Treatment for Specific Phobia of Vomiting (or Emetophobia)
By Lori Riddle-Walker, EdD, MFT
A significant portion of the population fears vomiting. You are not alone. Previously it was thought to be rare, likely due to sufferers having a fear of seeking help or a discomfort with even talking to others about this phobia.
The prevalence or percentage of people with Specific Phobia of Vomiting (SPOV), also known as emetophobia, is not known. It is estimated to be between 1.7 and 3.1% for men and 6 and 7% for women, with a total prevalence of 8.8% (unpublished study as cited in Philips, 1985; van Hout & Bouman, 2012).
SPOV commonly begins in childhood and has a chronic course (Veale & Lambrou, 2006; van Hout & Bouman, 2012). In our recent study, participants’ symptoms began in childhood before the age of 11, and the age range for the study of 19 years to 70 years reflects the chronic course of SPOV.
It is common to have SPOV occur with other psychiatric disorders. (Lipsitz et al., 2001; Veale, Costa, Murphy, & Ellison, 2011; van Hout & Bouman, 2012). This is important because SPOV is already a complex disorder with high anxiety and panic symptoms, and frequent somatic complaints. When SPOV occurs with other disorders, treatment is complicated even further. In our study approximately 50% of participants had co-occurring mental health issues.
Emetophobia can significantly affect social, family and work functioning, causing avoidance of important related activities or duties (Veale and Lambrou, 2006). It can be pervasive due to multiple avoidances, time-consuming or inconvenient safety behaviors (actions done to prevent vomiting or reduce anxiety about vomiting), preoccupation with body sensations, and panic or anxiety symptoms often triggered by catastrophic thinking or the replay of traumatic memories. An inability to work, difficulty caring for children, difficulties in the workplace, and avoidance of socializing are common occurrences.
The good news is a recent survey found that more emetophobics are seeking treatment (van Hout & Bouman, 2012). This has been our observation as well. People of all ages are coming forward for help.
Characteristics of Specific Phobia of Vomiting
As we have seen, SPOV is a chronic disorder, often with early onset. The characteristics of SPOV include:
- frequent intrusive imagery,
- panic and anxiety,
- increased feelings of disgust,
- over-focus on nausea and other somatic (body) sensations,
- safety behaviors, including checking and other ritualistic behaviors,
- avoidance of vomiting cues, which can include people, places, things or situations.
It can also include:
- disturbed eating leading to significant weight loss,
- decreased desire for social contact and interaction, and
- decreased functioning in general.
It often occurs with other psychiatric disorders such as depression, social anxiety, panic disorder, and obsessive compulsive disorder.
Treatment of Specific Phobia of Vomiting
The treatment protocol that we use has been developed based on current research. It begins with an assessment of symptoms and personal goal-setting. We want to help each person complete treatment having reached their own goals. Education about anxiety is a very important part of getting well. We also address any traumatic memories with Imagery Rescripting, a technique that helps put these memories in a context of comfort or mastery, instead of fear, loneliness, confusion, or helplessness. Other intrusive thoughts or images are also addressed.
The next phase identifies and addresses the cognitive processes, or thinking patterns, that keep anxiety going, such as over-monitoring for threats (e.g., people who look sick); over-monitoring of body sensations; and worry, self-reassurance and mental planning (e.g., finding means of escape).
Avoidance behaviors related to internal and external vomit and vomiting cues are identified and addressed. Internal cues may include being dizzy or light-headed; external cues may include bars and people drinking. Dealing with anxiety is taught using an acceptance and mindfulness approach.
Addressing avoidance behaviors uses gradual exposure to feared people, places, situations or things; behavioral experiments; and homework.
Last, we work to ensure relapse prevention skills are in place. (Boschen, 2007; Hunter & Antony, 2009; Veale, 2009).
For guidelines to find a therapist in your area, download our free guide: How to Find a Therapist for Emetophobia, Even if they don’t know what it is.
Boschen, M. (2007). Reconceptualizing emetophobia: a cognitive-behavioral formulation and research agenda. Journal of Anxiety Disorders, 21(3), 407-419.
Hunter, P., Antony, M. (2009). Cognitive-Behavioral Treatment of Emetophobia: The Role of Interoceptive Exposure. Cognitive and Behavioral Practice, 16, 84–91.
Lipsitz, J., Fyer, A., Paterniti, A., & Klein, D. (2001). Emetophobia: preliminary results of an internet survey. Depression and Anxiety, 14, 149-152.
Phillips, H. D. (1985). Return of fear in the treatment of a fear of vomiting. Behaviour Research and Therapy, 23(I), 45-52.
van Hout, W. J. P. J., Bouman, T. K. (2012). Clinical Features, Prevalence and Psychiatric Complaints in Subjects with Fear of Vomiting. Clinical Psychology and Psychotherapy, 19, 531–539.
Veal, D. (2009). Cognitive behaviour therapy for a specific phobia of vomiting. The Cognitive Behaviour Therapist, 2, 272-288.
Veale, D., Costa, A., Murphy, P., & Ellison, N. (2011). Abnormal Eating Behaviour in People with a Specific Phobia of Vomiting (Emetophobia). European Eating Disorders Review, DOI: 10.1002/erv.1159.
Veale, D., Lambrou, C. (2006). The psychopathology of vomit phobia. Behavioural and Cognitive Psychotherapy, 34, 139–150.