What Is… Emetophobia (Vomiting Phobia)

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.