No one likes being sick, but for people with emetophobia, vomiting can also be a source of incredible distress. A type of anxiety disorder, emetophobia is characterised by an extreme fear of vomiting, including feeling sick, seeing someone else being sick and seeing vomit.
Despite being one of the most common phobias in the UK, there is very little understanding about the disorder. People with emetophobia often go out of their way to avoid situations where they or someone else might throw up, which can have a huge impact on their day-to-day life.
We spoke to Chartered Psychologist Professor Kevin Gournay CBE, and Pablo Vandenabeele, Clinical Director for mental health at Bupa UK Insurance, about the fear of vomiting – including diagnosis, treatment, and how to manage the phobia:
What is a emetophobia?
Emetophobia is an extreme fear of being sick or seeing others vomiting. 'Most people dislike vomiting – however, this is something that can be controlled and is often limited to a certain moment in time,' says Vandenabeele. 'Emetophobia is more than just a dislike of vomiting. If you suffer with this phobia, you may experience a fear of vomiting, and this can cause you a significant amount of distress, anxiety and worry.'
By definition, a phobia is 'an extreme or irrational fear of or aversion to something'. This could be a certain object – bird feathers, for example – or a situation, such as flying or crowded spaces. Phobias are a type of anxiety disorder, and cause intense fear, distress and suffering for the person experiencing it. A fear becomes a phobia when it interferes with your life.
'Most of us have fears,' says Professor Gournay, 'lots of people don't like spiders or high places – but it only becomes a phobia once it interferes with your life. There's a continuum, with normal fear at one end of the spectrum and a clinically-significant phobia that requires treatment at the other. There are also people in-between that, who have an exaggerated – but not clinically severe – fear.'
Each emetophobia condition is unique, and behaviours can vary from person-to-person, says Vandenabeel. Some people may focus more on themselves – for example, persistent thoughts about a past experience of vomit, or excessive worry about not being able to stop throwing up – while others may be more fearful of their reaction to others' sickness, such as being unable to leave a crowded area if someone vomits.
'One of the main behaviours of emetophobia is taking significant steps to reduce the likelihood of being in a situation where vomit may occur,' Vandenabeel says. 'However, these steps can affect your everyday life – for example, taking extreme steps to avoid catching a sickness bug. This type of behaviour is also known as avoidance behaviour.'
The key symptoms and behaviours associated with emetophobia include:
Restricting your diet to only eat 'safe' foods thought to be less likely to cause vomiting or nausea.
Avoiding the consumption of alcohol, including bars and parties where large amounts of alcohol will be consumed by others.
Avoiding taking medication that could cause nausea.
Avoiding becoming pregnant, due to the possibility of morning sickness, or looking after children, in case they pass on germs that lead to illness.
Difficulty breathing, a tight chest and rapid heartbeat at the thought of vomit, sometimes leading to a panic attack.Avoiding 'germy' shared surfaces, such as doorknobs, toilets and handrails.
Excessive hand-washing and cleaning of food when preparing meals.
Checking for signs of illness in others and avoiding hospitals or those that may be ill.
Avoiding travel for work, school and social activities, along with public transport and crowded public spaces.
Becoming distressed by words associated with vomit e.g. 'puke' or 'throw up'.
Avoiding programmes or movies that involve vomiting.
On a rational level, people with emetophobia understand that vomiting isn't life-threatening and won't cause long-term physical harm. But this often makes the experience all the more distressing and can lead to feelings of shame. 'The ongoing stress and worry caused by emetophobia can have a big impact on your daily life,' Vandenabeel says.
Emetophobia avoidance behaviours
The avoidance behaviours associated with emetophobia can lead to other mental health conditions, such as anxiety. 'Over time, these habits can lead to social anxiety or agoraphobia – the fear of being in situations where it may be difficult to leave if things go wrong – as sufferers remove themselves from social situations to feel in control,' says Vandenabeel.
