Fear of vomiting, also known as emetophobia, is one of the lesser-known but extremely troublesome disorders. While the topic may seem trivial or even irrelevant, for those suffering from emetophobia, daily functioning can become a real challenge. The anxiety experienced, associated with the possibility of vomiting, makes life full of evasions, restrictions and constant mental tension. In this article, we will take a closer look at this specific type of anxiety, analyzing its causes, symptoms and effective treatment options.
What is a phobia?
Phobia, a word derived from the Greek language, where phobos means fear. Although anxiety has always accompanied humans, the term is used in psychiatry and psychology to refer to specific anxiety disorders. Anxiety can be a symptom of many somatic diseases, it appears in people struggling with addictions, but it can also be the result of neurotic disorders.
Types of phobias
In medicine there are many types of phobias, they include:
- agoraphobia, which is a disorder associated with being out in the open; it can run with or without pronounced panic attacks;
- social phobias;
- specific phobias, so-called isolated phobias;
- other anxiety disorders.
Specific phobias, isolated anxiety
Isolated phobias are a broad group of disorders. *Epidemiological studies suggest that, overall, the incidence of specific phobias is extremely high, at about 7-13% per 12 months.
In the literature, the triggers of irrational fear reactions are classified into four groups, related to: forces of nature, animals, resulting from a specific situation or related to blood (including those occurring at the sight of infection or wounds). This presentation makes it possible to distinguish many, often very unusual disorders in the group of specific phobias. Some are diagnosed extremely rarely. Arachnophobia, claustrophobia or acrophobia are terms that do not need to be explained, but there are also other disorders, such as aerophobia, or fear of air, lepidopterophobia (fear of butterflies), brontophobia (fear of thunderstorms), ancaptophobia (fear of wind), ergophobia (fear of work), ambulophobia (fear of walking) and many others.
Emetophobia – what is the problem?
One unusual example of a phobia is emetophobia, or fear of vomiting In Greek, emetikós means a user of vomiting remedies. People struggling with anxiety disorders experience anxiety in the context of vomiting. Most often, it doesn’t matter whether the vomiting is their own or that of others. Often, the mere imagination can also trigger an anxiety attack, such as panic anxiety.
Symptoms of emetophobia
The catalyst for the onset of a phobic reaction is both the mere sight of vomiting, the imagined activity, and the person’s subjective premonition that he or someone near him is about to vomit. Symptoms of emetophobia are:
- shortness of breath;
- a feeling of revulsion, associated with the imagined fearful situation;
- panic attack.
A symptom that affects functioning
When discussing the symptoms of emetophobia, a distinction is made between mental and physical complaints.
The most characteristic mental symptoms are anxiety and strong emotional tension. The risk of triggers makes a person cranky and has trouble focusing and concentrating. Often, the state of tension accompanies him for a long time, he remains on alert, vigilant, and his attention is directed to early detection of a potential threat. Remaining in constant emotional tension makes a person irritable, nervous. Sleep disorders and a characteristic way of thinking – catastrophic – also appear. When there is actual contact with the object, phenomenon or situation that is the cause of the phobia, the person loses a sense of security and control, feelings of panic increase.
Very characteristic physical symptoms may also appear. Heart rhythm disturbances, described as a feeling of palpitations, may occur in connection with the phobia. Among the frequently reported somatic symptoms are respiratory complaints – shortness of breath, shallow and uneven breathing. On the gastrointestinal side, the most characteristic are gastrointestinal disorders (nausea, vomiting, pain, cramping). In an emergency situation there is a feeling of heat, often accompanied by pain and dizziness. When they are very intense they can even lead to fainting. Fear of vomiting can cause specific sensory experiences, such as blurring of vision, flashes in front of the eyes, tinnitus or chills. In severely aggravated phobias, abnormalities in muscle tone are also observed, and temporary stiffness causes pain felt throughout the body.
A characteristic feature of phobias, including fear of vomiting, is that once the threat has passed, the person feels very tired, even exhausted. Often there is a very high level of sleepiness.
Causes of emetophobia-fear of vomiting
The causes ofemetophobia- fear of vomiting ( SPOV) disorders are not fully understood. Specialists surmise that their source is traced to an individual’s experiences. According to studies, the fear of vomiting often develops in childhood, lasts about 25 years on average and occurs almost exclusively in women. The gender difference may be a result of beliefs about vomiting itself; men are more likely to see vomiting as something that will help them feel better, as a cleansing function.
The research also underscores the link between increased internal locus of control and fear of vomiting. This is consistent with the experience of SPOV sufferers who are afraid of losing control and who may tell themselves that they can avoid vomiting by controlling the reflex response. The researchers found that people with anxiety have an increased tendency to shy away and high sensory sensitivity.
Diagnosis of emetophobia
Any anxiety disorder should be consulted with a specialist. In the case of emetophobia, it is very important to rule out other disorders. There is considerable overlap between SPOV, especially with health anxiety and obsessive-compulsive disorder.
The basis for diagnosis is to determine whether the severe anxiety present is directed at specific situations or objects. In the case of phobias, the patient often tries to avoid stressful situations by eliminating anxiety triggers as much as possible. These protective reactions require many sacrifices, the risk of exposure to factors that activate the phobic reaction makes such a person constantly feel fear.
A very characteristic symptom of phobia is that the reaction occurs immediately after contact with the triggering factor and is repetitive. Most often, the fear experienced is extremely intense, and at the same time it is even irrational, inadequate to the threat. An important issue in the diagnosis of phobias is the duration of symptoms ( at least 6 months).
Fear of vomiting. How to treat emetophobia?
