Emetophobia symptoms & experience
Put simply Emetophobia is the fear of vomiting. Beyond this it is loosely defined. Currently, it is covered by the Diagnostic and Statistical Manual (DSM), the so called ‘bible of psychiatric disorders’ as a specific phobia, sub category ‘other type’ (DSM V 300.29) these are the phobias which deal with fear of choking or vomiting. To put it another way it doesn’t have a standalone diagnosis. This does not fully reflect the opinions held in the medical world. A survey of Doctors in 2011 found that of four conditions which were proposed for inclusion in new guidelines emetophobia was the least ‘fashionable’, i.e. the one they took most seriously (Vandereycken 2011).
Recent years have seen the development of validated scales which may be used to identify and measure the severity of emetophobia (Veale et al 2013b). These scales include such questions as;
- I have been avoiding adults and children because of my fear of vomiting.
- I have been avoiding objects that other people have touched because of my fear of vomiting.
Which are rated on a 5-point scale. These have vastly improved the precision of diagnosis and accuracy of research outcome measure. However, because of copyright limitations these measures have done little for the average sufferer in getting recognition or help.
Emetophobia symptoms – two problems in one
A major problem with Emetophobia is that there may in fact be two issues present. This is likely to create confusion in understanding because the literature at times treatments them as the same thing. These two issues are;
1- A classic object phobia, the fear of something, in this case vomit. This fear can result in the avoidance of people who are likely to be sick and an inability to clean up vomit. This can be especially problematic for parents. Such a phobia is probably based on the ‘disgust’ or ‘fear of contamination’ responses. Like many object phobias it is likely to response well to treatment.
2- A phobia of being sick. The person with this type may or may not have a phobic response to vomit but mostly they fear that they will be sick. With these people the triggers may be internal, for example any gastrointestinal signal. Alternatively, it may be external, such as a location or scene in which they have previously experienced sickness. It may also be all of these things. Unlike people who fear vomit, these people cannot avoid all their triggers as they carry them around with them all the time.
We have some interesting findings from a 2001 study of people who self-identified as emetophobic (Lipsitz et al 2001). This gives us some insight to the lived experience of someone with emetophobia. This internet survey found that;
- Most sufferer’s fear being sick over witnessing others being sick.
- Most sufferer’s fear being sick in public over being sick in private.
- 90% experience symptoms every week.
- 70% experienced symptoms 6 or more days a week.
- Almost all were triggered by seeing food and digestive disquiet.
- Many had comorbid psychiatric disorders such as panic disorder, depression and agoraphobia.
Emetophobia symptoms & experience
The picture is one of great variety within a single condition. It is my belief that the second type of Emetophobia, the fear of being sick, has a lot in common with Irritable Bowel Syndrome (IBS) a connection I am not alone in making (see Sykes 2015, Pearson 2010). IBS is a condition in which a lot of sufferers demonstrate a fear of their own lack of control of bowel functioning. This is comparable to the fear of being sick.
It also shares elements of internal discomfort. In the case of IBS this is lower digestive track symptoms in Emetophobia it is upper digestive track and yet they are essentially the same tube. In both conditions it is common for sufferers to attempt to control symptomology with dietary changes. It is also common to control symptoms through awareness of the location of toilets. It may be that similar psychological approaches to treatment can be employed for both IBS and emetophobia.