Emetophobia is a
phobia that causes overwhelming, intense
anxiety
Anxiety is an emotion which is characterized by an unpleasant state of inner turmoil and includes feelings of dread over anticipated events. Anxiety is different than fear in that the former is defined as the anticipation of a future threat wh ...
pertaining to
vomit
Vomiting (also known as emesis and throwing up) is the involuntary, forceful expulsion of the contents of one's stomach through the mouth and sometimes the nose.
Vomiting can be the result of ailments like food poisoning, gastroenterit ...
. This
specific phobia
Specific phobia is an anxiety disorder, characterized by an extreme, unreasonable, and irrational fear associated with a specific object, situation, or concept which poses little or no actual danger. Specific phobia can lead to avoidance of the o ...
can also include subcategories of what causes the anxiety, including a fear of vomiting or seeing others vomit.
[Lipsitz, Joshua D., ''et al''. "Emetophobia: Preliminary Results of an Internet Survey." ''Depression & Anxiety'' (1091–4269) 14.2 (2001): 149-52.] Emeteophobics might also avoid the mentions of "barfing",
vomiting
Vomiting (also known as emesis and throwing up) is the involuntary, forceful expulsion of the contents of one's stomach through the mouth and sometimes the nose.
Vomiting can be the result of ailments like food poisoning, gastroenteri ...
, "throwing up", or "puking."
It is common for those who suffer from emetophobia to be
underweight
An underweight person is a person whose body weight is considered too low to be healthy. A person who is underweight is malnourished.
Assessment
The body mass index, a ratio of a person's weight to their height, has traditionally been used ...
or
malnourished
Malnutrition occurs when an organism gets too few or too many nutrients, resulting in health problems. Specifically, it is "a deficiency, excess, or imbalance of energy, protein and other nutrients" which adversely affects the body's tissues ...
due to strict diets and restrictions they make for themselves. The thought of someone possibly vomiting can cause the phobic person to engage in
extreme behaviors to escape from their anxiety triggers, e.g. going to great lengths to avoid even potential situations that could even be perceived as "threatening".
Emetophobia is clinically considered an "elusive predicament" because limited research has been done pertaining to it.
[Davidson, Angela L., Christopher Boyle, and Fraser Lauchlan. "Scared to Lose Control? General and Health Locus of Control in Females with a Phobia of Vomiting." ''Journal of Clinical Psychology'' 64.1 (2008): 30-9.] The fear of vomiting receives little attention compared with other irrational fears.
The event of vomiting may make anyone with this peculiar phobia
flee the scene. Some may fear someone throwing up, while others may fear themselves throwing up. Some may have both. Some may have anxiety which makes them feel like they will throw up when they actually might not. People with emetophobia usually experience anxiety; they often may scream, cry, or if it is severe, possibly pass out when someone or something has been sick.
Presentation
Complications
Emetophobics may also have other complicating disorders and phobias, such as
social anxiety
Social anxiety is the anxiety and fear specifically linked to being in social settings (i.e., interacting with others). Some categories of disorders associated with social anxiety include anxiety disorders, mood disorders, autism spectrum disor ...
,
fear of flying
Fear of flying is a fear of being on an airplane, or other flying vehicle, such as a helicopter, while in flight. It is also referred to as flying anxiety, flying phobia, flight phobia, aviophobia, aerophobia, or pteromechanophobia (although a ...
and
agoraphobia. These three are very common, because people who fear vomiting are often terrified of doing so, or encountering it, in a public place. Therefore, they may restrict their social activities so they avoid any situations with
alcohol or dining out in
restaurants
A restaurant is a business that prepares and serves food and drinks to customers. Meals are generally served and eaten on the premises, but many restaurants also offer take-out and food delivery services. Restaurants vary greatly in appearan ...
. Emetophobics may also limit exposure to
children for
fear of germs. Women with this disorder delayed
pregnancy
Pregnancy is the time during which one or more offspring develops (gestation, gestates) inside a woman, woman's uterus (womb). A multiple birth, multiple pregnancy involves more than one offspring, such as with twins.
Pregnancy usually occur ...
or avoided it altogether because of the fear of
morning sickness. People who have a fear of vomiting may avoid
travel
Travel is the movement of people between distant geographical locations. Travel can be done by foot, bicycle, automobile, train, boat, bus, airplane, ship or other means, with or without luggage, and can be one way or round trip. Travel c ...
because of the worry about
motion sickness
Motion sickness occurs due to a difference between actual and expected motion. Symptoms commonly include nausea, vomiting, cold sweat, headache, dizziness, tiredness, loss of appetite, and increased salivation. Complications may rarely include de ...
or others experiencing it around them. They may also fear
roller coasters
A roller coaster, or rollercoaster, is a type of amusement ride that employs a form of elevated railroad track designed with tight turns, steep slopes, and sometimes inversions. Passengers ride along the track in open cars, and the rides are ...
for the same reason.
