The purpose of this website is to provide resources for clinicians who are treating people with emetophobia. People with emetophobia may also use this site for self-help.
**Please note that this website contains words, concepts, and imagery that will be upsetting to people with emetophobia.
Characteristics of Emetophobia
Emetophobia is classified as a type of phobia. Phobias are extreme fear about a specific object or situation. A case can be made that emetophobia functions more like obsessive-compulsive disorder. Regardless of classification, it is an extraordinarily debilitating problem.
People with emetophobia fear throwing up. Most commonly, the fear centers around oneself throwing up. For others, the fear may be about seeing other people throw up, and often both are triggering. For some, the thought of throwing up in front of others is terrifying with the imagined accompanying shame. Sensations or situations that could lead to vomiting are avoided if possible.
Typically, it begins in childhood and affects more females than males. Like most anxiety disorders the severity falls on a continuum. Virtually no one likes to vomit, and it is typical to have a disgust response. However, for people seeking treatment, the degree of severity is almost always extreme. It is common to panic when triggered. The urge to avoid anything associated with the possibility of throwing up is debilitating.
Unlike other anxiety disorders, people with emetophobia believe that if they can exert enough control over themselves or the situation they can prevent it from happening. This reinforces the extreme measures that people may take. Although the research suggests this might be modestly effective in preventing throwing up, the cost to one’s daily life is dreadfully high. Clinicians will need to take into account the strongly held belief by their patients that all the measures taken are the reason they have not thrown up and there will be much resistance to giving those up.
Most people with emetophobia struggle with either nausea or fearing its onset. For some, the nausea is daily with little relief. For most, it is frequent but episodic. This, of course, becomes completely intertwined with eating or not eating. It is common for nausea to be experienced as so strong people feel sure they will vomit. However, in the main study about this, 98% of people reported they did NOT vomit when nauseated (Höller, et. al 2013).
One of the main reasons the phobia persists is that once it starts the fight or flight response results in GI discomfort. It becomes a chicken or the egg problem. Is the nausea first or the anxiety? We do recommend that people with emetophobia consult with either an adult or pediatric physician to rule out any medical conditions.
One of the features that can become a medical issue is food restriction. Often emetophobia is misdiagnosed as anorexia nervosa. Ironically, as clinicians begin an intake about this with patients, they inquire about eating disorder symptoms. Invariably they ask about bulimia. I guess it is hard from many clinicians to understand just how intense the fear of throwing up is. A person with emetophobia would NEVER be bulimic. Food restriction can present in various ways. It might be that only certain foods are safe or certain foods are considered as dangerous. Often people will stop eating before they feel full so if they are sick the amount of chyme (partially digested food) is limited. Food might be restricted in certain contexts. For example, eating at a restaurant may be avoided but okay at home. Sometimes the subsequent weight loss can become a medical issue.
Avoiding and trying to feel safe become an intrinsic and intrusive part of daily life. These are called safety behaviors because their purpose is safety-seeking. Although they provide rapid albeit limited relief (hence very reinforcing) they actually perpetuate the phobia. They both confirm to the person with the phobia that something is ‘dangerous’ and should be avoided, as well as exclude the experiences that would disconfirm the threat. An extensive list of these behaviors can be found here.
The treatment that is most effective with all anxiety disorders (apart from medication) and what we recommend on our site and upcoming text is called exposure and response prevention (ERP). This is part of an overall treatment most clinicians are familiar with called cognitive behavior therapy. Clinicians should be familiar with ERP before using our site with patients and we recommend education, training, and supervision if possible before undertaking the treatment of emetophobia. Exposure is intentionally presenting something that is triggering to the patient. Response prevention is practicing a different response and eliminating the safety behaviors. A brief overview of safety behaviors relevant for treating children is here. There are innumerable excellent explanations of the process but here are a few we find helpful.
Although the publishing journal prohibits us from publishing a link on our site, Jon Abramowitz wrote a very helpful article in 2013 called the practice of exposure therapy. His overview would be helpful for clinicians who are learning about or practicing that treatment.