People with emetophobia are also more likely to engage in obsessive behaviours, such as compulsive hand-washing and dietary restriction. 'This behaviour can become obsessive to the point where a diet becomes extremely restrictive or eating until feeling full is avoided – leading to the possibility of developing tendencies of an eating disorder,' he says.
Phobias often develop after a traumatic experience, says Vandenabeel. 'In the case of emetophobia, this may be because someone has experienced vomiting in public, suffered from bad food poisoning, watched another person vomit or having another person vomit on them,' he says.
Some adults that have lived with emetophobia for many years may not remember the experience that triggered their phobia, Vandenabeel continues. But the condition can also begin spontaneously without a clear cause. This usually happens during childhood, rather than adulthood.
Emetophobia is diagnosed when the fear of sickness begins to affect home, school, work and social life, says Vandenabeel. It's usually diagnosed by a mental health professional with the below criteria:
Excessive fear and anxiety response when triggered by vomit.
Displays of avoidance behaviour, such as excessive washing of hands or avoiding those that may be ill.
Steps taken to avoid catching a bug or avoid situations where there may be vomit are having a negative impact on day-to-day life.
Fear of vomit has not developed as a behaviour to cope with another phobia.
Experiencing symptoms for at least six months.
If you are experiencing any of these symptoms, it's important you contact your GP to discuss the treatment options available to you, Vandenabeel says. It doesn't matter if you can't pinpoint a specific experience that led to the phobia developing. You don't need to know the root cause of emetophobia to effectively treat it.
The most effective treatment for emetophobia is cognitive behaviour therapy (CBT). It's a form of talking therapy that can help to treat emetophobia 'by challenging and changing the way you think,' says Vandenabeel. 'CBT is based on the idea that your thoughts, feelings, physical symptoms and behaviours are all linked.'
As well as allowing you to identify any negative behavioural patterns, 'CBT also helps you to deal with overwhelming problems by breaking them down into smaller parts in a positive way,' he continues. 'To treat emetophobia, over time you will gradually be exposed to the fear of vomit with your therapist and learn new ways to cope with your fear and anxiety.'
Exposure therapy is also another treatment option for emetophobia, and involves progressive exposure to the source of your phobia over time, e.g. introducing certain foods into your diet. 'People often respond quite well to exposure by looking at video clips on the internet of people being sick,' adds Professor Gournay. 'That sometimes helps because the person can get used to the idea. It helps reduce the level of negative emotions attached.'
Emetophobia management advice
To learn to manage and hopefully overcome emetophobia, it may help if you develop self-help strategies as well as seeking therapy. The more you can do to help yourself overcome feelings of distress, the more in control of the condition you will feel. Try the following:
✔️ Talk to a friend
Confide in someone you trust – opening up to someone can help you feel less isolated.
✔️ Learn how to de-stress
Learn relaxation and mindfulness techniques to manage feelings of panic and anxiety. Meditation, deep breathing exercises and stretching may help.
✔️ Find support
Join an online support group and connect with other people with emetophobia. It can very comforting to know you are not alone in how you feel.
✔️ Do your research
Try reading a self-help book on phobias, or try an online programme. There are several app-based CBT courses available on the NHS apps library,
Some people take anti-vomiting drugs for emetophobia, but this can be very dangerous and should be avoided unless under the supervision of a medical professional. There is also no evidence that psychiatric drugs, antidepressants or tranquillisers have any effect on phobias. By seeking therapy and cultivating self-help strategies, you can eliminate the disorder over time and enjoy a phobia-free future.
Further help and support
If you are struggling with any type of phobia or anxiety disorder, for additional support try one of the following resources:
No Panic: a registered charity which helps people who suffer from panic attacks, phobias, obsessive compulsive disorders and other related anxiety disorders.
BABCP: a multi-disciplinary interest group for people involved in the practice and theory of behavioural and cognitive psychotherapy.
Anxiety UK: a charity which specifies in helping those suffering from anxiety.
The Samaritans: a charity providing support to anyone in emotional distress.
Mind: a charity that makes sure no one has to face a mental health problem alone.
Last updated: 13-01-2020
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