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.
Specific phobia symptoms
Symptoms of a specific phobia include:
- Marked fear/anxiety about a specific object/situation
- That specific object/situation almost always leads to immediate fear/anxiety
- The fear/anxiety is disproportionate to the actual danger that is posed
- The object/situation is actively avoided or, when it can’t be avoided, endured with intense fear/anxiety
Symptoms must cause clinically significant distress or functional impairment, and they must persistent, typically lasting for 6+ months.
The DSM-5 identifies several types of specific phobia, and emetophobia falls into the “other” type.
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 oneself 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). 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.
Measuring emetophobia
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. It has 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.
Treatment
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 them. Exposure 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 at a young age 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.
My Inner Mishmish also has a post with tips on supporting someone with emetophobia.
References
- 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.
- Substance Abuse and Mental Health Services Administration. (2016). DSM-IV to DSM-5 specific phobia comparison. In Impact of the DSM-IV to DSM-5: Changes on the National Survey on Drug Use and Health.
- 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.
The Psychology Corner has an overview of terms covered in the What Is… series, along with a collection of scientifically validated psychological tests.
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Ashley L. Peterson
BScPharm BSN MPN
Ashley is a former mental health nurse and pharmacist and the author of four books.
Interesting write-up. There is so much in the DSM-V, that over the next year, you could probably do a “rewrite” of the book in your series, and you wouldn’t even be halfway done.
It’s really fascinating the broad spectrum of mental illness experiences that people can have.
Absolutely!
That was fascinating to read and thank you for raising awareness of this. At a young age, I suffered from Emetophobia for years. Sometimes I still have flare ups but not as bad as it was back then. This illness wasn’t widely known then so I didn’t get very good treatment for this either, I was just branded as a naughty teenager x
That must hace felt awful. I’m glad it’s better under control now than it was.
We know someone afflicted with this during childhood. Comorbid with OCD. Exposure therapy involved watching videos over time, discussing it with a Therapist, focusing on reality (versus catastrophizing). The person rolls us the treatment worked, and our seems to have. Yet the Gastro-unawareness:avoidance seems to have persisted. So we don’t know if those are related.
The social stigma of public committing (ie in class at school) as a child can be not far behind urinating on oneself. And seeing others vomit can reinforce the stigma
We wonder if normalizing vomiting as involuntary and common would help vulnerable children. Maybe also having reinforcement from adults in the setting where the child is anxious (ie teachers) reinforce that it’s normal, not offensive or punishable, not worthy of judgment by the adult might help. Thanks for writing about it
Those sound like good ideas to support children in coping.
Emetophobia is such a curious thing really. I’ve had a couple specific phobias throughout my life, some more and some less severe, some have almost disappeared by now, and I also have emetophobia which is probably the most severe one for me, and the strangest, so I can share what it feels like to have it in practice, at least what it feels like for me, and maybe it will help someone to understand it if they want to.
I don’t really even know what has caused it for me. I’ve always been quite anxious of vomit as far as I can remember but I never had any condition that would make me vomit a lot as a kid or anything like that, not that I can remember anyway. I’d even say that I’ve always vomited only rarely, I’ve never had any significant gastrointestinal issues at all, unless psychosomatic. and I’ve read somewhere that actually it is common for people with emetophobia to not be very throw-upp-y themselves in reality. My own view is also that I’m probably too blocked emotionally by the anxiety to vomit, but that may not be true.
The only thing that I remember that might have had some impact on the development of that phobia for me is when I was very little and went to a costume party with my parents, but I was not feeling well all day and was throwing up before we went there and then also apparently when we were at that party. I only remember that whole thing very vaguely and I don’t find it particularly distressing when I think about it now, so it’s hard for me to think that it would affect me in such a spectacular way for my whole life, but I have no other idea how it could have started out for me, and curiously I also really really really dislike all sorts of balls, proms, discos, dancing parties… I mean I’m not the kind of person to like such things to begin with but my dislike and fear of them is much worse than of many other things involving socialising and I could never fully understand or rationalise it either.
