By: Jaclyn Rink, MSCP, LLP

If you have never heard of Emetophobia before, quite simply, it’s a big word that can be defined as the fear of vomiting. However, how it shows up for most individuals can often be the opposite of simple. Emetophobia can go as far as to cause nutritional deficits, avoidance of social gatherings, school refusal, somatic issues, and obsessive behaviors around health and wellness for both the individual and those around them. You may be thinking, “Well, yeah.. no one likes throwing up,” and although this is a universal truth, people with emetophobia dislike it so much that it becomes an intense fear that rules their day-to-day life and interactions.

Where does it come from? Most people who are diagnosed with emetophobia have a history of a (perceived) overly negative experience with vomiting. It can be related to an incident that happened personally or acquired vicariously. This bad experience is subjective to the individual and could be due to a time when they threw up in public, had norovirus for 5 days, vomited after eating their favorite food, were mistreated by someone while they were sick, or watched a parent throw up while receiving chemotherapy, etc.

People with emetophobia present with a hypervigilance of both internal and external stimuli that are linked to vomiting or sickness (e.g., nausea, a friend mentioning they don’t feel well, being in a theme park, eating a rare steak). Its cognitive roots are based on the illusion of control, as the individual feels like they have mastery over both their own bodily functions and the actions of others. Avoidance behaviors are falsely reinforced, as they begin to believe that their protective efforts are what have been successful for prevention. This, however, is a façade, since vomiting is a normal, necessary, bodily process completely out of our control. For example, Someone vomits after eating a cheese stick. They removed all dairy from their diet and have not been sick since. They now believe ( and have proven to themselves) that they must continue to avoid dairy if they don’t want to throw up, ignoring that there could have been many other reasons why they threw up after eating the cheese stick.

Many people who suffer from emetophobia have a comorbid psychiatric disorder, such as OCD or generalized anxiety, with an average onset age of 9.2 years. The prevalence of emetophobia is higher in females (almost double that of males). There is also a high correlation between emetophobia and those who have had significant childhood medical incidents. Those who struggle with emetophobia have an increased risk of developing certain eating disorders (such as ARFID) due to the avoidant and restrictive eating behaviors associated with the phobia.

What to do? Just like other phobias, the individual who struggles with emetophobia can’t just reason or logically talk themselves out of their fear. Phobias hijack the nervous system, causing both physical and mental symptoms that are associated with a threatening situation (real or not). Many people who struggle with phobias experience panic-attack-like symptoms such as racing heart rate, slowed digestion, sweating, difficulty breathing, dizziness etc. When you stop to think about it, what are the key symptoms that someone experiences right before they throw up? Dizziness, sweating, stomachaches, and rapid heart rate. So, emetophobia is incredibly sticky and challenging to treat because it is inherently self-reinforcing.

The way we treat emetophobia is through a very structured exposure and response prevention plan (ERP) that involves participating in hierarchal exposures to feared stimuli and situations, paired with ongoing support from your therapist. Most treatment involves dual exposures of seeing/hearing others vomit, as well as tolerating one’s own internal feelings and sensations associated with vomiting. Repeated exposures to these feared stimuli help to slowly rewire the brain by decreasing hypervigilance to both external and internal cues, and attaching a new (and safer) meaning to these feelings and thoughts. ERP therapy helps the individual take back control over their life and decrease the intensity of their symptoms.

At MFS, our staff is trained in the treatment of emetophobia and its comorbid disorders such as OCD, ARFID and GAD. If you or your loved ones are struggling with this phobia, please reach out to us at 734-416-9098

References: Emetophobia: Understanding and treating fear of vomiting in children and adults; Dr. David Russ and Anna Christie.