Lipsitz et al.'s findings also showed that those with emetophobia often have difficulties comfortably leading a normal life.
Many find that they have problems being alone with young children, and they may also avoid social gatherings where alcohol is present.
Retaining an occupation becomes difficult for emetophobics. Professions and personal goals can be put on hold due to the high anxiety associated with the phobia,
[Frank M. Dattilio. "Emetic Exposure and Desensitization Procedures in the Reduction of Nausea and a Fear of Emesis." ''Clinical Case Studies'' 2.3 (2003): 199-210.] and travelling becomes almost impossible for some.
In Lipsitz et al.'s survey, women with emetophobia said that they either delayed pregnancy or avoided pregnancy altogether because of the morning sickness associated with the
first trimester
Pregnancy is the time during which one or more offspring develops ( gestates) inside a woman's uterus (womb). A multiple pregnancy involves more than one offspring, such as with twins.
Pregnancy usually occurs by sexual intercourse, but ...
,
and if they did become pregnant, it made pregnancy difficult.
Other inhibitions on daily life can be seen in meal preparation.
Many emetophobic people also have specific "rituals" for the food they eat and how they prepare it.
They frequently check the freshness of the food along with washing it several times in order to prevent any potential sicknesses that they could contract from foods not handled properly.
They might overcook food products in fear of getting a
foodborne illness
Foodborne illness (also foodborne disease and food poisoning) is any illness resulting from the spoilage of contaminated food by pathogenic bacteria, viruses, or parasites that contaminate food,
as well as prions (the agents of mad cow disease ...
Eating out is also avoided, if possible, and when asked Lipsitz et al.'s survey, many felt they were underweight because of the strict
diets
The Low Countries comprise the coastal Rhine–Meuse–Scheldt delta region in Western Europe, whose definition usually includes the modern countries of Luxembourg, Belgium and the Netherlands. Both Belgium and the Netherlands derived their ...
that they put upon themselves.
In addition, many emetophobes avoid certain foods all together due to negative memories they may have with it relating to vomiting, and often eat a limited number of foods due to feeling like a vast majority of foods aren't 'safe'. Those who suffer from emetophobia might avoid anything that has an unpleasant smell or aroma, in fear of
This includes eating anything that might have a bad smell.
They might also avoid any sight that may induce vomiting in them or other people.
Emetophobia and anorexia
There are some cases where anorexia is the result of a fear of vomiting instead of the
typical psychological problems that trigger it.
In Frank M. Datillio's clinical case study, a situation where anorexia results from emetophobia is mentioned. Datillio says, "...in one particular case report, atypical anorexia in several adolescent females occurred as a result of a fear of vomiting that followed a viral illness as opposed to the specific desire to lose weight or because of an anxiety reaction.".
It is not clear that this should be termed "anorexia", however. In cases such as this, many emetophobes may also have
avoidant/restrictive food intake disorder
Avoidant/restrictive food intake disorder (ARFID) is a type of eating disorder in which people eat only within an extremely narrow repertoire of foods. It is a serious mental health condition that causes the individual to restrict food intake by ...
(ARFID), which is characterized by a general disinterest in food, sensory issues with food (taste, texture, look, smell) or a fear of adverse consequences from eating (vomiting or choking).
Oftentimes, this phobia is
comorbid
In medicine, comorbidity - from Latin morbus ("sickness"), co ("together"), -ity (as if - several sicknesses together) - is the presence of one or more additional conditions often co-occurring (that is, concomitant or concurrent) with a primary ...
with several others, making it necessary to deal with each phobia individually in order for the patient to recover fully. For example, it is common for people with emetophobia to also have a fear of food, known as
cibophobia, where they worry that the food they are eating is carrying
pathogens
In biology, a pathogen ( el, πάθος, "suffering", "passion" and , "producer of") in the oldest and broadest sense, is any organism or agent that can produce disease. A pathogen may also be referred to as an infectious agent, or simply a ger ...
that can cause vomiting. As such, people will develop specific behaviors that will, in their minds, make the food safe to eat, such as a ritualistic type of washing or the intentional overcooking of meat to avoid the intake of harmful pathogens. In time, these fears can become so ingrained that the person who has them can begin to experience anorexia nervosa. Again, it is not clear that this should be deemed "anorexia" rather than, for instance OCD, given this different presentation.
