The Emetophobia Clinic of Ontario

Emetophobia Counselling

Emetophobia or ‘vomiting phobia’ (fear of vomiting) is the extreme fear of sickness and vomiting. There hasn’t been a whole lot of literature and research on the condition, which is surprising given how many people complain about emetophobia symptoms. Prevalence ranges from 1.7% to 3.1% for males and from 6% to 7% for females (Phillips, 1985; von Hout & Bouman, 2006). Similar to people diagnosed with an anxiety disorder, many individuals who experience difficulties with emetophobia describe performing safety-seeking and avoidance behaviours. For example, many people diagnosed with emetophobia would describe avoiding seafood, not eating at restaurants that have poor reviews, or staying away from sick people. Individuals who have emetophobia may also have had negative experiences from vomiting or seeing others vomit which may have triggered the onset of the condition. The onset may also follow medical illness which may have influenced the sufferer to become hypervigilant around bodily sensations around their stomach.

How is Emetophobia treated?

Cognitive Therapy combined with Exposure and Response Prevention (ERP) has been demonstrated through research to be highly effective in treating emetophobia. Cognitive therapy helps individuals with emetophobia better understand how their perception of vomiting may be distorted or catastrophic. The goal of the therapy is to help improve self-efficacy and self-confidence. This is done by examining rigid beliefs one may have about vomiting and challenging harm-related thoughts. Focus is also attended to coping and how an individual can manage some of their feared thoughts around vomiting.

Therapy will also explore examining fears around the panic like sensations one feels before a vomiting episode or managing the actual episode of vomiting. Individuals with emetophobia may also become increasingly more sensitive to stressful situations where an upset stomach may occur and may interpret these sensations as threatening. This appraisal is what is challenged in therapy.

How is the Emetophobia maintained?

Perceptions of others being sick may also lead to further anxiety, which may only increase stomach sensations and thoughts that the sufferer may throw up. The thoughts could further increase anxiety leading to an escalation in gastrointestinal (stomach sensations) symptoms that the sufferer may be sensitive to thus increasing their fear that they may vomit. Avoidance behaviours such as avoiding certain foods or nausea avoidance altogether will only further increase the fear of vomiting. Safety behaviours such as carrying gravel will also further increase the fear and make it more difficult to learn to manage the anxiety. Put simply safety behaviours and avoidance increase the anxiety and will only maintain the emetophobia. Therapy will help reduce the safety and avoidance behaviours in an effort to help the patient ready themselves for exposure.

How does the treatment of Emetophobia compare to IBS treatment?

Many people who experience emetophobia describe performing checking behaviours around their stomach. Similarly, people with Irritable Bowel Syndrome (IBS) do the same. Both conditions are described as a persistent chronic course without periods of remission in symptoms. Just like IBS, physiological arousal plays a key role in emetophobia and can be the hallmark symptom of the disorder. Individuals with emetophobia are more likely to report higher scores on measures of sensitivity to body sensations compared to a group of non-sufferers. Similarly, as IBS patients check their stomach for distressing symptoms emetophobia sufferers often do the same. This behaviour may influence neural activity in the areas they check (the stomach), thus making them more sensitive to upset stomach cues than non-sufferers. In treatment, meditation and mindfulness has demonstrated to be quite effective in managing with the stomach hypersensitivity and attention issues emetophobia sufferers experience difficulties with.

Social phobia-like factors in Emetophobia

Some emetophobia sufferers may also describe having a heightened sense of sensitivity to the opinion of others. They may describe fearing being negatively evaluated if they are sick. Part of the therapy course may be evaluating for such fears and creating a specific treatment plan to challenge negative thinking around evaluation and preparing specific exposure-like activities that would help reduce the fear.

Obsessive Compulsive Disorder factors in Emetophobia

Individuals with OCD may also present with symptoms of emetophobia. This needs to be carefully teased out by your practitioner. People with the OCD subtype may describe their symptoms as more intrusive and may also participate in ritualistic behaviour.

Exposure with Response Prevention

Treatment for emetophobia requires exposing the sufferer to vomiting-related objects or situations. This may sound scary, but it’s done so with the guidance of the psychologist and the readiness of the patient. Motivation and client collaboration is key to success when working with exposure. The patient has full control and will only participate in activities that they feel ready to attempt.

Do I need to vomit to get better?

No, vomiting is not required to perform exposures or to finish treatment. Most patients with emetophobia are more so concerned about the symptoms of vomiting and not the actual episode itself. In fact, most sufferers would describe relief after vomiting.