emetophobia (fear of vomiting)

Hi

I guess this is kind of an eating disorder! my diet is affected because I fear vomiting & only eat certain safe food.

anyone else have these problems.

Judith

Hey freakyj, glad to see the rooms being used! i'm sorry to hear about ur difficulties, i know a few ppl with these problems, i hav eating disorders, and have like many others moved btwn diagnostic criteria over the yrs, i know quite a few ppl with ur specific difficulty and i had it (v minor) due to fear of getting an infection from vomitting. I've copied and pasted the floowing from Dr.Veale's website, someone had written asking about this phobia and i've posted the question and answer, and also the link to the site at the end, i hope it's of some use...


Vomit phobia (29/08/05)

I have had a phobia of vomiting - both myself and others - since around the age of 13, and the obsessive and avoidance parts of the behaviour increased over the following 10 years. I’am now 32, am unable to work, and have also had various other ‘labels’ at different times including social phobia, agoraphobia, anxiety disorder with panic attacks, and M.E. The M.E is still ongoing but I am accepting of the fact that this could well be fed by, and possibly rooted in my general anxiety difficulties.
Over the years I have gained a lot of self-insight into my past as well as present patterns of response through long-term counselling. This has been very helpful and, amongst other things, I would link the emetophobia primarily to issues around emotional control or losing control etc. However it would appear that whilst understanding the roots of a fear does help, it does not cure the phobia! I have therefore also had several courses of CBT and have made some progress over the years in terms of functional life e.g. with difficulty, I can now go on short bus rides, sit in a doctors waiting room, eat in public, cope with shops etc but there are many more things that are still impossible, or that I avoid. In particular I would like to have children but fear both morning sickness and, perhaps most of all, whether I would be able to look after my child if they were sick. My question to you is whether, in your experience, graded exposure programmes (that is exposure to specific 'face to face risks', say, to hospital wards, vomit bowls, videos) are of benefit to this type of phobia? I have read somewhere that emetophobia is more difficult to treat than simple phobias and that graded exposure is not always the best choice of treatment. Could you comment on whether this is true - and why - or whether, having benefited from other therapies such as CBT, counselling and medication, graded exposure may be another useful piece of the jigsaw especially in relation to preparing for having children? Also, if this is a ‘difficult to treat phobia’ how easy is it to find a practitioner who has specific experience of, and expertise in, treating this particular phobia? "

Answer.
Thank you. There is very little research into vomit phobia and so it is difficult to give any hard facts. Most therapists would agree that vomit phobia can be difficult to treat (and more difficult than treating other specific phobias such as insect or heights). The symptoms are often long-standing and significantly handicapping.

Vomit phobics frequently experience nausea in anticipation of vomiting as a symptom of anxiety. This leads to excessive vigilance for sensations of nausea which intensifies the sensations in a vicious circle. The sensation of nausea becomes misinterpreted as evidence of impending vomit and being paralysed with fear. Vomiting is associated with the feared consequences of losing control, and to a lesser extent of becoming very ill or choking. Vomit phobics tend to avoid situations which are associated with an increased risk of vomiting (e.g. pregnancy) or of others vomiting (e.g. being near a drunk). However many of the situations avoided would be associated with an extremely low risk of vomiting (e.g. using a public toilet). In common with other anxiety disorders, safety seeking behaviours” are likely to prevent individuals from testing out their fears of vomiting or may intensify the sensations (for example looking for an escape route; trying to keep tight control of their behaviour; taking medication; reading; sucking antacids; checking the sell by date and the freshness of the food; washing hands & teeth excessively; checking the health of themselves and of others; behaviour and magical thinking, such as ‘not stepping on a 13th stair’ or repeating a word or action a certain number of times’ so as not to vomit.

For Cognitive Behaviour Therapy (CBT), you need a good psychological understanding of your vomit phobia and to identify the factors that are maintaining the problem (especially your beliefs about vomiting, the safety seeking and avoidance behaviours). It is striking that for vomit phobics despite a career of preventing themselves from vomiting; the frequency of vomiting is no less than anyone else (unless the person is getting regularly drunk etc). Thus you are trying too hard to stop yourself from vomiting but it has virtually no effect on whether you are going to vomit. You may think you are in control but like the rest of us, there is limit to your influence and if in the very unlikely event that you do catch something that makes you vomit there is very little you can do about it! Vomiting is highly adaptive for getting rid of toxins in the gut - you'd be far iller if you couldn't vomit.

A person with vomit phobia may recognise the very low probability of vomiting but believes that the awfulness of vomiting is so high or that the consequences of vomiting are too dangerous and awful. As a result their solution of avoidance, safety seeking behaviours and excessive vigilance for vomiting are now their problems. The problem however is of being excessively worried about vomiting and therfore believing that they may be paralysed with fear.They rate vomiting as being 100% awful and are therefore trying too hard to prevent themselves from vomiting. Thus for effective CBT it is crucial to act as if it is a worry problem and to enter situations and activities associated with nausea (caused by anticipatory anxiety) without excessive vigilance and safety seeking behaviours. The aim would be to refocus attention away from the nausea in avoided situations and to do this repeatedly to disconfirm the prediction of vomiting and to therfore improve the quality of your life. Here the emphasis is on being functional as the strategy of trying never to vomit has a significant cost and yet has no effect on the frequency of vomiting. In other words we would encourage you to act in your valued directions in life (such as wanting to be a mother) despite the sensations of nausea and fear of vomiting as this will subside over time. The aim of therapy would be to help you drop your safety seeking behaviours and all the situations you avoid associated with the fear of vomiting. However, it has to be done consistently and regularly (preferably daily) without trying to control or escape from your feelings and sensations of nausea.

