Following is a very brief description of some of the medical conditions that might be a factor in emetophobia. Our book covers these in more detail (April 2023). Typically, any physical distress (e.g., nausea, GI distress, esophageal discomfort) is the result of anxiety. However, there are occasions when the phobia may be a result of or impacted by a medical condition. For our patients, we often recommend at least a consult with their physician. If there is a condition and it is successfully treated, then behavioral treatment is easier and faster.
Gastroesophageal Reflux Disease (GERD)
This is the result of a weak or malfunctioning esophageal sphincter causing stomach acid to come up the esophagus. The symptoms may be a burning feeling, acid burps, trouble swallowing, sore throat, cough, or chest pain. Medication and diet changes are usually the recommended treatments. More information can be found here.
Eosinophilic Esophagitis (EoE)
Considered rare but increasingly prevalent, EoE is a chronic allergic inflammatory disease. For reasons still unknown, but possibly due to a food allergy, white blood cells build up in the esophagus. Common symptoms include abdominal pain, food impaction, difficulty swallowing, vomiting, chest pain, and failure to thrive. It is diagnosed by endoscopy and if white blood cells are not visible at first, then a biopsy is done to look for them.
It remains a long-held belief that ulcers are caused by stress or by a combination of stress and spicy or difficult-to-digest food. We now know that ulcers, which are sores in the stomach lining, are almost always caused by the presence of bacteria. Despite this knowledge being fairly prevalent, some people with emetophobia believe that their anxiety is causing ulcers. The symptoms of gastric ulcers are nausea, loss of appetite, and pain in the stomach or even the small intestine. These symptoms are indicative of many other gastric diseases and also of anxiety. Once diagnosed this can be successfully treated with antibiotics. More information can be found here.
Gastroparesis is a condition where the muscles of the digestive tract are slow or stop altogether so the stomach does not empty properly. The result is a feeling of fullness (even when the stomach is not at all full), acid reflux, pain, and nausea. The cause of gastroparesis is not wholly known but viral infections, damage to the vagus nerve in surgery or by accident, some medications, and some autoimmune disorders such as scleroderma may lead to it. Gastroparesis can be treated medically. More information can be found here.
Inflammatory Bowel Disease (IBD)
IBD takes two forms: Crohn’s and ulcerative colitis. The latter affects the large intestine, while Crohn’s can affect any part of the GI tract. IBD is not to be confused with IBS (irritable bowel syndrome) as IBD is usually much more serious. The symptoms of IBD are mainly pain and diarrhea, but patients can also experience fever, bleeding, fatigue, and weight loss. These are autoimmune diseases. More information can be found here.
Median Arcuate Ligament Syndrome (MALS)
MALS is a disease caused by the median arcuate ligament sitting lower than usual and therefore pressing on the celiac artery. This slows blood flow to the digestive system and also presses on nerves. The result is a great deal of pain. MALS can be asymptomatic for a time but when symptomatic is quite terrible. It mostly affects thin, young women. As with other GI diseases, MALS can cause nausea, diarrhea, and pain which is worse after eating. MALS is difficult to diagnose since the symptoms can mimic gallbladder, other digestive problems, or liver disease. More information can be found here.
Superior Mesenteric Artery Syndrome (SMAS)
SMAS can also be called Wilkie’s syndrome, mesenteric root syndrome, and a couple of other names. It is a complicated condition wherein the duodenum is compressed by the superior mesenteric artery and the abdominal aorta. It often occurs in children, mainly girls and young women aged 10-30. Since these girls and women are notoriously slim, sometimes even emaciated, it is often misdiagnosed as an eating disorder. The symptoms of SMAS are nausea, vomiting, abdominal pain, acid reflux, and abdominal distention. More information can be found here.
A frequent symptom that people with emetophobia describe is an uncomfortable sensation in the throat. There is a muscle that surrounds the top of the esophagus that is always in a contracted state. Normally, it is not the focus of one’s attention. It only relaxes when a person swallows. Sometimes, the muscle will spasm and it feels uncomfortable. Often people with emetophobia interpret this as a signal of impending vomit. Actually, it means the sphincter or ‘gate’ is shut so nothing will come up. More detail and information about treatment can be found here.
Irritable Bowel Syndrome (IBS)
‘Irritable bowel syndrome (IBS) is a common disorder that affects the large intestine. Signs and symptoms include cramping, abdominal pain, bloating, gas, diarrhea or constipation, or both. Only a small number of people with IBS have severe signs and symptoms. Some people can control their symptoms by managing diet, lifestyle, and stress.’ (Mayo Clinic) More severe symptoms can be treated with medication and counseling. While we don’t doubt that IBS is a real disorder unrelated to anxiety, we nevertheless are mindful of the fact that IBS can also be caused by and/or related to anxiety. Many patients (although certainly not all), upon being successfully treated for their emetophobia have expressed that their IBS went away as well.
Retrograde Cricopharyngeus Dysfunction (R-CPD)
R-CPD is the inability to burp due to a type of deformity in the upper esophageal sphincter, which cannot relax to release the air bubbles. We are unaware of any scientific evidence or studies done on R-CPD and emetophobia, but from anecdotal evidence it seems as if many people with emetophobia have this disorder. People with emetophobia also remark that they are in online groups for R-CPD and that there are several members there with emetophobia. The connection could be that trapped gas leads to discomfort and nausea. More information can be found here.
Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infection (PANDAS)
Pediatric Acute-onset Neuropsychiatric Syndrome (PANS)
PANDAS and PANS are the sudden and dramatic onset of symptoms that are exactly like OCD or tic disorders normally associated with Tourette syndrome. Accompanying symptoms may be separation or other anxiety, irritability, major depression as well as a host of others previously atypical for the child. The sudden onset of symptoms always follows an infection of Group A Streptococcus (GAS). This infection can be asymptomatic, which further complicates the likelihood of a correct diagnosis. ‘Sudden onset’ often means that parents can identify the exact day when the child’s behavior changed. Kids who previously had OCD can experience a worsening of symptoms just as suddenly.
Despite these being somewhat rare conditions, we have both experienced more than one patient having been diagnosed with one or the other. As emetophobia is so under-researched, we do not yet know exactly how PANDAS/PANS affects previously diagnosed children, or whether PANDAS/PANS itself can lead to sudden onset of emetophobia or worsen the symptoms. The Pandas Physicians Network diagnostic guidelines list restricted food intake as part of one of the four essential symptom clusters required to make the diagnosis. Specifically, they note that fears of choking or vomiting may drive the food restriction.