Fear of Vomiting – Emetophobia
A simple google scholar title search on Emetophobia*1 produces 40 scholarly articles. Do the same search for Irritable Bowel Syndrome (IBS), a condition which has a lot in common with Emetophobia, and we get 16,000 articles. My point is the Emetophobia is a neglected problem.
Emetophobia, sometimes referred to as Specific Phobia of Vomiting (or SPOV for short) is estimated to effect as many as 3.1% of men and 7% of women (Philips 1985, Van Hout & Bouman 2006). Those with it live in a state of frequent and intense anxiety which
Emetophobia is a forgotten condition which has not received the attention it deserves. In this series of blogs, we are going to look at what the worlds of psychology and medicine do currently know about emetophobia; what the symptoms are, what the causes might be and how it can be treated.
Emetophobia is one of two things, and for many people it is both.
1) The fear of vomit – the person with this fears seeing people vomiting or vomit itself. This is most likely based on the fear-of-contamination response. They will tend to avoid sick people and babies.
2) The fear of being sick – the person with this fear, fears being sick and anything which reminds them of being sick, such as gastric disquiet, the V word (that’s vomit in this case), and of course other people being sick or their vomit. This is different from the ‘fear of vomit’ as the vomit reminds the sufferer of their own chance of vomiting rather than experiencing a fear-of-contamination response. These people tend to avoid people who are ill for fear that they will get ill. They also often become socially insular because the fear of being sick in public can inhibit their ability to go out. They will commonly enter into a behaviour referred to as ‘toilet mapping’ in which they will be uncomfortable in any area where they do not know the location of all the lavatories.
Emetophobia – causes
It is generally considered that people with Emetophobia have nothing physical wrong with them. In fact, there is some evidence that through avoiding the unwell they have fewer incidents of illness than average. Cognitive psychology suggests a model of development with a number of steps
1) The person gets ill, very badly.
2) This then makes them worried about being ill again.
3) This results in ‘body monitoring’ where they pay hyper attention to the signs and symptoms coming up from the body.
4) When a potential symptom arises, they assess this as a threat i.e. ‘my stomach is making noises, I’m going to be sick’.
5) This then makes them even more anxious which causes a tension in the digest exacerbating the symptoms.
6) This further increases their stress and a cycle of attention and anxiety is reinforced.
7) The worry about illness becomes embedded and they remain trapped in a recurrent cycle (steps 2-6) which is divorced from the original bad illness.
This is only the cognitive theory and there is strong evidence for associations with sufferer’s having increased bodily awareness and a history of heightened anxiety which predates their emetophobia.
Several different successful treatment approaches have been documented over the years including
- Cognitive psychology
- Cognitive Behavioural Therapy (CBT)
- Transactional analysis
- Eye Movement Desensitisation and Reprocessing (EMDR)
However, for most of the above there is a theme which most of them share, this is a technique called Graded Exposure or Systematic Desensitisation. This is where the client is put into a relaxed or confident state and presented with different triggers for anxiety. Where possible the triggers will be graded so they start with the least challenging and work up to the most challenging. This may be done either in life or in the imagination and is commonly augmented with changes in internal language or imagery of the digestion which promote more appropriate responses.
1- Google scholar with no patents or citations