Graded exposure has also been described –for example in imagination to vomiting, simulated vomit, joke vomit, or videos of others vomiting. We don’t know how effective these strategies are as we just don’t have the research data. Videos of another person vomiting may have limited benefit since the main fear is usually of the self vomiting. Watching simulated vomiting or others vomit may also not be sufficiently realistic. Inducing vomiting by a prescribed emetic such as ipecachuana is sometimes described. It could theoretically be justified for a single behavioural experiment to test the “awfulness” of vomiting but it cannot be done repeatedly for ethical and practical reasons. Another obstacle to exposure to simulated or real vomit is that it may not alter the rating of the “awfulness” of vomiting or the beliefs about the consequences of vomiting. Exposure to vomiting can sometimes be counter-productive – for example one person I saw with vomit phobia described repeated exposure to vomiting by a prescribed emetic as confirming for her the awfulness of vomiting and making her even more determined to avoid vomiting. However, another patient with vomit phobia who had had emergency surgery vomited repeatedly post-operatively which she described as having benefit in reducing her fear.

One can also use exposure in imagination to vomiting and role plays of the self vomiting (since this seems to be more important than others vomiting). The aim here would be to reduce the “awfulness” of vomiting to enable you to drop your avoidance, excessive vigilance and safety seeking behaviours. A therapist might also attempt to decrease the rating of the awfulness of vomiting and to develop more adaptive beliefs (for example “Being sick is very unpleasant, but not awful since there are much worse things that could happen”) and helping you to re-rate the awfulness of vomiting on a continuum (for example 0% being “unpleasant” up to 100% being “awful”). Another obstacle for vomit phobics is the fear of losing control if they did vomit. Lastly, it may be important to explore the meaning or imagery associated with “losing control” and to practice“losing control”.

In general I would advise you try to overcome vomit phobia before you get pregnant. You may have difficulty in looking after your child if they were sick and it would be best to practice on other children – unfortunately other children are not sick to order!

You need to ask a practitioner whether they have experience of treating this vomit phobia – it sounds as you are already quite knowledgeable. A good start would we www.babcp.com under “Find a Therapist” (which at present only covers private therapists. If you cannot get expertise locally on the NHS, then you could ask your local psychiatrist to refer you to our unit at the Centre for Anxiety Disorders at the Maudsley Hospital.

There is self help support group on the web “Gut Reaction” . I also have a FAQ on vomit phobia on this website.

ME or chronic fatigue can also be treated by CBT. I would recommend the book "Overcoming Chronic Fatigue" for you by Mary Burgess and Trudie Chalder published by Robinson.

David Veale

http://www.veale.co.uk/ask.html

Hi,

I have emetophobia aswell, and it affects my diet a lot. I have lost a lot of weight because of this, and have been starving myself for periods since I'm so scared that the food that comes down eventually will come up. I'm also really scared of contamination so the very little amounts of foods thah comes down have got to be heated in order to kill viruses and bacteria.

My doctors has diagnoes this as an unspecified eating disorder or something like that.

have they diagnosed it as a separate thing too menelwa? i don't know if they should, im just asking! lol. im sorry to hear it afects ur diet a lot and im sorry ur losing lots of weight *hugs and positive vibes* ur not alone and u can beat this! r u getting any treatment or found anything that has helped!?

pc xXx

I've recently started EFT (Emotional freedom technique) It is working but only slow progress cos i've had this phobia for so long almost 35 years. My problems are very deep seated & I have more than the phobia & ocd. I am working on the root cause of the phobia & emotions which surround it, then the phobia & ocd will begin to fade away.
My phobia as been different to other sufferers of emetophobia! I dont really want to go into detail, but my phobia as no real connection with being sick! got u all thinking now LOL!!!

I have another therapy session on friday.

Judith

oo let us know how the eft goes! im sorry uve been suffering for so long but i hope it gets better! i hate having lots of different complex problems, sometimes the mountain feels to high to climb in some melodramatic way but i have fiath in u! i hope the session went well 2day FJ and u dnt have to share anything u dnt want to, obviously! lol

pc xXx

I've began to put the pieces of the puzzle together! I've heard ppl say it's like a jigsaw puzzle! hey I've found that it is!!
For the first time ever i can see connections/paths which have lead me to where I am!
If it wasnt for my new therapy then I would never have found out.
EFT (emotional feedom technique) is something new to me & it does really work, it sort of helps u to be free emotionaly & it helps to clear the fog! [^] It also depends on the therapist & if u have a good relationship with them, I get along with mine & I have full trust in him so that helps a lot.

Judith

aww wow fj!! im so glad somethings helping, ur *probs* sounds complex, like mine, and im guessing a lot of others, so im so pleased ur gaining som clarity! keep us updated, well done!!

pc xXx

Hey. I have this phobia too, and it affects my eating. I also used to starve myself but am begining to put on a bit of weight. I wish you all the luck in the world in overcoming it

hey manicmoggy! im sorry ur suffering too, and im sorry u went thru the starving *positive vibes and hugs* im sure u have lots to offer here! what help hav u had? was it any good? keep posting.

pc xXx