What Is Emetophobia and How Does It Develop?

Emetophobia is classified as a specific phobia of vomiting and involves significant fear/anxiety related to vomiting-related cues, such as feeling nauseous, seeing or hearing others vomit, and the experience of vomiting. The fear associated with emetophobia is persistent and must last for at least six months in order to be diagnosed as a specific phobia. While the act of vomiting is aversive for everyone, people with emetophobia experience a more extreme fear/anxiety that is out of proportion to the situation. Consequently, they will exert great efforts to avoid encountering cues that are related to or that would remind them of vomiting. The fear/anxiety associated with emetophobia causes significant distress and/or functional impairments in important life areas, such as health, relationships, and work/school.

Emetophobia may present as a standalone diagnosis, but often occurs along with other conditions, such as Obsessive-Compulsive Disorder (OCD), Illness Anxiety Disorder, Panic Disorder, Social Anxiety Disorder, and Avoidant-Restrictive Food Intake Disorder (ARFID). The age of onset for emetophobia typically occurs in childhood or early adolescence, but it may persist and/or become problematic during adulthood. People who have emetophobia have often experienced a significant vomiting incident (food poisoning, stomach flu, etc.), which triggered the onset of their phobia.

Specific phobias, including emetophobia develop in response to a trigger. The trigger may be experienced in a visual, auditory, olfactory (smell), or gustatory (taste) way and may create unpleasant bodily sensations. The person interprets the trigger as threatening or harmful to a degree that is out of proportion with the actual situation/experience. Situations that are interpreted as dangerous provoke an extreme degree of fear/anxiety, which causes the person to engage in avoidant methods of coping. Avoiding the trigger reinforces the fear surrounding it and generally increases the person’s efforts to distance himself/herself from all related triggers. Avoiding and exerting efforts to prevent contact with one’s triggers preserves the fear and blocks the person’s chances of having a corrective experience, which would enable him/her to learn that the situation is not as probable and/or as difficult as anticipated. Avoidance precludes new learning from taking place and therefore, the misinterpretation of threat never has a chance to be corrected. Please see our previous blog entry – Understanding the Cycle of Anxiety – for more information about the anxiety cycle.

Emetophobia Anxiety Cycle:

Symptoms of emetophobia include, but are not limited to:

• Fear of seeing and/or hearing others vomit
• Worries/fear of vomiting
• Anxiety about experiencing physical sensations associated with vomiting (feeling full, stomachaches, nausea, etc.)
• Worries about experiencing uncontrolled vomiting
• Fears about not being able to find a bathroom in time, if feeling ill
• Worries about vomiting in public and feeling embarrassed

In response to these symptoms, people implement various avoidance strategies in attempts to create distance between themselves and their triggers. Such behaviors may include, but are not limited to:

• Avoiding situations where vomiting could occur (driving/flying (motion sickness), amusement park rides that spin or loop, exercise, eating in restaurants, etc.)
• Restricting/limiting new and/or certain foods due to concerns that consumption will lead to vomiting or cause an upset stomach
• Avoiding foods that have caused vomiting in the past
• Excessive checking of food labels to determine if the ingredients are “safe” and won’t cause gastrointestinal distress
• Excessive checking of expiration dates on packaged foods
• Overcooking foods to kill dangerous pathogens
• Eating small amounts of food to avoid feelings of fullness
• Bringing anti-nausea medication, mints, ginger ale, water, crackers, antacids, etc. when out of the house in case of nausea/vomiting and/or taking these things preemptively
• Avoiding taking medications that list nausea as a possible side effect
• Avoiding social situations that involve eating
• Avoiding public places associated with eating (coffee houses, bars, restaurants, cafeterias, mall food courts, work break rooms, etc.)
• Scanning the body for physical sensations associated with vomiting and closely monitoring those body symptoms
• Avoiding people who have recently been sick and/or appear unwell
• Avoiding places where there are sick people (doctor’s offices, the school nurse, hospitals, etc.)
• Avoiding watching tv shows or movies in which there is a vomiting scene
• Avoiding things perceived as dirty or gross so that the smell/germs does not provoke nausea/vomiting
• Avoiding dental appointments due to concerns about the gag reflex being triggered

How Is Emetophobia Treated?

