What is emetophobia, or fear of vomit?
Emetophobia is a specific phobia that involves an extreme fear of vomiting, seeing vomit, watching other people vomit, or feeling sick. People with emetophobia often live with anxiety and engage in behaviors that affect their daily life.
Most people don’t like vomiting, but rarely does it overtake their thoughts. People with emetophobia, on the other hand, spend a lot of time worrying about vomiting, even if they or those around them don’t feel ill. Just the thought that someone could vomit is sometimes enough to cause intense distress.
This ongoing distress can have a big impact on how you live. For example, you may not eat out, avoid crowded places or travel, avoid new foods, stay away from people who may be sick, or constantly monitor your own health. For many people with emetophobia, the condition influences almost every part of their life.
While the anxiety caused by emetophobia might feel overwhelming, the condition is usually treatable with the help of a therapist.
Having emetophobia means that you likely make significant efforts to avoid being in situations where you or someone else might throw up. You may find yourself building your days around avoiding these scenarios.
Other behaviors that might point to emetophobia include:
- eliminating foods or places that you associate with vomiting
- not eating new foods or drinking new beverages
- eating slowly, eating very little, or eating only at home
- smelling or checking food often to make sure it hasn’t gone bad, or throwing away food before it expires
- overcooking food
- not touching surfaces that could have germs that lead to illness, such as doorknobs, toilet seats or flushes, handrails, or public computers
- avoiding hospitals or clinics where people might be sick or might vomit
- using antacids to prevent feelings of nausea or stomach upset before they occur
- excessively monitoring your own health through temperature taking and similar activities
- washing hands, dishes, food, and food preparation tools excessively
- avoiding drinking alcohol or taking medication that could cause nausea
- avoiding travel, school, parties, public transportation, or any crowded public space
- avoiding the use of certain words, like “vomit” or “puke”
- checking on the wellness of others and avoiding them if they appear sick
- avoiding bad smells like garbage or soiled items
- having trouble breathing, tightness in the chest, or increased heart rate at the thought of vomit
These behaviors are accompanied by mental health symptoms, such as:
- extreme fear of seeing someone vomit
- extreme fear of having to throw up and not being able to find a bathroom
- extreme fear of not being able to stop throwing up
- extreme fear of choking on vomit
- distress at the thought of embarrassment because of throwing up
- panic at the thought of not being able to leave a crowded area if someone vomits
- anxiety and distress when feeling nauseated or thinking about vomit
- extreme fear of becoming sick and going to the hospital
- persistent, irrational thoughts linking an action to a past experience involving vomit (for example, avoiding any plaid clothing after throwing up in public while wearing a plaid shirt)
Keep in mind that people often experience phobias, including emetophobia, in different ways. For example, you may worry more about vomiting yourself than seeing others vomit.
In addition, people with specific phobias are usually aware that their reaction to the object of their phobia isn’t typical. For example, you might do everything in your power to avoid eating food cooked by someone else, but you know this isn’t how most people live.
This knowledge generally isn’t helpful and often just makes the experience more distressing. It can also lead to feelings of shame, causing you to hide your symptoms from others.
Specific phobias often develop after a specific incident. The incident creates an association between a thing — which may be an object, a situation, or an event — and fear.
In the context of emetophobia, this might involve:
- getting extremely sick in public
- having a bad case of food poisoning
- vomiting during important holidays
- seeing someone else throw up
- having someone vomit on you
- having a panic attack during an incident of vomiting
Emetophobia can also develop without a clear cause, leading experts to believe that genetics and your environment may play a role. For example, having a family history of specific phobias or other anxiety disorders can increase your risk.
It also often begins in childhood, and some adults who have lived with emetophobia for decades may not remember the first triggering event.
If you can’t pinpoint any experience that might have led to your emetophobia, don’t worry. Treatment can still help even if you don’t know what originally caused the phobia.
What causes nausea and stomach pain?
Living with emetophobia or generalized anxiety often means experiencing nausea, dizziness, and feelings of sickness. These are some physical signs of panic attacks and many types of anxiety.
For someone with emetophobia, it’s challenging to see nausea and stomach pain as anxiety symptoms and not signs they may vomit.
It can be a vicious cycle, where the symptoms of emetophobia make the experience worse.
By working with a therapist, or adopting techniques of mindfulness or meditation, you may see your anxiety symptoms decrease and therefore experience less nausea and stomach pain.
