Anxiety about Vomiting
Fear of Vomiting – Emetophobia
Emetophobia is categorised as one of the fairly common specific phobias diagnosed within the spectrum of anxiety disorders. In fact, it has been coined the fifth most common phobia in the world.
Individuals experiencing emetophobia, hold an intense fear of vomiting –either in themselves or witnessing it through others, or both. Some may experience the same levels of distress when they witness others vomiting as if it is happening to themselves, or assume that they will soon be sick too. The disorder can manifest in both males and females of all ages, but is most commonly identified in women, and is reported more severely in adolescents than adults.
Individuals with the disorder constantly monitor how their body is feeling, looking out for any possible signs of illness emerging (particularly in their stomach and throat), for fear that any signs could initiate or indicate anxiety cause vomiting. Sometimes individuals with emetophobia can recognise that their fears of vomiting are not actually grounded in scientific evidence, and that the action of vomiting itself will not result in the unrealistic outcomes they have catastrophized. This is up until the wave of panic takes over their rational thoughts and behaviours – taking on similar characteristics to those of panic disorders; the difference being emetophobics focus on sensations in their stomachs and throats (instead of sensations in their heart, chest, or head).
In addition to situations that could potentially trigger illness and thereby induce vomiting or chocking related behaviours, emetophobics typically also fear their own bodily responses, as they associate feelings of panic and high distress to potentially bring about nausea. This can fuel a vicious cycle of unremitting panic attacks over prolonged periods, as they are unable to escape their own body stimulating the distress in the first place. Many individuals with the disorder will compare the outcome of vomiting to be as terrible as dying – illustrating just how distressing their fear of vomiting is, and what precautionary measures they will take to prevent it.
In some cases, emetophobics will exhibit the symptoms of other anxiety disorders, such as Obsessive Compulsive Disorder – OCD (intrusive obsessive thoughts that lead to compulsive actions to alleviate their distress); agoraphobia (fear and avoidance of a situation that could trigger their anxiety); restricting their food intake to resemble the characteristics of eating disorders (or engaging in other behaviours associated with those of eating disorders, particularly the preparation of food), and Post- Traumatic Stress Disorder – PTSD (experiencing extreme distress when something triggers a reminder of a past traumatic event).
Examples of common behaviour people with emetophobia might engage in can include:
- avoidance of people and places that could be associated with germs and illness
- taking extreme precautionary measures to prevent the spread of germs – such as excessive sanitation procedures
- Restricting their food intake if they have the slightest worry it could lead them to feel sick, or that the food itself could be contaminated
Many individuals with the disorder may feel a sense of shame about their fears, and are commonly too embarrassed to admit their problems to others. Often they mask their fear of vomiting in other phobias or dislikes that they feel will be more “accepted” by others – such as: fear of heights, fear of flying, fear of the commitment to motherhood (for fear of morning sickness), intolerance or dislike of certain foods, or particular situations and places they associate a high risk to (such as situations involving other people preparing their food for fear of contamination; fear of food being past its used by date; fear of being in places that would not have the facilities for them to escape to vomit if they needed to; or places that would not meet their standards of hygiene (like movie theatres, public transport, large public celebrations or parties).
- Pregnancy – fear of morning sickness/ fear of dealing with the fact that babies vomit
- Eating food prepared by others, for risk of food poisoning, or avoiding food that could make them feel sick
- Substances that may have a side effect of vomiting (particular medication, anaesthesia, alcohol)
- Fear and avoidance of psychotherapeutic treatment – for fear of exposure therapy
- Particular situations or events that may involve other people vomiting (amusement parks, music concerts/ nightclubs, children’s birthday parties)
- Fear of hospitals, nursing homes, schools (as these places are often associated with higher risk for germs, or exposure to other people who are sick or who may vomit)
- Travelling for fear of motion sickness
- Public toilets/ public transport for risk of germs
- Fear of particular careers that may limit sick days
There are a number of underlying issues that could trigger emetophobia – all of which will vary across individuals. Many emetophobics report having experienced a past traumatic situation associated with either themselves vomiting or witnessing someone vomitting (usually during childhood) – although the common causes for others, could be the result from a number of unrelated traumatic life events, anxious family environments, or a history of separation anxiety.