Exposure and Response Prevention (ERP) treatment is the gold standard therapy for treating Emetophobia (as well as other types of Specific Phobias). ERP targets the avoidance behaviors that maintain the fear and facilitates a corrective experience, whereby the association between previous triggers and fear/anxiety is lessened. Exposure work for emetophobia will incorporate imaginal, interoceptive, and in vivo interventions. Please see our previous blog entry – Exposure and Response Prevention (ERP) – for more information on ERP.

Individuals with emetophobia may not only fear the feeling of nausea but they may also experience it on a regular basis. Anxiety can cause multiple types of physical symptoms, and abdominal distress (indigestion, nausea, stomach pain) is a commonly reported symptom associated with anxiety. Please see our previous blog entry – The Deconstruction of a Panic Attack – for more information. Once the fear of vomiting is present, hypervigilance about stomach activity typically ensues. The person becomes hypervigilant of his/her stomach sensations in an attempt to circumvent any uncomfortable symptoms before they lead to the feared outcome of vomiting. The anxiety that the person feels about uncomfortable gastrointestinal symptoms can intensify feelings of nausea. Thus, one objective of the treatment process is to reduce the person’s focus on and reactivity to uncomfortable stomach sensations. ERP treatment is intended to help the person better tolerate such physical symptoms and to recognize that although the symptoms might be unpleasant, it is not inevitable that they will lead to vomiting. While anxiety inflates the perception of vomiting risks, vomiting is generally far less likely to occur than what the person is predicting.

A special consideration for emetophobia treatment is that individuals with this phobia believe that if they take the proper precautions, they can prevent their fear of vomiting from happening. This perception of control is not as likely to be seen in other phobias, such as fears of needles, storms, clowns, etc. The belief that the person holds about his/her ability to manage gastrointestinal symptoms reinforces the likelihood that he/she will continue to take precautions, such as scrutinizing food labels, avoiding certain foods, preemptively using anti-nausea medication, etc. Since the person has come to believe that his/her avoidance behaviors have prevented vomiting incidents, there will be resistance to discontinuing those behaviors. Thus, Response Prevention methods are a critical part of the treatment process for emetophobia. The avoidance behaviors performed to “prevent” vomiting must be phased out in order for corrective learning to occur and for the fear to be dismantled. The avoidance behaviors associated with emetophobia tend to be performed under duress, are time-consuming, and can significantly limit the person’s functioning in important life areas. Therefore, another objective of treatment is to begin or resume activities (traveling, socializing, eating, etc.) that are of value to the person and that will enhance his/her quality of life.

Need Help or Support?

If you or a loved one are struggling with an anxiety disorder, OCD or any other mental health concerns, know that you are not alone. If you are a parent or a caregiver and are seeking additional information about these diagnoses and how you can best support your child, our office provides parent training with the SPACE program. Please see previous blog entry – SPACE- Supporting Parenting for Anxious Childhood Emotions — for more information on SPACE.

To seek help for these or any other mental health concerns, please contact The OCD & Anxiety Center at (630) 522-3124 or info@theocdandanxietycenter.com. We have offices located in Oak Brook and Orland Park, Illinois and in Marietta, Georgia that specialize in helping individuals overcome anxiety disorders, Obsessive-Compulsive Disorder, and other co-occurring mental health conditions. We provide telehealth services that are available in Illinois, Indiana, Iowa, and Georgia.

At The OCD and Anxiety Center, we can provide treatment both in the office and at off-site locations (your home, mall, school, etc.). We will work closely with you to create an individualized treatment plan and discuss the appropriate frequency of appointments (once a week or more, if needed). We look forward to working with you!

Dr. Ashley Butterfield is a licensed psychologist at The OCD & Anxiety Center in Oak Brook, IL.  She specializes in Cognitive Behavioral Therapy and Exposure and Response Prevention Therapy for anxiety, OCD, and anxiety-related disorders. She is comfortable working with children and adults and is able to provide treatment both in the office and outside of the office, wherever anxiety happens.