Emetophobia and obsessive-compulsive disorder
There are many cases of emetophobes can also suffer from
Obsessive–compulsive disorder
Obsessive–compulsive disorder (OCD) is a mental and behavioral disorder in which an individual has intrusive thoughts and/or feels the need to perform certain routines repeatedly to the extent where it induces distress or impairs general ...
. Both Emetophobia and
Obsessive–compulsive disorder
Obsessive–compulsive disorder (OCD) is a mental and behavioral disorder in which an individual has intrusive thoughts and/or feels the need to perform certain routines repeatedly to the extent where it induces distress or impairs general ...
have similar symptoms and behaviors according to Allen H. Weg, EdD. This includes:"obsessional thinking, hyper-awareness and reactivity, avoidance, compulsive rituals, and safety behaviors"
Often, Emetophobia will get misdiagnosed as
Obsessive–compulsive disorder
Obsessive–compulsive disorder (OCD) is a mental and behavioral disorder in which an individual has intrusive thoughts and/or feels the need to perform certain routines repeatedly to the extent where it induces distress or impairs general ...
.
Causes
There is a strong agreement in the scientific community that there is no specific cause of emetophobia. Some emetophobics report a traumatic experience with vomiting, always in childhood. Some suggest that individuals with emetophobia are victims of childhood abuse – sexual or physical. Although this is occasionally true, it seems to be no more prevalent than in the general population (Christie, 2004). Some experts believe that emetophobia may be linked to worries about lack of control. Many people try to control themselves and their environment in every possible way, but vomiting is difficult or impossible to control which can lead to anxiety or in other cases severe anxiety.
There are many factors that can cause a legitimate case of emetophobia. Dr. Angela L. Davidson ''et al''. conducted an experiment where it was concluded through various surveys that people with emetophobia are more likely to have an internal
locus of control
Locus of control is the degree to which people believe that they, as opposed to external forces (beyond their influence), have control over the outcome of events in their lives. The concept was developed by Julian B. Rotter in 1954, and has sinc ...
pertaining to their everyday life as well as health-related matters.
A locus of control is an individual's perception of where control comes from. Having an internal locus of control means that an individual perceives that they have their own control over a situation, whereas an external locus of control means that an individual perceives that some things are out of their control. She explains how this phobia is created through the locus of control by stating, "Thus far, it seems reasonable to stipulate that individuals with a vomiting phobia deem events as being within their control and may therefore find it difficult to relinquish this control during the act of vomiting, thus inducing a phobia."
In an internet survey conducted by Dr. Joshua D. Lipsitz ''et al.'' given to emetophobic people, respondents gave many different reasons as to why they became emetophobic. Among some of the causes listed were several severe bouts of vomiting as children and being firsthand witnesses to many severe vomiting in others due to
illness
A disease is a particular abnormal condition that negatively affects the structure or function of all or part of an organism, and that is not immediately due to any external injury. Diseases are often known to be medical conditions that a ...
,
pregnancy
Pregnancy is the time during which one or more offspring develops (gestation, gestates) inside a woman, woman's uterus (womb). A multiple birth, multiple pregnancy involves more than one offspring, such as with twins.
Pregnancy usually occur ...
or
alcoholism
Alcoholism is, broadly, any drinking of alcohol that results in significant mental or physical health problems. Because there is disagreement on the definition of the word ''alcoholism'', it is not a recognized diagnostic entity. Predomi ...
.
Treatments
Assessment
There are two assessment tools used to diagnose emetophobia: the Specific Phobia of Vomiting inventory and the Emetophobia Questionnaire. They are self-report questionnaires that focus on a different range of symptoms.
There have been a limited number of studies in regard to emetophobia.
Victims of the phobia usually experience fear before vomiting but feel less afterwards. The fear comes back, however, if the victim fears they will throw up again.
Medications
Also noted in the emetophobia internet survey was information about medications. People were asked whether they would consider taking anxiety
medication
A medication (also called medicament, medicine, pharmaceutical drug, medicinal drug or simply drug) is a drug used to diagnose, cure, treat, or prevent disease. Drug therapy ( pharmacotherapy) is an important part of the medical field and ...
to potentially help their fear, and many in the study answered they wouldn't for fear that the drugs would make them nauseated.
Others, however, stated that some psychotropic medications (such as
benzodiazepines and
antidepressants
Antidepressants are a class of medication used to treat major depressive disorder, anxiety disorders, chronic pain conditions, and to help manage addictions. Common side-effects of antidepressants include dry mouth, weight gain, dizziness, hea ...
) did help with their phobia, and some said
gastrointestinal medications were also beneficial.
Cognitive behavioral therapy
Cognitive behavioral therapy (CBT) is a psychological treatment that can be used to help calm anxiety. It is most commonly used to treat certain behaviors by changing people's actions and thoughts by using a variety of different techniques to figure out why the fear is occurring.