It definitely got worse for me when I was in my pre-teens and teens when I was reeeally neurotic and had a lot of health anxiety, which only happens to me rarely now when it comes to something else other than vomit, and then at some point my emetophobia got so bad that one of the staff at my boarding school was concerned that I had anorexia because I ate very little. Things have improved since then, mostly on their own, but it’s very much a coming and going thing and can relapse at times. I guess my relationship with food still isn’t exactly healthy, but it rarely happens now that I would stop eating anything at all because I’d be scared of throwing up. I still have a list of no-no products that I don’t eat solely because at some point in my life I vomited after eating them and while I don’t know for certain that it is them that caused it, I can’t get over it and risk it again, although I have managed to start eating a couple of those things recently, even though they sometimes still trigger a lot of anxiety for me. I’m also always more anxious after eating some combinations of food that I feel unsure of, yet I don’t think it has ever happened that I would vomit because of eating some bad combination of products. I also hate medications that can cause vomiting as a side effect.
I am not just scared of vomiting myself, but also other people vomiting, sounds similar to vomiting like gagging or choking, and I don’t even like the words for vomit in all the languages I know, they just sound so… I don’t know! 😀 Just scary but in a strange way, I can’t describe it.
I used to find it really difficult to even read about people vomiting in books, or as I say hear the words describing it, or people talking about it, even slight gagging sounds would make me freak out. These days it’s usually much better and if I’m generally feeling well and not too anxious overall, I can read about vomiting, unless it’s really extremely graphic and detailed but even if it is it usually won’t make me feel as awful at it could some years ago. I can hear the words relating to vomit or use them myself and, again, if I’m generally doing well and there are no other major triggers that won’t be a problem at all.
I’ve also noticed that having Misha has helped me to overcome some of my vomit fears, because of course cats tend to vomit more often than humans. A cat vomiting doesn’t sound as scary as human, even just because it’s quieter, but still, at the beginning when he started to live with us, it used to terrify me, now I’m only a bit jittery when that happens and get over it quite quickly. The topic of vomit is a bit more tolerable for me since then as well. I cannot be with people who are vomiting though, no matter how much I love them, and especially not when there’s even a slight suspicion that their condition may be contagious. I might love them to pieces but I will do all I can not to interact with them, which often makes me feel quite selfish. And these days hearing people vomit – apart from feeling unwell myself – is one of the strongest triggers for me and can really set me back. I can’t even watch movies with people vomiting. It actually surprises me that I have equally strong reaction to just hearing a sound of vomiting alone, and a real person vomiting close to me. So I dread the tummy bug season, and when it hits my family or I just meet someone who seems affected, I go nuts about washing my hands and see noroviruses everywhere and then I also do have quite a hard time eating until the danger goes away, and I drink apple cider vinegar in hopes that it will prevent me at least in some way from getting sick.
Another bad trigger for me is just anxiety, of any kind, so it’s quite a vicious circle sometimes. It’s probably because I often feel nauseous and dizzy while anxious, no matter what’s the cause of my anxiety. But I usually succeed at rationalising it these days and have developed some strategies to help me out.
I don’t really experience any stronger or weaker symptoms when it comes to vomiting in public. Of course that would be very unpleasant and quite humiliating for anyone, but when I’m scared of vomit, it doesn’t really matter to me if the thing will happen in public or when I’ll be all alone, it’s quite equally scary.
People in my surroundings who know about it often seem to think that I’m scared of it because of potentially choking and dying, or because it is so disgusting, but it’s not true and I can’t really say why. Everything about is just scary.
That’s interesting that Misha has helped a bit as a form of exposure. I used to occasionally cat-sit for my brother’s cat, and I agree, cats vomit in a far more dignified way than humans can.
I can imagine how anxiety and emetophobia would really feed off each other and creat that vicious circle.