Like other anxiety disorders, the main treatment for overcoming emetophobia involves Cognitive Behavioural Therapy (CBT), with the guidance and ongoing support from an experienced psychologist in the area. The therapist will work with the individual to firstly identify their automatic (and irrational) negative thought patterns about vomiting. The next step involves restructuring: teaching them new techniques to replace their existing thoughts with cognitions that are instead, grounded in facts and evidence. An important consideration is that this will involve GRADUAL exposure therapy, NOT literal exposure to vomiting induced within the individual themselves.
The exposure component is tackled according to a “fear hierarchy” that can be devised after the individual identifies a number of scenarios they fear with their therapist, placing these in order of least to most distressing. From here, the individual will work with their therapist to slowly expose them to the list of stimuli they have identified in their fear hierarchy – gradually working toward decentralising their distress. Elements of a fear hierarchy could include the following examples of stimuli focused around vomiting, in order of threat:
- Pictures of words emetophobics fear
- Devising a list of sentences to be spoken aloud
- Funny cartoons
- Pictures of people looking sick
- Pictures of people actually being sick (least to most graphic)
- Videos of fictional characters being sick
- Videos of real people being sick (least to most graphic)
- Range of sounds/ noises (from least to most explicit)
- Particular real life trigger situations and environments (babies, hospitals, public toilets, food prepared by others)
Alternatively, emetophobics and their therapist can work through an already devised list of gradual exposure pages, involving similar elements to those listed above, from this helpful resource: http://www.emetophobiaresource.org/
For the most effective desensitization to occur during exposure therapy, it is recommended that the distress of the emetophobic does not exceed a 5 point threshold (where 1= no fear and 10 = highest level of distress) on a Subjective Units of Distress (SUB) scale. As these exercises only involve exposure to hypothetical stimuli, it is important for the emetophobic to imagine themselves in the situations (thereby raising their anxiety) and then work through various relaxation techniques to lower it – eventually replacing their old reactions, with new positive and rational cognitions and behaviours.
Some tips that may be helpful:
- Don’t expect too much too soon – overcoming emetophobia is a gradual process, requiring large amounts of trust, commitment and patience! It is essential the individual feels that they can trust their therapist, and eventually learn to trust themselves and others.
- Engage in regular exercise – It will help to elevate your mood and reduce and manage your anxiety.
- Try a range of relaxation techniques, including breathing exercises, meditation, or yoga. Your therapist will be able to teach you some deep abdominal breathing methods that can be practised at any time and place. Music may also be a helpful form of relaxation therapy, it has been shown to assist stress relief by occupying and distracting your brain from unhelpful thoughts.
- Don’t be afraid to seek help – Remember, (exposure) therapy does NOT involve situations requiring the action of vomiting itself. Getting the help you need, will teach you new techniques to recentralise your negative thought patterns to ALLEVIATE your anxiety, so that you can take control over your life (instead of your anxiety controlling you)
The act of vomiting is generally considered unpleasant by most people’s standards, and many will go to great lengths to prevent it from happening. Either witnessing it in others, or experiencing it themselves, the act of vomiting is generally considered unpleasant by most peoples’ standards – and many will go to great lengths to prevent it.
The anxiety disorder, emetophobia is characterised by an extreme, debilitating fear of vomiting –so much so, that it interferes with the individual’s daily life activities and functioning, including the completion of everyday tasks, work commitments, exposure to public places, and partaking in social events.
The length of treatment will vary for each individual, but it is recommended therapy sessions are spread over roughly 16 weeks. Sessions can be done either face to face, or via the internet through online therapy (e-therapy). Online therapy would benefit those who feel it would be easier or “safer” for them to attend sessions in the “comfort” of their own home.
Who we recommend
Carbonell, D. (2009-2014). Emetophobia: The Fear of Vomiting. Retrieved from http://www.anxietycoach.com/emetophobia.html
Christie, A. (2004-2011). Information & Help for Emetophobia. Retrieved from http://www.emetophobiahelp.org/fact-sheet.html
SkillsYouNeed. (2014). Music Therapy. Retrieved from http://www.skillsyouneed.com/ps/music-therapy.html