Emetophobia: The Vomit Phobia
Written by: Dr. Kat Harris, PhD, LCP
An intense, disproportionate fear of vomiting might not sound all that debilitating for those who don’t suffer from emetophobia or for those without a loved one with emetophobia. However, having an intense fear of vomit can wreak havoc on one’s life and interfere in one’s ability to engage in activities that they might otherwise love to do, such as travel, eat at restaurants, try new foods, attend school, watch certain movies or tv shows, have children or care for sick children, spend time around children, visit a loved one in a hospital, etc.
Essentially any activity that might create a situation perceived as being conducive to nausea or vomiting might be completely avoided or only engaged in with significant safety behaviors or compulsions such as bringing medications, water, safety people, excessive checking, washing, reassurance seeking, etc.
Emetophobia is sometimes considered a Specific Phobia and is sometimes considered to be a form of Obsessive-Compulsive Disorder. Either way, the recommended treatment is Exposure and Response Prevention (ERP). ERP is a type of Cognitive-Behavioral Therapy (CBT). This treatment includes having individuals confront the things that cause them anxiety and distress and then having the client "response prevent," or in other words stop engaging in, or significantly modify, the avoidance/safety behaviors/compulsions that are normally used in response to external (e.g., certain foods, public transportation) or internal (e.g., feeling dizzy, the thought “I might puke”) triggers. This is done in a safe, gradual, systematic way to ensure that individuals are as successful as they can be.
There are typically three exposure types: in-vivo, imaginal, and interoceptive.
An in-vivo exposure is an exposure where a client is asked to directly face their feared situation or physical trigger in real life. In the case of emetophobia, this may encompass traveling via various modalities (e.g., flying, taking a bus, train, driving, etc.), eating foods outside of what the client may usually deem “safe” (e.g., foods with certain textures that are normally avoided, eating foods that have not been excessively checked for their expiration), listening to the sound of someone else vomiting in a movie or tv show, looking at or holding a substance that resembles the texture or smell of vomit, mimicking the motion or experinece of vomiting, reading a book about vomit (yes those exist), etc.
An imaginal exposure refers to an exposure where a script or informal image is used to confront a feared situation and/or image specific to the client’s fear. These might be used as a build-up to in-vivos, or may be used when exposure to the in-vivo might not be feasible. For example, the client might be asked to imagine sitting with the possibility of vomiting, imagine eating at a certain restaurant and incorporate their senses such as what they would hear, smell, and taste, etc.
An interoceptive exposure involves asking a client to face their “interoceptive symptoms” that are associated with their fear of vomiting. Interoceptive specifically means physical/somatic symptoms/symptoms associated with the internal state of the body. For someone with emetophobia, this might include intentionally inducing symptoms such as dizziness, nausea, hot flashes, etc. Usually, a mental health provider will clear their client’s for light to moderate activity with their client’s physician and ensure that interoceptive exposures are indicated.
The goal of all of these exposures and treatment is not necessarily to induce vomiting. The goal is to encourage the client to approach the situations, people, places, things, physical symptoms, and thoughts that they might normally avoid because of their fear, and teach them that they are safe and can handle the distress associated with facing their fears, and that they can do so without the use of avoidance, safety behaviors and/or compulsions. And IF they do vomit, they can handle that too. This all, with the goal of getting the individual back to their life, doing things that they love to do and value, with the power and freedom that comes with not being bossed around by anxiety.