In this series, I dig a little deeper into the meaning of psychology-related terms. This week’s term is emetophobia.
Emetophobia, or fear of vomiting, falls under the diagnosis of specific phobia in the DSM-5. However, it hasn’t been as well researched as other types of phobias. As a phobia, it goes far beyond a dislike of vomiting (and really, does anybody like vomiting?); rather, it is something that becomes all-encompassing, causing a significant degree of impairment.
Characteristics of emetophobia
For the most part, it seems to start at a young age and tends to persist unabated over time. It tends to be focused more on a fear of the self vomiting rather than others, and the fear is worse in public settings.
A Dutch study found that emetophobia was associated with high disgust propensity (whether someone is likely to become disgusted) and disgust sensitivity (whether someone experiences disgust intensely), and high disgust sensitivity was predictive of worse symptoms of emetophobia. The researchers weren’t surprised at the connection to disgust, but they were more interested in the predictive link between disgust sensitivity and symptom severity.
Emetophobia incorporates elements seen in other disorders as well, including panic attacks, high sensitivity to how others may evaluate them (similar to social phobia), and an obsessive preoccupation with the gastrointestinal system. It’s also commonly comorbid with other mental illnesses, including generalized anxiety disorder, panic disorder, OCD, and hypochondriasis,
The illness may begin after a medical illness involving a difficult experience of vomiting. Hypervigilance then develops to gastrointestinal stimuli, and there is misappraisal of these cues so they are viewed as dangerous. This can lead to avoidance, which decreases self-efficacy in managing natural gastrointestinal cues, which feeds into further avoidance.
There are a couple of validated scales for measuring emetophobia. The Emetophobia Questionnaire (EmetQ-13, available as an appendix in this paper) covers avoidance and perceived dangerousness, with questions around avoidance of different forms of transport, avoidance of places where no medical attention would be available, avoidance of other people who may be likely to vomit, and the belief that seeing/smelling vomit is likely to cause vomiting.
Exposure is commonly used to treat phobias, but there are some challenges with implementing this for emetophobia. It’s harder to set up exposures, and it’s also difficult to convince someone to try it. Being exposed to hearing/seeing recordings of people vomiting is one option, Exposures may also focus on avoidance behaviours rather than actual vomiting.
Overall, though, there’s very limited research on the treatment of emetophobia. I would be curious to know whether there’s anything that might work in terms of prevention. If it often starts in young following episodes of physical illness, are there steps parents could be taking to prevent it from developing into a phobia in the first place?
Do you have any thoughts on this condition?
For more on this topic, check out this recent post on Anxiety and Liz.
- Boschen, M. J. (2007). Reconceptualizing emetophobia: A cognitive–behavioral formulation and research agenda. Journal of Anxiety Disorders, 21(3), 407-419.
- Boschen, M. J., Veale, D., Ellison, N., & Reddell, T. (2013). The emetophobia questionnaire (EmetQ-13): Psychometric validation of a measure of specific phobia of vomiting (emetophobia). Journal of anxiety disorders, 27(7), 670-677.
- Sykes, M., Boschen, M. J., & Conlon, E. G. (2016). Comorbidity in emetophobia (specific phobia of vomiting). Clinical psychology & psychotherapy, 23(4), 363-367.
- van Overveld, M., et al. (2008). An internet-based study on the relation between disgust sensitivity and emetophobia. Journal of Anxiety Disorders, 22(3), 524-531.