Emetophobia

Fear of vomiting has a name: emetophobia.  In fact, it has two names; it’s also technically known as “Specific Fear of Vomiting” (or, SPOV), and it is one of many specific phobias (like fear of snakes, fear of heights, etc.)  And, like other specific phobias, it is associated with enormous anxiety, and a level of fear that would generally be considered out of proportion to the feared issue, in this case, vomiting.  Most people find vomiting, or seeing someone vomit, even in the movies, rather disgusting.  But the individual with emetophobia finds it just about unbearable.  The phobia is typically associated with the individual’s fear of vomiting themselves; however, many also fear witnessing someone else vomit, even if it were happening on a screen. 

 Studies on the prevalence of emetophobia vary in their findings, but, overall, estimates range from less than 1% of the population to as much as 8% of the population.  It tends to be more common in females than males. It frequently starts in childhood, with a range of onset between about age 7 and age 15, with an average of about 9 years of age.  Often an experience of seeing someone vomit, or having one’s own particularly unpleasant experience of vomiting, can trigger the development of this disorder.  And while it may initially involve anxiety about a limited range of vomit and nausea-related issues, the individual often becomes increasingly aware of and frightened by nearly everything that could have nausea and/or vomiting as a component, such as:

  • many or most foods – the individual with emetophobia may worry that the food product might be spoiled or, in the case of poultry, undercooked; or they may be apprehensive about a food that they had once felt had caused them nausea or vomiting;

  • crowded places – the individual with emetophobia may worry that someone in the crowd might have a gastrointestinal disorder that might cause that person to vomit, or the individual might worry that someone in the crowd has a gastrointestinal issue that is contagious and might result in the individual with emetophobia getting sick and vomiting;

  • transportation – the individual with emetophobia may worry that a passenger that was, or had been in the recent past, on the particular means of transportation might have a gastrointestinal problem, and that passenger’s germs might still be on some of the vehicle’s surfaces, thus causing the individual with emetophobia to be at risk for becoming ill or vomiting;

  • amusement parks – the individual with emetophobia may worry that someone in the park may experience dizziness after a ride and might then begin to vomit;

  • boats -the individual with emetophobia may worry that the movement of the boat may cause seasickness  for either themselves or someone else on the boat, thus triggering vomiting;

  • restaurants – the individual with emetophobia may worry that another patron of the restaurant might ingest spoiled food and vomit, or someone in the establishment might have a gastrointestinal problem and may vomit; or the individual with emetophobia may vomit from spoiled food or from contagion;

  • bars -the individual with emetophobia may be concerned that someone might become intoxicated and vomit;

  • hospitals and doctors’ offices – the individual with emetophobia may worry that patients in these places may vomit or may transmit an illness that might cause the emetophobic individual to get sick and vomit; etc.

 The list is almost endless. 

 Typically beginning in childhood or adolescence, the phobia often continues to be problematic as the individual enters adulthood.  Left untreated, it can last for decades. Interestingly, despite frequently feeling nauseous and vulnerable to vomiting, it seems that individuals with emetophobia actually don’t vomit any more frequently than individuals without this disorder. 

 Due to the intensity and pervasiveness of the emetophobic’s anxiety, emetophobia therefore tends to involve hypervigilance, fear and apprehension pertaining to everyday situations that might result in exposure to vomit; and, relatedly, substantial avoidance of these same everyday activities, resulting in the individual with emetophobia having a constricted lifestyle.  It can be so debilitating that some children with emetophobia resist going to school, and some women avoid getting pregnant (for fear of morning sickness).

Due to the enormous fear of vomiting, individuals suffering from emetophobia tend to be hypersensitive to bodily sensations that feel like nausea.  While the nausea most likely represents sensations resulting from extreme anxiety, it nonetheless feels like a sensation that may result in vomiting, and thus the individual struggling with this sensation can often become very careful about what they eat.  And, as a result, they may restrict their food intake, and then struggle to maintain their proper weight.  In addition, their restriction of nourishment may lead to significant hunger pangs, headaches and/or lightheadedness.

Therapy for Emetophobia

One element of therapy for emetophobia involves helping the individual recognize which of their thoughts about nausea and vomiting might be irrational.  These might include a presumption that every moment of nausea represent a very real likelihood that they will vomit, or the sense that vomiting and/or witnessing vomiting is something that occurs in everyday life on a very frequent basis, substantially disproportionate to the actual incidence of vomiting.  Some individuals with emetophobia also have the irrational thought that wearing the cleaned attire that they might have worn on a day when they witnessed vomiting will likely result in either that they, or someone else, will vomit.

Treatment for emetophobia can also involve helping the sufferer to understand that their feeling of nausea is likely a result of anxiety, and thus the therapy may involve techniques that help them adjust to the feeling so that it isn’t as frightening.  These techniques may involve teaching the individual various types of relaxation exercises that help to reduce the sensation of nausea.

