooked meal or go to a routine appointment alone. Every aspect of my life was severely afflicted in the aftermath of an allergic reaction I was “cleared” from months ago.

Seeking Help

At my mom’s suggestion, and my loss for answers, we decided to seek professional help. Just four months after my reaction, every Saturday morning I began going to therapy. With the help of my new counselor, we processed through the mental and emotional toll of my recent allergic reaction – much of which was dismissed following my “all clear” at the emergency room. She utilized cognitive and behavioral therapy techniques to educate me about the body’s biological response to danger, explore effective coping strategies, and rediscover my sense of safety.

After months of unexplained distressing symptoms and fainting spells, I was finally provided with an answer. An anxious temperament dating back to my childhood had predisposed me to developing a Trauma and Stressor Related Disorder, characterized by reoccurring panic attacks and obsessive compulsive tendencies – All in response to my life threatening allergic reaction.

The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) is the psychology dictionary that details the symptomatology of all mental illnesses recognized by the American Psychiatric Association. Psychologists and counselors alike utilize this collection of criteria to diagnose and treat their clients. Previously known as “Shell Shock,” Posttraumtic Stress Disorder (PTSD) is often associated with veterans returning from war. While this disorder can certainly affect those in our military, this diagnosis is now applied much more broadly. Posttraumatic Stress Disorder requires a specific “Exposure to actual or threatened death” to meet full diagnostic criteria. Throughout the Posttraumtic Stress Disorder section of the DMS-IV, the American Psychiatric Association has listed hypothetical examples of traumatic events, such as serious vehicle accidents and physical abuse. Medical incidents also qualify as “Exposure to actual or threatened death” in the eyes of American Psychiatric Association – And on page 274, they directly identify anaphylactic shock.

While I certainly characterized my evening in the emergency room as a traumatic event, it was undoubtedly validating to see my experience plainly recognized by the leaders of the field.

*DISCLAIMER: Not every traumatic event (Ex. Anaphylactic shock) results in a diagnosable disorder. Please seek consultation from your doctor or a licensed mental health professional for more information.

A New Normal

Because anaphylaxis symptoms often mirror those of panic attacks (Stay tuned for a full blog post about the Fight or Flight Response), differentiating between a real or imagined threat was nearly impossible. Every shallow breath from panic symptoms felt like a tightening throat from nut allergens; Every racing heartbeat from anxiety felt like the beginning of an allergic reaction.

I attended approximately nine months of weekly therapy sessions tackling these exact concerns. Although the counseling I received in high school empowered me enough to head off to college out of state that next fall, I am by no means cured of my food anxiety. In fact, I continue to struggle to manage stress related to food allergies and beyond daily. While beginning to discern between anxiety and anaphylaxis was a leading treatment goal of my healing process, I am far from mastering it even seven years later. Despite my carefree smile in the photo above, the first sip of that drink had me second guessing my safety just weeks ago.

Trauma lives within the body and leaves a lasting impact that is not healed overnight. I have accepted that adjusting to my body’s natural alarm system will be an ongoing crusade throughout my lifetime.

“We have learned that trauma is not just an event that took place sometime in the past; it is also the imprint left by that experience on mind, brain, and body. This imprint has ongoing consequences for how the human organism manages to survive in the present. Trauma results in a fundamental reorganization of the way mind and brain manage perceptions. It changes not only how we think and what we think about, but also our very capacity to think.”

– Bessel van der Kolk, The Body Keeps The Score: Brain, Mind, and the Body in the Healing of Trauma

Breaking the Stigma

A right of passage for seniors at my high school, the infamous Water Wars league debuted late spring semester. Split into teams of five, the elimination tournament had students dodging water balloons around the community just to win bragging rights. There were a strict set of rules, but anything off of school property was fair game. If you were splashed with water by the opposing team, you were out! Desperate the join in on the fun, I was gutted knowing I would have to watch from the sidelines. My teammates and opponents would surely learn about my Saturday morning routine, and I did not want anyone to know I was seeing a therapist.

Seeking professional help was a secret I kept from close friends and family for a number of years. I had always been the person others turned to for help and reassurance, so admitting my own struggles made me feel weak.

