Phobias of vomiting are not unusual, but can be debilitating. In extreme forms, emetophobia can lead to someone becoming agoraphobic; feeling paralyzed with fear to leave their homes, be around other people, or take care of their children. Despite all of this fear, people with emetophobia rarely throw up.
It’s unclear exactly what causes some people to develop emetophobia, but here is how it is believed to be maintained:
1. First, there is a trigger
- Feeling nauseous, even very low levels
- People who are ill (“…because I might get sick from them and throw up”)
- Certain types of food (“…because it might make me vomit”)
- Eating food prepared by others or at certain restaurants (“I might get food poisoning and throw up”)
- Hearing or seeing certain words/phrases (“throw up, vomit, puke, spew, blow chunks, upchuck, pray to the porcelain God, lose your lunch, queasy, nauseous, dry heaves, and so on”)
- Dentist appointments (“I might gag and throw up”)
- Hospital or doctor’s offices (“I’ll catch a stomach bug and then throw up”)
- Watching someone vomit
- Spinning
- Vomit scenes in movies or television
- Smelling or cleaning up vomit
2. The triggers activate certain thoughts and beliefs.
- “I’ll lose control”
- “I’ll panic”
- “I’ll choke”
- “I’ll go crazy”
- “I’ll die”
- “I won’t be able to cope”
- “The misery will last forever”
- “The vomiting will go on and on”
3. The above thoughts and beliefs trigger intense feelings of anxiety, uncertainty, and dread which feels extremely unpleasant.
4. The person with emetophobia, in order to feel better and to prevent the catastrophic beliefs from coming true, uses avoidance and safety behaviors.
- Avoid doctor/dentist appointments
- Avoid needed surgical procedures (because of anesthesia possibly causing vomiting)
- Avoid certain foods/restaurants
- Avoid people or places where they believe they may pick up germs
- Carry anti-emetics (medicines to prevent vomiting) at all times, maybe take them preemptively
- Make spouse in charge of taking care of sick children, cleaning up vomit, etc
- Change the channel if vomiting scene comes on
- Go to movie only after reassurance of zero vomiting scenes (or cover face during that scene)
- At amusement parks, stick to the “safe rides” that don’t spin
- Needless to say, avoid vomiting at all costs
5. The person does not vomit and they attribute this to the avoidances and safety behaviors. Given their catastrophic beliefs, it feels as if they narrowly dodged a very dangerous bullet. They are then more likely to continue with the avoidances and safety behaviors.
6. This keeps them from learning that life would be ok even if they faced their fears. They would learn, in fact, that their catastrophic predictions do not come true. They would learn that they can face their fears and see that everything will be alright.
Treatment for emetophobia involves Cognitive-Behavioral Therapy with an emphasis on Exposure with Response Prevention (ERP). It involves setting up a hierarchy of feared situations and facing fears, starting with the easier items and working up. While this treatment is challenging, it can be quite effective.
If you have emetophobia, you are not alone. It is a real and serious disorder that has a specific and effective treatment.
Eric Goodman, Ph.D.