Since I apparently suffer from it, yeah. I was reading the post and my first thought (before you said it) was ‘I BET this has to do with social phobia’. For myself I don’t recall when, exactly, it cropped up. I never heard any stories from my childhood (with my biologic family anyway) where it was a problem. It was disgusting obviously, but well I didn’t have social phobia as severely either. I suspect it has its roots (along with my social phobia and generalized anxiety disorder) in that time in foster care. I do not have a pivotal moment though. I just know, that now? I’m better at realizing why it’s necessary now and then, but I still find it horribly disgusting and will do much to avoid doing it. The last spontaneous one was when I was in the hospital, waiting with a friend who could not stop throwing up and wisely went to the ER (this was pre-C-19), where they gave her some sort of anti-emetic. Two doses actually because the first didn’t even slow down events. At some point I had to excuse myself and I threw up too (but had had a queasy stomach all evening, even before my friend needed my support). Maybe it’s the obsessive component that makes it so bad for those of us who suffer with it. We’re perhaps fairly fixated on our internal workings in the first place and any deviation from normal makes us anxious.
Emilia was just commenting that her emetophobia and anxiety become a vicious circle, and yeah, it makes sense that being extra-sensitive to what’s going on internally, either in an anxious or obsessive way, makes the emetophobia situation that much worse.
Thank you for bringing awareness about this.
Yes I am an emetaphobe!
It is one of my worst fears!!!
I also have Generalised Anxiety Disorder and some social anxiety too. Separation anxiety Disorder, so no doubt all that may have added to it.
I am always conscious of how my stomach feels. It seems to be a thing. Like you are OCD about it. Because my worry and stress go to this area, I often have bloating or trapped wind.
But when or if someone feels sick around me, it is the quickest way to get rid of me. I will be out of there like a shot.
Throughout my childhood, my only parent, who was my father never much cared about my feelings, and they were either made fun of, or just ignored or totally walked all over. So whenever I felt ill, he gave no consideration to it. In fact one time I felt very nauseous and was so scared, and he promised me I would feel better if I drunk this solution he gave me. Unbeknownst to me, it was salt water, and yes I threw up, but it was such a shock, and he just thought it was funny!
When I was on holiday and felt badly sick, he would walk in with food…and wouldn’t care that I was on the bathroom floor having a panic attack, in a cold sweat, and so scared I could hardly breathe.
He would do stuff like this all the time.
This was not the only sick type story. I used to wake up at my alcoholic mother’s house when very young and hear her being sick every morning from all the alcohol she drunk night before, and I used to hate it. I used to cover my eyes and nose.
So basically vomiting or even feeling sick brings fear, severe anxiety, and panic attacks, it is like I would rather deal with anything else but that.
That certainly makes sense given what you’ve been through.
I remember the holiday one because I remember being so totally exhausted from reaching and everything else…
And I was dripping with sweat. My father picked me up, as I had no strength left, and he put me on the bed. I fell asleep…
He then took advantage of the situation, sexually.
When I finally woke up the next day, I knew he had done stuff, as you just get this cold dread come over you.
I was severely dissociating.
There was just too much anger, and absolute hate for me to process.
But I could not show that anger or that hate.
I had to pretend like none of it happened.
No child is ever in a position to be able to handle that kind of situation any other way than by survival instinct.
You are always welcome to write anything you want and as much as you want on my blog. ❤️
I’ve never heard of this, thank you for the information 🙂
Wow, very interesting. I too think it makes sense that this is co-morbid. It would be interesting to know if anyone has this but does NOT also have some form of anxiety.
Thanks for your work!
A friend of mine has this condition. It depends on how she feels if I can come over. She is really worried someone might vomit and how she would be effected by that. I don’t know if it stems from childhood as she doesn’t always mentions it. It seems to flare up when the occasion arises.
It certainly seems like quite a difficult condition to manage.
