Trigger Warning: this blog post may include words and experiences associated with this phobia.
The Journey
Our journey started in Aug 2023, a couple of weeks before my daughter was set to begin 4th grade. A little back story about my and my daughter’s mental health. I have had what I thought was generalized anxiety since college. I didn’t struggle with it until postpartum and then again about a year ago when I realized I actually have OCD (that’s a post for another time). My daughter experienced anxiety around the age of 7 with storms which led to separation anxiety. She saw a therapist and underwent EMDR (Eye Movement Desensitization and Reprocessing) which greatly improved her anxiety.
Fast forward to Aug 2023, I noticed my daughter not wanting to eat much, especially at dinner time. She would often say she wasn’t hungry, even though she hadn’t had anything to eat in a while. Of course, initially, we didn’t think much of it. However, not wanting to eat, quickly turned into asking questions that revolved around eating (again, typically dinner). Questions like “How much do I have to eat?” and “Do I have to eat it all?” She soon started showing signs of anxiety around mealtime (mostly dinner), becoming distressed and tearful. We started accommodating this behavior by letting her pick her food and bargaining on the amount she would need to eat before being dismissed from the table. As you can imagine, my anxiety took off. One evening she asked, “Can I eat dinner while we go on a golf cart ride?” This behavior continued to worsen, so I contacted her pediatrician.
The Discovery and Diagnosis
My daughter has always been good at expressing herself and being open with us. Upon asking why she wasn’t eating, she informed us that she was afraid she would eat too much and throw up. I was shocked at this reasoning because she hadn’t vomited in over a year. However, she soon started to associate her fear with the last time she did get sick, which was in the middle of the night, after baking cookies. After talking about this with a friend, she informed me a classmate of my daughter’s had experienced a similar situation. Luckily the mother was willing to talk with me and share about their experience with emetophobia, the fear of throwing up. I had never heard of the term. The mother became such a blessing to us in such a low time. We started a friendship, and she provided me with so much support during our journey, as her daughter was nearing the end of her ERP (Exposure and Response Prevention) journey.
During an evaluation with her pediatrician, we discovered that my daughter was losing weight (weight she couldn’t afford to lose in the first place). Of course, my OCD brain took off and I ruminated about the worst-case scenarios of the possible effects of emetophobia. We made a collaborative decision to begin therapy with a backup plan of starting a low-dose SSRI (Selective Serotonin Reuptake Inhibitor) if we didn’t see improvement.
First Steps and Investigating
My daughter began what I call “talk therapy”, where she would talk about ways to cope with her anxiety, specifically around eating and the fear of throwing up. At the same time, I was doing my own research. I started with a recommended book on how to reduce/eliminate accommodations, Breaking Free of Child Anxiety and OCD: A Scientifically Proven Program for Parents by Eli. R. Lebowitz. It was so informative to understand that making accommodations, while the intent was to comfort my daughter, only made the anxiety worse and started to shrink the world around her. Her fear of throwing up grew from being afraid to eat too much to other situations that might cause vomiting. She didn’t want to sit in the back seat of the car or go on long car rides that might make her car sick. She limited sweets including her favorite, ice cream. She started checking expiration dates and didn’t even want to visit our local fair because of the rides that might make her sick. Once it got to the point of not wanting to go to school, I knew we needed to add on the SSRI because the fear was not only affecting her health but now her everyday functioning.
Beginning to Change
The emetophobia increased her separation anxiety because she feared being away from me and getting sick. I honestly was consumed by this new anxiety that had taken over my daughter’s life (and essentially our whole family). Dr. Lebowitz’s book taught ways parents can positively affect a child’s anxiety, even if the child is reluctant to work on the anxiety. The book includes worksheets to put the suggestions into action. My most valuable takeaway from the book, other than learning that accommodations are more harmful than good, was that to be supportive of my child and her anxiety, I had to show acceptance and confidence. Accepting that I understood her anxiety and confidence she could cope with the anxiety. The most important thing for people to understand about emetophobia, and anxiety in general, is that it is irrational thinking. We could tell my daughter over and over she wasn’t going to throw up, but she wasn’t hearing it. Even if it did provide her with reassurance, she needed to hear it again and again. Reassurance feeds anxiety.
More Resources
Another supportive resource I happened upon is Natasha Daniels, a child therapist who specializes in OCD and anxiety. Her AT Parenting Community includes training courses, podcasts, support group calls, and a forum with direct contact with Natasha. She also has YouTube videos and courses that are directed to children. Natasha provided a high level of support for the many questions I had. It was through Natasha that I first learned the gold standard for emetophobia treatment was exposure and response prevention (ERP). But that was a problem as finding a therapist specializing in ERP with children AND experience treating emetophobia was nearly impossible.
Thankfully, the supportive mother I mentioned, shared Dr. David Russ and Anna Christie’s website, Emetophobia.net. It was through the website that I was able to locate a therapist list for emetophobia therapists. At the time, there was ONE listed in our state. ONE!! I reached out and thankfully the therapist was able to recommend a practice, Indy Child Therapist, LLC. and personally reach out and refer my daughter. Although we were put on a waitlist and would have to do virtual sessions, my hope was beginning to be restored.
While we waited and continued with “talk therapy”, I purchased and read Emetophobia: Understanding and Treating Fear of Vomiting in Children and Adults by Dr. David Russ and Anna Christie and purchased the children’s book by Dr. David Russ, Emetophobia: The Ultimate Kid’s Guide. These two books were life savers. While I learned all about emetophobia, the children’s book explained the phobia to my daughter.
We Did this at Home!
Using their website, we were able to do ERP at home. Luckily my daughter was very open to ERP and I allowed her to be in control of her challenges as recommended by Dr. Russ and Anna. My daughter would agree to do the exposures/challenges and would make the decision when to move forward on the challenge ladder (all outlined on the website). We used a reward system where she would earn tickets for completing exposures and then exchange the tickets for prizes.
By the time my daughter was able to get into the therapist specializing in ERP and emetophobia from Indy Child Therapist, LLC., we had nearly completed her challenge ladder. Her therapist did help us with some higher-level challenges along with preparing us for recovery.
Crisis?
Near the end of my daughter’s ERP, her worst fear happened…she vomited. Would this set us back? Would she panic? All these questions were racing through my mind. Thankfully she handled it well and actually said “I feel like laughing because that wasn’t as bad as I thought it would be!”
There is Hope
My daughter no longer restricts what she eats, she gained more than her weight goal at her pediatrician check-up, her separation anxiety has resolved, and she is thriving once again! I share this to provide awareness and hope to anyone else in a similar situation. Since our journey began, I have had two other families reach out with a child struggling with emetophobia.
As a mother with OCD, I sometimes find myself checking to see if my daughter seems anxious or if she is showing any signs of emetophobia returning. It is easy to catastrophize the worst-case scenario, especially since we started in such a dark place. That’s when I have to remind myself that the realistic goal for treatment of any anxiety is not for the anxiety to be gone, but to be able to manage the anxiety.
Webmaster update: Lauren recently did a podcast about this topic. You can find it here: podcast link