While these aspects of cognitive behavioral therapy (such as exploring and challenging irrational thinking) might be helpful, they usually aren’t sufficient to ally the chronic worry, and the tendency to avoid potentially vomit-related situations.  Therefore, treatment typically also involves methods to desensitize the individual from their overall anxiety so that they can spend less time being afraid, less time avoiding the things that make them afraid, and more time doing the things that they would enjoy, if only they weren’t so afraid.

 The therapy that provides this desensitizing strategy usually involves exposures; very gradual, customized exposures.  The exposures involve two categories.  One category involves carefully calibrated exposures to the things that they have been avoiding, thus gradually helping them to participate in the life that they have been unable to enjoy, as a result of their fear.  And the other category involves sensitive, gradual exposure to things specifically related to vomit, so that the individual can begin to shed the pervasive fear that haunts their daily life in the first place, and has caused avoidance of things they might otherwise enjoy, in the second place.

Exposure Therapy

Many people who struggle with emetophobia have researched treatment for it and have heard about exposure therapy.  They may have learned that exposure, of one sort or another, to issues and situations associated with vomit and vomiting, is generally the most common and important component in a treatment dealing with the disorder.  Knowing this, many individuals are apprehensive about seeking help for themselves, as the idea of being exposed to anything related to vomit seems like it would be unbearable.

It is important to keep in mind that the therapy can be delivered in a careful, sensitive and very gradual manner.  The exposures can be very mild, almost innocuous. For example, the exposures might simply involve looking at cartoon pictures of cartoon characters who appear to possibly be experiencing a stomach ache.  Or the exposure might involve reading sentences that have a remote or benign allusion to nausea, or might involve walking up to a restaurant and simply reading the menu posted on the window.  The pace of the therapy is conducted in conjunction with the individual, and is guided by what the sufferer feels they can tolerate.  And, quite often, the therapy involves significant others in the individual’s life.  This might include family members (especially parents, when the individual with emetophobia is a child), and other important people in the individual’s life, as a sufferer’s treatment is enhanced by the other people in their life knowing the best ways to interact with them so as to facilitate their progress.

Individuals often wonder what an exposure therapy for emetophobia looks like.  The exposures to the fear tend to be of two types, as mentioned above.  One type involves involves having the individual begin to gradually take part in activities that they have been avoiding. This aspect of the therapy involves designing small, manageable experiences that expose the individual to their fear that they might encounter vomit by having them do something small that they might have ordinarily avoided. For example, if an individual has been avoiding going to restaurants, the therapy might start with them looking at a menu, displayed outside the restaurant, and then walking way.  Once doing that elicits no anxiety (and it might take several trips to the restaurant before that happens) they then might go into the restaurant and ask to look at the menu.  Once doing that does not elicit any anxiety, they then might go to the restaurant and be seated, and have a glass of water, and then leave, and so forth. 

Helping an individual to resume the everyday experience of going to restaurants can be painstakingly slow for some individuals, and faster for others, keeping in mind that the exposures are customized to meet the particular needs of each individual. Ultimately, such as in the case of going to restaurants, diminishment in anxiety will demonstrate to the sufferer that they can manage their fear; and will also demonstrate that the likelihood of disaster (exposure to actual vomit) is actually pretty small. And, too, the pleasure associated with an enjoyable restaurant experience (good food, nice ambience, pleasant wait staff) might distract the sufferer from whatever remaining anxiety they may have, and may ideally override the restaurant-related anxiety, such that going to restaurants will seem more like a fun thing to do, and less like a dangerous thing that needs to be avoided. This sort of exposure helps the individual reengage, or develop, a more normal lifestyle that incorporates the sorts of activities that people tend to pursue and enjoy, activities that an individual with emetophobia would enjoy, if only they weren’t so frightened.

While one aspect of the exposure therapy part of the treatment involves gradual involvement in everyday activities that were once avoided, the other aspect involves exposures to things that might not occur in everyday life.  This part involves strategically-designed exposures to aspects of vomiting that don’t typically happen in the normal course of a day.  That is, specific exposures to nausea and vomit-related situations that the individual is frightened about, but that they may never have to encounter.  A relatively low-level example of this sort of exposure might involve reading words that are used to depict vomit (such as reading the words “barf” or “upchuck”) or looking at cartoon pictures of cartoon characters looking nauseous.  They may, eventually, once the individual feels ready, build up to looking at photographs of nauseous human beings, and, eventually, once the individual is ready, viewing videos of people who are vomiting.  It can’t be emphasized enough that the treatment can be orchestrated to move along at a pace that the client and the therapist, together, determine to pursue.  This aspect of an exposure therapy works by desensitizing the individual to vomit-related issues, helps the individual to learn that they can have exposure to vomit-related situations and manage their anxiety to the point of hardly feeling any anxiety at all.  This helps the individual to learn that it is not necessary to live in terror, constantly anticipating the prospect of seeing or experiencing vomit.

