The fear of vomiting, or emetophobia is one of the most often treated phobias at the OC Anxiety Center. Many people are surprised by its frequency and its devastating effects. It stops people from attending work and school, makes people avoid driving and traveling, and prevents individuals from attending social gatherings. Its affects can vary significantly, can occur at any age and last for a lifetime unless treated.
Very often people are able to work around other phobias: avoiding giving a speech, flying on an airplane or staying away from dogs can be somewhat feasible. However, emetophobia, similar to panic disorder, is a fear of a body response: it’s hard to avoid one’s own body.
There are different fears in vomiting: the heaving sensation, the smell, the sight and the sound in the moment are common. Other concerns are related to becoming ill: being around sick individuals (is the illness is likely to lead to vomiting), touching items that someone else has touched who was sick. These symptoms often lead to a misdiagnosis of Obsessive Compulsive Disorder (OCD); a thorough differential diagnosis must be completed to ensure correct treatment. Additional symptoms can include avoidance of certain types of food (raw vegetables like salads, raw meats like sushi, or “undercooked” foods like a medium rare steak). Behaviors can include excessive handwashing, resisting touching individuals who look ‘dirty’ or may be ill, avoidance of certain foods or restaurants, and demand specific food preparations are made. Individuals with a fear of vomiting may also avoid parties where there is drinking and activities that may lead to excessive body movement, like exercise, roller coasters, or even the possibility of motion sickness. Very often there is anticipatory anxiety of these events, leading to difficulty sleeping and focusing in adults to crying and tantrums in children (as well as adults, honestly).
Gratefully, the treatment for emetophobia is straightforward, brief and efficacious. Here at the OC Anxiety Center, we utilize a 10 session protocol, which can be completed in as short as five days. We employ empirically supported treatment protocols, focusing on Cognitive Behavioral Therapy (CBT) with an emphasis on Exposure and Response Prevention (ERP). The goal is to help individuals understand how and why we vomit (psychoeducation), followed by cognitive challenging (changing underlying thinking patterns from irrational emotional fears to logical likely outcomes), and finally normalizing strong emotional and physiological responses by engaging in systematic desensitization (exposure). This includes interoceptive exposure (normalizing feeling dizzy, having a rapid heartbeat, and a full stomach), as well as visual, audio and olfactory cues associated with vomit. We are always willing and often engage in the exposures with our patients in session before assigning it as homework, including vomiting with our patients as necessary. We never ask our patients to do something we wouldn’t do ourselves.
The treatment is very effective if the individual is motivated to change (much like weight loss), but requires the correct methodology, correctly applied by a skilled clinician. We have also found at our clinic specifically (and backed by research in the field generally) that this treatment can be applied both in person and virtually. If you or someone you know is suffering from emetophobia, please feel free to contact us directly at 949-689-5892.