Exposure treatments
Exposure methods, using video-taped exposure to others vomiting,
hypnosis
Hypnosis is a human condition involving focused attention (the selective attention/selective inattention hypothesis, SASI), reduced peripheral awareness, and an enhanced capacity to respond to suggestion.In 2015, the American Psychologica ...
, exposure to nausea and exposure to cues of vomiting, systemic behavior therapy,
psychodynamic
Psychodynamics, also known as psychodynamic psychology, in its broadest sense, is an approach to psychology that emphasizes systematic study of the psychological forces underlying human behavior, feelings, and emotions and how they might relate t ...
and
psychotherapy have also shown positive effects for the treatment of emetophobia. However, in some cases it may cause re-traumatization, and the phobia may become more intense as a result.
Etymology
The
root word for emetophobia is ''
emesis
Vomiting (also known as emesis and throwing up) is the involuntary, forceful expulsion of the contents of one's stomach through the mouth and sometimes the nose.
Vomiting can be the result of ailments like food poisoning, gastroenteriti ...
'', from the Greek word , which means "an act or instance of vomiting", with ''-phobia'' meaning "an exaggerated usually inexplicable fear of a particular object, class of objects, or situation."
People with emetophobia frequently report a vomit-related traumatic event, such as a long bout of
stomach flu, accidentally vomiting in
public
In public relations and communication science, publics are groups of individual people, and the public (a.k.a. the general public) is the totality of such groupings. This is a different concept to the sociological concept of the ''Öffentlichk ...
or having to witness someone else vomit, as the start of the emetophobia. They may also be afraid of hearing that someone is feeling like vomiting or that someone has vomited or the mention of any word relating to the act of vomiting, usually in conjunction with the fears of seeing someone vomit or seeing vomit.
Notable people with emetophobia
* Jamie Borthwick
*
Charlie Brooker
Charlton Brooker (born 3 March 1971) is an English television presenter, writer, producer and satirist. He is the creator and co-showrunner of the sci-fi drama anthology series ''Black Mirror'', and has written for comedy series such as ''Bras ...
*
Denise Richards
Denise Richards (born February 17, 1971) is an American actress, television personality, and former fashion model. Her most recognized roles are Carmen Ibanez in ''Starship Troopers'' (1997), Kelly Van Ryan in '' Wild Things'' (1998) and Bond gi ...
*
Ashley Benson
Ashley Victoria Benson (born December 18, 1989) is an American actress, model, and singer. She is known for her role as Hanna Marin in the teen mystery-drama series ''Pretty Little Liars'' (2010–2017). Benson has starred in films, including ' ...
*
Christina Pazsitzky
Christina Pazsitzky (born June 18, 1976), known by her stage name Christina P,[About Chri ...](_blank)
*
Bella Ramsey
Isabella May Ramsey (born in September 2003) is an English actor. She is known for her breakthrough role as young noblewoman Lyanna Mormont in the HBO fantasy television series '' Game of Thrones'' (2016–2019), and subsequent television ro ...
*
Matt Watson
See also
*
List of phobias
The English suffixes -phobia, -phobic, -phobe (from Greek φόβος ''phobos'', "fear") occur in technical usage in psychiatry to construct words that describe irrational, abnormal, unwarranted, persistent, or disabling fear as a mental dis ...
*
Emetophilia
*
Mysophobia
Mysophobia, also known as verminophobia, germophobia, germaphobia, bacillophobia and bacteriophobia, is a pathological fear of contamination and germs. The term was coined by William A. Hammond in 1879 when describing a case of obsessive–com ...
*
Anthropophobia
*
Sitophobia
*
Nosocomephobia
Nosocomephobia is defined as the excessive fear of hospitals.
Dr. Marc Siegel, a physician and clinical professor at New York University Medical Center says, "It's perfectly understandable why many people feel the way they do about a hospital ...
*
Nosophobia
Nosophobia, also known as disease phobia or illness anxiety disorder, is the irrational fear of contracting a disease, a type of specific phobia. Primary fears of this kind are fear of contracting HIV infection (AIDS phobia or HIV serophobia), pul ...
*
Pharmacophobia
*
Tokophobia
Tokophobia is a significant fear of childbirth. It is a common reason why some women request an elective cesarean section. The fear often includes fear of injury to the baby, genital tract, or death. Treatment may occur via counselling.
It is a ...
*
Cibophobia
References
*{{cite web , last1=Goodman , first1=Ken , title=Fear of Vomiting, or Emetophobia , url=https://adaa.org/understanding-anxiety/specific-phobias/fear-of-vomiting , website=ADAA , access-date=July 14, 2022
Phobias
Vomiting