In the midst of flu season, it may be helpful to explore a lesser known phobia related to sickness and vomiting. This phobia, emetophobia, is described as an irrational fear of vomiting. It may also include a fear of feeling nauseous, seeing someone vomit, hearing vomiting, smelling vomit, or seeing vomit itself. Emetophobia is classified as a specific phobia (other type) in the DSM-5, and is experienced by around 7% of women and 2% of men. While the onset of this phobia can occur at any age, it mainly arises in early childhood, is most likely addressed in late puberty, and those with genetic predispositions for anxiety in general may be at risk of experiencing emetophobia. Though it is not a widely discussed or well-known phobia, this condition can cause debilitating social, emotional and physical symptoms for individuals and causes significant impairment to the quality of life of those who suffer with it.
Beating the Stigma
Because the condition is understudied and not very well-known, emetophobia has the tendency to be viewed as a trivial, mild type of phobia. In fact, not much is known about its exact prevalence in the general population or how the phobia manifests. However, it is the case with emetophobia (as well as other phobias) that symptoms may start out small (discomfort at the sight of vomit), then fester and grow until the fear governs a person’s life (hearing the word ‘vomit’ can send them into a panic).
Having a fear of vomiting does not sound like it would be a very debilitating condition. Who is actually getting sick to the point that they feel the need to vomit often? Well, it is not just the sight or smell of vomit that triggers fear in those who suffer with the phobia. Those with emetophobia suffer from constant anxiety and may even anticipate that a bad case of food poisoning or air-borne virus can induce a vomiting-related illness at any moment. This creates a persistent state of fear and worry for these individuals, and the fear of not knowing when they might be in the presence of vomit is sometimes even worse than the act.
Some behaviors that you might not have associated with emetophobia include:
- Avoiding TV shows that may depict scenes with vomit, gagging, or toilets
- Restricted eating
- Refusing to eat in restaurants
- Refusing to eat in others’ houses in fear of expired ingredients
- Compulsively checking food ingredients
- Overcooking food to kill germs
- Avoid getting pregnant in fear of morning sickness
- Avoiding having children in fear of having to clean up their vomit
- Having to clean the bathrooms constantly in fear that they might smell like vomit
- Avoiding public places in fear of catching an illness that will cause them to vomit
- Compulsively washing their hands
- Cleaning the house for hours in fear of germs
- Rarely leaving the house because of unknown germs
- Avoiding alcohol
- Avoid bars/people who drink
- Avoid boats/cars/planes because of potential motion sickness
From these examples alone, it is clear to see that those who suffer from emetophobia are affected in all areas of their lives almost daily. It is not just a condition that might bother individuals when flu season comes around or during a wild night out. Rather, emetophobia can be an everyday burden that only gets worse when people take further and further precautions to shield themselves from the potential of being around vomit.
Symptoms and Impact
Individuals with emetophobia may avoid social situations and prevent themselves from experiencing common life experiences in fear that they might throw up or see someone throw up. The thought of vomit can bring individuals to such states of anxiety and fear that they begin to feel nauseous — making the situation even worse. Nausea can trigger emetophobia to worsen, and lead people to misinterpret their nausea as a sign that they will throw up when they actually won’t.
- Anxiety upon hearing words like “vomit”, “throw up”, or “barf”
- Experiencing intrusive images of themselves throwing up or seeing throw up itself
- Running away, crying, screaming, or even passing out when someone around them vomits
- Spending excessive amounts of time planning how to avoid being sick
- Thinking about how to escape a situation
- Scanning all public places for where the restroom is
- Avoiding people who cough or appear sick
- Even the appearance of a pale face may be triggering
- Avoidance of public restrooms
- Inability to eat foods that have previously made them or someone they know vomit
- Avoidance of “risky” foods
- Becoming underweight or malnourished due to restrive eating
- Avoiding watching a show that might depict or include vomit
“Attention” or “Thought” symptoms:
- Self-focused behavior in the sense of checking themselves constantly for illness
- Being on constant alert about their surroundings
- Thoughts of worse case scenarios
- For example, a never-ending case of vomiting in which they lose control forever
- Thoughts of others finding them repulsive or disgusting if they do vomit
Those with emetophobia may concurrently experience other disorders or phobias such as social anxiety, agoraphobia, obsessive-compulsive disorder, and illness anxiety disorder. Since the fear of vomit or being around vomit involves being around other people or being in public, it is common for emetophobics to ignore these spaces and other people for extra precaution. Additionally, individuals with an internal locus of control may also struggle more with phobias such as emetophobia. This is because these individuals believe that the outcomes of actions are a result of their own doing; therefore, because they cannot control when or where they might vomit, the phobia manifests. The restrictive complications associated with this phobia can become so severe that individuals may not be able to work properly or hold a job in a public work space, travel in any capacity, be alone with children or sick individuals, or even achieve any of their personal goals.
Of course, many of those who struggle with emetophobia are aware that their fear of vomit is irrational and debilitating. Many are unable to lead normal lives as a result of the condition, and this is where treatment and active coping strategies can be extremely helpful in reducing many of its symptoms.
Cognitive-Behavioral Therapy (CBT)
Cognitive-behavioral therapy, or CBT, is a type of talk therapy that aims to change the way that people think, to change maladaptive thoughts and behaviors into adaptive ones. It involves an unlimited number of sessions in which a counselor and a patient talk through the patient’s thoughts in a structured way. Essentially, its goal is to look at the root causes of distorted thinking patterns and change them accordingly. A 2017 study reported that CBT is a widely accessed mental health intervention and has been used by around 57% of patients, with a success rate of 50-75% for reducing symptoms of social anxiety. In the context of emetophobia, CBT may be a great tool for helping individuals rewire their thought processes surrounding vomit and reduce their avoidance toward people and social environments in which vomit may be present.
Exposure and Response Prevention (ERP)
A common behavior therapy usually targeted toward OCD, exposure and response therapy (ERP) exposes patients to situations that provoke their phobias in a gradual manner and in a safe environment. During ERP, patients are slowly exposed to triggering situations with the goal of creating coping skills that help them tolerate that situation. For example, a person with emetophobia might be asked to watch a video of someone vomiting. They are put in a situation in which they are made to feel anxiety, but anxiety that they can tolerate. After some time, they will be able to watch the video of someone throwing up and not feel so anxious. Patients will move on to more difficult exposure situations, and so on. The aim of ERP is to help patients tolerate triggering situations and surroundings with coping skills and repeated exposure to make it less daunting.
Typically, specific phobias like emetophobia can be successfully treated with psychotherapy and behavioral therapy like those mentioned above. There are currently no specific medical treatments for the condition, but for more intense cases of emetophobia, selective serotonin reuptake inhibitors (SSRIs) may be prescribed as a supplement alongside therapy to lower the anxiety associated with the phobia.