All Things Allergies was founded over a year ago, but I am finally ready to share my story. I have been floored with the number of individuals who have privately reached out to me about food anxiety. A few short years ago, I thought I was alone in this battle. Little did I know, I had a whole online community awaiting to support me. These connections continue to be the inspiration behind my blog – All Things Allergies is the resource I wish I had growing up with food allergies. Back in the height of my food anxiety, I would have been so comforted knowing I was not the only person suffering through this. If I can empower just one person with my vulnerability, every step in my recovery process will have been worth it.

A Particle of Goodness

“And nothing shows more strength than finding a particle of goodness in the worst of situations.”

– Unknown

With tragedy comes triumph. While my allergic reaction derailed much of my senior year and continues to impact my everyday functioning, there were undeniable particles of goodness.

Because of the significant impact that my therapy journey had on the trajectory of my life, in the fall of 2021, I enrolled at The Chicago School of Professional Psychology to pursue my Master of Arts degree in Counseling Psychology. And this summer, after graduating with my limited license, I will be continuing my education at The Chicago School as a doctoral candidate in Clinical Psychology (Dr. Bauder has a nice ring to it, right?!).

The food allergy community deserves experts in the field doing advocacy work and ground breaking research on these topics. As I begin my doctoral education with a focus on the connection between food allergies and mental health, I take solace in knowing my suffering will not go to waste. Instead, my newfound strength can serve countless others in the future. My personal struggles with mental health and allergic reactions not only guided me towards a career in psychology, but towards a calling in life. I found even more than I could have asked for in those fifty minute sessions with my first therapist.

Resources

At the 2019 Food Allergy Conference for Education and Science (FACES) in Chicago, Illinois, I connected with licensed mental health professional, Tamara Hubbard, LCPC. She led a presentation alongside Dr. Jeanna Herzog, PhD., about the emotional impacts of anaphylactic episodes. Tamara Hubbard has created a Food Allergy Counselor Directory that spotlights mental health professionals across the United States who specialize in food allergy treatments. Her website also offers unique insights and resources for food allergy families struggling with a new diagnosis, resilience, or anxiety concerns. I hope to find myself on her directory one day!

Once deciding to steer my future towards a career in psychology, I began volunteering for a non-profit organization called Crisis Text Line. This twenty-four hour crisis hotline is operated completely via text message, perfect for the growing generations less comfortable with verbal communication. Whether you are struggling to calm down from a severe panic attack, need assistance processing through world events, experiencing suicidal thoughts, or are just looking for someone to listen, Crisis Text Line is there for you. Text HOME to 741741 to chat with a certified volunteer crisis counselor today.

Self care is a continuous process in and outside of the therapy room. One of the saving graces that has supplemented my counseling journey is the art of mindfulness meditation. Applications like HeadSpace and Calm offer moments of serenity throughout your busy day. Practicing thought acceptance, deep breathing, and grounding techniques are powerful tools for managing anxiety.

New York Times bestseller The Body Keeps The Score: Brain, Mind and Body in the Healing of Trauma was essential for understanding the physical and emotional mechanisms behind my body’s trauma response post diagnosis. Recommended by my therapist and a favorite in the psychology field, this book helped normalized the years of symptoms I never understood.

The connection between mental health and food allergies is a topic that will continue to be highlighted on All Things Allergies. Check out the ‘Mental Health’ highlight reel on my Instagram feed for research publications, newfound resources, inspiring quotes, and personal stories related to food anxiety.

Ready to start the therapy journey yourself? Psychology Today can help you find licensed, qualified, and experienced mental health professionals in your area at the click of a button.

Conclusion

With the widespread fear and social isolation brought upon by the COVID-19 pandemic, like many others, I have elected to reengage in therapy this past year to ensure a prioritization of my own mental health. There is no shame in asking for support – It shows strength, not weakness!

To anyone out there dealing with something similar – You are not alone. One of the best ways to rid our communities of invalidating stigmas or stereotypes is to foster healthy dialogues and meaningful conversations. Our communication is key, so never hesitate to reach out to me with questions or concerns. Head over to the ‘Contact Me’ page of allthingsallergies.com for the best ways to get in touch.

All the best,

*DISCLAIMER: The content of this post is for educational purposes only, and should not be substituted for medical or professional advice. Please consult with your doctor or a licensed mental health professional for more information.