Some clinicians are beginning to combine mindfulness with cognitive and behavioral treatments. A 2020 study with 33 participants found short periods of meditation 6 days a week over 8 weeks reduced indicators of stress, anxiety, and heart rate variability.
Extreme fear or anxiety around a particular object or situation is typically diagnosed as a phobia when it starts to cause distress that negatively affects your life at home, school, or work.
Other criteria for an emetophobia diagnosis include:
- a significant fear and anxiety response that happens immediately after seeing or thinking about vomit
- active avoidance of situations that could involve vomit
Some of the main symptoms of emetophobia involve obsessive-compulsive behavior, so emetophobia might first present as obsessive-compulsive disorder (OCD).
Emetophobia can also appear similar to agoraphobia. The fear of vomiting or seeing other people vomit can become so strong that it leads to panic, making it difficult or even impossible to leave your house.
But if your only reason for avoiding public places is a fear of vomit, you’ll likely be diagnosed with emetophobia, not agoraphobia.
Psychologists can treat emetophobia with talk therapy by working through thought patterns about vomit. Many therapists also expose people gradually to vomit through videos and similar techniques.
Phobias don’t always require treatment. In some cases, people find ways to work around them. But some feared objects or situations, such as elevators or swimming, are easier to avoid than others.
Because emetophobia can cause a number of distressing behaviors that impact essential parts of your life, like eating or seeking medical treatment, you may find it hard to work around this phobia.
In general, it’s a good idea to seek help if your phobia affects your quality of life or you find yourself wondering how things would be different if you didn’t have a phobia.
Most people find that exposure therapy and, in some cases, medication, provide relief.
Exposure therapy
Exposure therapy is considered to be one of the most effective treatments for specific phobias. In this type of therapy, you’ll work with a therapist to slowly expose yourself to what you’re afraid of.
For emetophobia treatment, this might involve eating new food in a restaurant or spinning until you start to feel slightly nauseous. As you try these things, you’ll also be given techniques to help you cope with feelings of anxiety and fear during the exposure.
If this sounds overwhelming, consider looking into systematic desensitization. This is a type of exposure therapy that involves tackling your fears over the course of multiple exposures that gradually become more intense.
Cognitive behavioral therapy (CBT)
CBT is a type of therapy that helps you learn how to identify and challenge negative thoughts that cause distress.
CBT for specific phobias also involves exposure to your phobia. As you’re gradually exposed, you’ll work with your therapist to address the anxiety and distress you experience when thinking about vomiting and learn ways to cope with it on your own.
Results of a 2016 study looking at 24 people with emetophobia suggest CBT has benefits as a treatment. This randomized controlled trial was the first of its kind, so more research may help support this finding.
HOW TO FIND A THERAPIST
Finding a therapist can feel daunting, but it doesn’t have to be. Start by asking yourself a few basic questions:
- What issues do you want to address? These can be specific or vague.
- Are there any specific traits you’d like in a therapist? For example, are you more comfortable with someone who shares your gender?
- How much can you realistically afford to spend per session? Do you want someone who offers sliding-scale prices or payment plans?
- Where will therapy fit into your schedule? Do you need a therapist who can see you on a specific day of the week? Or someone who has nighttime sessions?
Next, start making a list of therapists in your area. If you live in the U.S., head over the the American Psychological Association’s therapist locator.
Concerned about the cost? Our guide to affordable therapy can help.
Medication
Since emetophobia is a relatively rare mental health condition, there’s no standardized medication treatment. It’s also hard to use medication to make specific phobias go away, but certain drugs may help reduce symptoms of anxiety or panic.
Beta blockers can help prevent increased blood pressure and heart rate and other physical anxiety symptoms that result from adrenaline. These are generally taken before going into situations that might trigger your phobia.
Benzodiazepines are sedatives that can help you feel less anxious, but they can be addictive and aren’t recommended for long-term use.
A drug called d-Cycloserine (DCS) may have benefits when used during exposure therapy. A 2017 literature review of 22 studies looking at people living with anxiety, OCD, or post-traumatic stress disorder (PTSD) found that DCS appeared to increase the effectiveness of exposure therapy.
However, exposure therapy is generally very effective for treating phobias on its own, so supplementing therapy with a drug may not be necessary.
Emetophobia can have a big impact on your day-to-day activities, but treatment can help you to regain control. It may take some time to find the right therapist and treatment approach for your needs, but it’s worth it to alleviate the distress in your life.
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