Properly diagnosed emetophobia can be effectively treated. Due to the nature of its symptoms, it is a condition that is mainly treated with psychotherapy. In practice, two types of psychotherapy are used in working with the patient:
- according to the behavioral-cognitive concept, its essence is to carry out activities based on 4 pillars (exposure, reduction of protective behaviors, change of focus factors, and consequently change of cognitive patterns);
- based on psychodynamic therapy, at the core of which are assumptions similar to psychoanalysis.
Previous studies and observations prove that the cognitive-behavioral model has real, high effectiveness in working with people diagnosed with specific phobia. In this variant, it is necessary to take into account the factors that cause specific disorders. It is necessary to realize that a person creates reality by assigning meaning to specific stimuli. Understanding this pattern makes it possible to influence the modification of learned behavior.
Although psychotherapy is the cornerstone of phobia treatment, it is not the only method. In people whose anxiety is particularly severe and episodes of acute panic attacks are observed, the doctor may decide to include pharmacotherapy. Among the preparations used are:
- serotonin reuptake inhibitors;
- monoamine oxidase inhibitors;
- selective serotonin and norepinephrine reuptake inhibitors;
- tricyclic antidepressants;
- anxiolytic drugs.
In the initial phase of therapy, preparations from the benzodiazepine group may also be used, whose function is mainly to reduce perceived anxiety.
In practice, for many people, effective treatment requires the simultaneous combination of an appropriate variant of psychotherapy with properly adjusted medications. It is important to remember that they are selected by a psychiatrist. Medications cannot be used “on their own”, the treatment regimen and therapeutic dose is determined by the doctor, taking into account the specific situation of the patient, including the severity of symptoms, individual health situation, comorbidities, etc.
Cognitive-behavioral therapy in the treatment of emetophobia
In cognitive-behavioral therapy (CBT), specialists reach for a variety of approaches, tailoring the choice to the patient’s individual situation, the severity of symptoms, and the cause of the disorder. CBT therapy for the treatment of emetophobia is conducted by qualified psychotherapists, whose task is to properly establish a therapy plan.
Cognitive-behavioral therapy uses the following methods: psychoeducation, cognitive restructuring and also behavioral interactions. The therapist should normalize the experience of vomiting as an adaptive process that improves the client’s chances of survival in the event of illness. Information can be given on how vomiting is beneficial and prevents disease by getting rid of toxins.
It is also necessary to take steps to reduce protective mechanisms, as well as systematic, regular exposure to internal and external stimuli that cause phobia. An analysis of specific phobia treatment studies has shown that in vivo exposures provide the most evidence of effectiveness.
The main principle of graded in vivo exposure is to choose both:
- internal vomiting signals past memories of vomiting, thoughts, images or sensations associated with vomiting,
- external vomiting signals that are avoided (e.g., the smell of vomit).
In exposure therapy, we gradually expose the patient to the exposures while minimizing safety-seeking behavior and focusing attention and monitoring nausea.
There are different responses to the current threat of impending vomiting that are subject to therapeutic interactions.
- Avoiding thoughts and images of oneself or others vomiting and interoceptive cues that trigger nausea.
- Avoiding external threats that may lead to vomiting or nausea.
- Excessive vigilance in monitoring external threats (e.g., people who might get sick or looking for an escape route).
- Focused attention to monitor nausea.
- Preoccupation with and planning mental escape routes for vomiting by others.
- An exaggerated sense of responsibility and belief in one’s ability to refrain from vomiting.
- Behaviors associated with seeking safety, including compulsive checking and seeking reassurance from loved ones.
In CBT therapy, all of these reactions are interpreted as areas of perpetuating anxiety, so in view of this, I work to minimize these reactions in therapy.
“I’m afraid I’m going to vomit.” The impact of fear of vomiting on daily life
Fear of vomiting can severely hamper life and daily functioning. Irrational fear causes people struggling with the phobia to make efforts to avoid risky situations. Thus, they try to limit contact with people they suspect may vomit. Often a kind of “risk group” for them are children or people in a state of alcoholic intoxication. They try not to stay in crowded places, so they forgo cultural events, such as concerts, and avoid traveling by public transportation. They identify travel by boat or airplane as a danger, due to the higher risk of vomiting (in themselves or other passengers).
A big problem is the conviction that certain food groups can lead a person to vomiting. Sometimes certain products are identified as unsafe, such as cold cuts or meat – they can raise concerns about whether they are actually fresh. Such behavior leads to nutritional restriction, which can bring health problems. A properly adjusted, balanced diet is the foundation of health. It helps provide essential nutrients.
The fear of vomiting in young women can be so strong that they will consciously put off the decision to become mothers, fearing that they will not be able to cope with the anxiety. During the first trimester of pregnancy, many ladies struggle with nausea and vomiting, and unfortunately, but it is impossible to predict if and in whom such complications will occur.
The comfort of life of those struggling with the fear of vomiting largely depends on how they have developed the ability to avoid threatening situations. It is worth being aware that such action is not a cure, the problem still exists and at any time can cause the onset of aggravated symptoms, including an attack of acute panic. In order to avoid extreme situations, it is best to opt for appropriate treatment and really get the symptoms under control.
Bibliography:
- K. Adamczyk, D. Adamczyk, R. Wójcik, U. Fałkowska, E. Soroka, Rare specific phobias – types and treatment, https://journals.viamedica.pl/psychiatria/article/download/58177/45556
- A. Nitka-Siemińska, Anxiety disorders – characteristics and principles of treatment https://journals.viamedica.pl/forum_medycyny_rodzinnej/article/download/37816/26730
- *https://www.cambridge.org/core/journals/the-cognitive-behaviour-therapist/article/cognitive-behaviour-therapy-for-a-specific-phobia-of-vomiting/C8E04C5AAAB902B63560EA0E0827E393