Interesting. My initial thoughts along these lines are what I often think when reading about such symptoms. Since we all have a natural disdain for vomiting, at one point does it become an actual bonafide disorder? Similarly, I know many people who are absent-minded. They’re not nearly so absent-minded as I am, however, since in my case this is connected to being severe ADHD with Dyslexia and on an autism spectrum (high-functioning autism.) Yet many people are absent-minded, though not to the extent that it’s an illness requiring treatment.
I guess I have this question with respect to many disorders. It also relates to stigma on some level.
In general terms I’d say the line between normal and pathological has a lot to do with the impact on the person’s life in general. For example, most of us dislike vomiting, but don’t give it any thought aside from times when it’s happening or imminent. For people with emetophobia, multiple aspects of their lives revolve around trying to avoid vomiting.
That’s a very clear distinction. Maybe it will help me against some of the stigma related to my own disorder. What happens with me isn’t just the usual old age absent-mindedness that people can shrug off or laugh at it. It something that seriously impacts my life for the worse in every area of life unless it’s held in check. Thanks for this.
That’s exactly the kind of difference I was thinking of
Wow, reading some of your followers comments, I hadn’t thought this was so common. Fortunately, since hypnosis and training as a hypnotherapist, I don’t have any phobias, but I do understand the anxiety around them.
I’m not sure if I’d even heard of it before I started blogging. Perhaps it’s something that’s just not getting recognized as often as it should. Then again, perhaps rarer diagnoses are more represented in the blogging world compared to the overall incidence. For example I don’t think I ever treated a patient with diagnosis DID, yet in the blogosphere I know of quite a few people who have it.
No, I’d never heard of it either and nor did I work with anyone with a DID diagnosis. Yes, I tend to come across more in the blogging community than anywhere else. It’s all really interesting. Thank you and well done, another great article Ashley.
Thank you!
Interesting, I don’t have emetophobia but I do have quite a lot of feelings/experiences around vomiting.
Whenever I’ve come around from surgeries, I have about 2 hours where I’m throwing up every 10 minutes, and after surgery you wake up with an empty stomach of course, since you had to fast before it. So, it’s just dry-retching after dry-retching, like clockwork for 2 hours. It’s very exhausting! I had 3 ear surgeries when younger and I’ve had 6 knee ops, so I’ve been through that a lot of times!
As well as that, I almost choked on sick once when younger. I had suddenly become nauseous from a stomach bug or something, but I was dehydrated and the vomit was thick…urgh, and my parents were watching TV in the living room. I was in the utility area of the house downstairs, and I could neither throw up nor breathe for a while. I tried kicking the cupboard door with all my might to get their attention, but that was useless! Very typical of my parents! I managed to get the sick out using my fingers and the last of my strength, but it was a horrible experience. Also my parents showed no understanding when I told them afterwards, and went back to watching their TV program…🤦♂️
So given all of that, I could probably be forgiven if I’d developed emetophobia. I do have a very strong fear of being sick whilst nauseous, I physically put it off for as long as possible, I do anything to avoid the sensation of being sick! And I really hate being sick alone, if there are people around I always want somebody to supervise me, or be there to pat my back which always helps me! Also, when I hear other people being sick, I rush to see if they are ok and if I can help.
That’s intersesting that it’s helpful for you to have someone around. I’d much rather have people steer clear of me when I’m sick.
Yes, purely because I don’t want to choke to death on sick 😆. Also, whenever I’m nauseous, I make sure to drink water before I’m actually sick, so that it definitely won’t get stuck again…!
If I’d never had that bad experience, perhaps I’d be the same as you. But I see being sick as a very intense, painful and exhausting thing. It makes me cry from the exertion, my nose runs, I get adrenaline rushing. It’s scary, because of the one bad experience. I definitely always want the moral support to get through that :).
Yeah, god, it actually really shakes me up.
The fact my parents showed no concern probably didn’t help.