An analogy to exposure strategies might be what happens when someone goes to a swimming pool.  When a person first enters the pool, the water feels unpleasantly cold; but, with time, the water feels comfortable.  We know that the temperature of the water doesn’t change; but, instead, the individual’s brain and body adapt to the temperature.  By exposing their body to the water in the swimming pool, the person is desensitized from experiencing the water as unpleasantly cold.

Actually, many adults don’t immerse themselves into the water in a swimming pool right off the bat.  They may start by dipping their feet in the water, gradually permitting themselves to feel comfortable with that.  Then they may slap some water on their arms and face; and, when that seems to be bearable, gradually, they may enter the water, until, with time, their whole body is immersed.  This exemplifies gradual exposure to the situation of dealing with what, in the absence of gradual exposure, is anticipated to produce a very uncomfortable chill. When someone does this gradual entry into the swimming pool often enough, they begin to think of the unpleasantly cold water in a swimming pool as something that they can quickly learn to tolerate, and, with time, enjoy.  And, eventually, they may think of going to a swimming pool as something that is thoroughly fun, and not something to feel a little apprehensive about.

Another analogy might involve driving a car.  Everyone knows that a car ride might result in a car accident in which someone might get hurt or die.  And many people who embark on the experience of learning to drive (and many of their parents) feel apprehensive about the prospect of taking on an activity that has the potential to result in injury or death.  Obviously, there is often anxiety associated with the process of learning to drive.  But, once an individual has learned to drive, they may still be worried that driving may result in a car accident.  However, over time, with enough exposures to driving the car, they (and their parents) begin to desensitize from the fear, until, eventually, it doesn’t occur to anyone that there is something to fear when they embark on a drive.

And so, similarly, with the person who struggles with emetophobia.  Taking part in a restaurant experience a little at a time, knowing that there is the risk of some sort of vomit event, can result, over time, in the realization that while a vomit event could happen, it probably won’t, and that it’s worth it to take the risk to go to the restaurant and have an enjoyable experience.  And, furthermore, permitting exposures to all manner of vomit-related situations (e.g., pictures and videos pertaining to vomit), over time, can desensitize the individual to the pervasive terror of vomit, until, eventually, vomit represents something that may be disgusting, but not something that is dangerous.

The website www.emetophobia.net was put together by Anna Christie and David Russ and,  along with offering a variety of types of information about emetophobia, it also provides a hierarchy of exposures that can be used by clinicians who work with individuals with emetophobia, or can be used as a self-help device by the sufferers themselves. This website can provide someone considering therapy an opportunity to get a sense of what an exposure therapy might look like, remembering that each therapy is individualized, and therefore unique.

Anna Christie, one of the individuals who created www.emetophobia.net, is a former sufferer (turned clinician) who achieved success through treatments that she undertook for herself, including the use of exposure therapy.   You can read about her and her inspirational journey to achieving an essentially emetophobia-free existence on her own website, www.emetophobiahelp.org.  

There are additional aspects of a treatment for emetophobia that a therapist might incorporate into the therapy.  These might include developing and pursuing simulations of the vomit experience (e.g., pretending to vomit by spitting out pea soup or watery oatmeal into a toilet).  A simulation can start with a doll doing the pretend vomiting before moving on to the individual doing so. It may start with watching the therapist do the simulation first, before the individual with emetophobia does it. 

Treatment for emetophobia might also involve the use of EMDR (eye movement desensitization and reprocessing), one of the trauma treatments that might be used in association with an individual’s traumatically-experienced episode(s) of a vomit-related situation that seemed to have set off the development of their emetophobia.

Additional Resources:

Books:

The following are books that either capture a sufferer’s (and often, also, their loved ones’) experience of emetophobia and/or describes therapeutic approaches that help to diminish the phobia.

Books Primarily for Adults:

Cicciatore, Micheline.  (2018) When a Child’s Anxiety Takes Over: A Mother’s Struggle to Save her Child From Emetophobia.

Goodman, Ken. (2020) The Emetophobia Manual: Free Yourself From The Fear Of Vomit and Reclaim Your Life.

(There are webinars and podcasts featuring Ken Goodman discussing emetophobia.  These can be accessed on the Anxiety and Depression Association of American website ADAA.org.)

Keyes, Alexandra and Veale, David. (2022) Free Yourself from Emetophobia.

Lovitz, Dara and Yusko, David.  (2021) Gag Reflections: Conquering a Fear of Vomit Through Exposure Therapy.

Russ, David and Christie, Anna.  (2023) Emetophobia: Understanding and Treating Fear of Vomiting in Children and Adults.

Watkins, Samantha. (2018) Scared to be Sick: A self-help workbook for Emetophobia.

Books Primarily for Children:

Carlson, Nancy. (2014) Sometimes You Barf.

Huebner, Dawn. (2022) Facing Mighty Fears About Throwing Up.

Neely, Erin. (2022) Emetophobia: An ERP Activity Book

Roche, Jaime. (2023) Tummy Troubles.

Russ, David.  (2022) Emetophobia: The Ultimate Kids Guide. (At the time of this writing, this book is only available on kindle.)

Telgemeir, Raina. (2019) Guts.