I also woke up in agony once after a knee surgery, in the bedroom next to theirs. Was screaming out for ages and ages, no one came. Eventually threw my crutches as hard as I could against the shared wall, nothing. They eventually came after about half an hour. Said they hadn’t heard!
Yet my dad is always the lightest sleeper ever, he always wakes up at small sounds in my experience.
A bomb could go off in my family house and nobody would give a shit! 🤦♂️
In that context yeah, your response definitely makes sense.
Robin – it seems from what you’ve put you have emetaphobia.
I’m sorry for all that you went through.
What causes the initial damage, is not actually the being sick, although sometimes that also can like in your case, but also the circumstances and environment surrounding that episode of illness or nausea, or vomiting.
People are generally more vulnerable when feeling/being ill and it’s natural to want comfort or support at that time.
What the child says when the parents or caregivers are not doing anything or being of support of comfort or even abusing the situation, is:
I am really scared.
I am hurting.
I am vulnerable.
I am afraid.
Please will you give me comfort?
I need help, please.
That’s one part of the what the child says, but another part says:
Why are you ignoring me?
Can you not see I need help here?
Hello? Please?
I don’t understand, do you not care?
Is this wrong?
I absolutely hate this
This is the worst feeling in the world.
I never want this to happen again.
And therefore increases the change of emetaphobia.
Thank you for your reply! Perhaps, although it’s not something that has a significant impact on my life, so I don’t feel the need to label it in this case. But it’s interesting that this kind of issue can be so common (and more severe) that there’s a label. Perhaps my experiences with nurses being extremely helpful has counteracted some of that childhood fear :).
“Why are you ignoring me?
Can you not see I need help here?
Hello? Please?
I don’t understand, do you not care?
Is this wrong?
I absolutely hate this
This is the worst feeling in the world.
I never want this to happen again.”
Oh, you don’t know how many times I shouted and screamed these things out, literally, during my childhood 😅. Just reading them gives me flashbacks, haha.
I know, because it was the same for me too.
It is important for the child within us to be heard now.
😊
Thank you very much for your empathetic response! 💙
You actually helped me to understand it myself too more…so thank you 👊
Thanks! That is awesome. You’re welcome!🤘.
A condition I’ve had since childhood! Interesting you would bring this up when I was just talking to someone about this condition.
The only thing I remember happening in childhood related to vomiting is when I was really young my mom left me at a neighbor’s house while she went out and I got sick and started throwing up so bad that I couldn’t even stand up without vomiting. I think that experience of being so sick I had no control over it and my mom not being around to comfort and take care of me really made me afraid of throwing up. I was embarrassed about it too at the time, because I didn’t want to throw up all over our neighbor’s house but I couldn’t control it. He ended up putting me out on the porch so I wouldn’t keep throwing up inside lol.
Luckily, I don’t throw up easily. In fact, I haven’t actually thrown up any real substance since I was 16 (over 20 years ago now), although I have had dry heaves a few times. I was actually worried about my seeming inability to throw up, but my GI Dr says it isn’t that unusual and if I really had to get something out my body would do what it needs to do.
It’s really interesting how many people here on WordPress have it. I’m not sure if it’s more common people realize, or if there’s just a higher than typical concentration of people on WordPress.
Yeah, who knows. I’ve met quite a few people who have it to some extent, even if they don’t know there is a name for it.
Huh, interesitng.
I have never heard of this…thank you for sharing this interesting info! ❤️
I wrote my dissertation on emetophobia as I suffer from it myself and there was so little research on it – but I remember reading the studies on disgust and it was like someone had flicked a switch. I could reel off an endlessly long list of stuff that I’m disgusted by and up until then I thought I was just fussy 😂 There definitely needs to be more research done on the condition, despite how common it actually is it’s still met with the response “well, no one likes throwing up!” Thanks for sharing and raising some awareness 🙂 x
What’s really interested me since positing this is how many people have said they have it, and it’s so strange that something so common is under-researched.
Totally agree, I was shocked to learn that two people in my last job had it for one! x