Kylie had always been an anxious child. She didn’t like being separated from her mother, Sidney. As a three-year-old, she developed a persistent cough, a vocal tic, after a bout with walking pneumonia. Soon there were other compulsive behaviors, like asking repetitive questions.
In pre-K, Kylie threw up after eating canned peaches and, from then on, became increasingly fearful of vomiting or being around vomit. “It was very insidious,” says Sidney, who has a master’s degree in special education. “I think her mind was working and taking these little baby steps down this path of fear almost.”
One night, Kylie told her mother she wasn’t going to wear her pajama top to bed. Soon, she was refusing to wear any pajamas, and she slept on top of the covers. Then she dragged a comforter into her closet and slept on that. Next came the pillow, which she used to prop herself up into a sitting position while she slept. She was five years old.
Kylie’s parents tried reassuring her. They tried using rewards. If they attempted to march her over to the bed, Kylie panicked. “Kicking, screaming, punching,” says Sidney. “It was like, imagine if you’re going to be murdered imminently and you knew that.”
Kylie’s problem is called emetophobia, or the severe fear of vomiting or seeing others vomit, and it’s surprisingly common among both children and adults.
Defining Emetophobia: More Than Just Disliking Vomit
Emetophobia is defined as a severe and irrational fear of vomiting. It is more than just a simple dislike of vomiting; it’s a phobia that can significantly disrupt a person’s life. Individuals with emetophobia experience extreme anxiety related to vomiting, which can manifest in various ways, from avoiding certain foods or places to obsessive behaviors aimed at preventing vomiting. This fear can be directed at vomiting themselves or witnessing others vomit.
How Emetophobia Develops: Triggers and Early Signs
Experts estimate that a significant percentage of children presenting with anxiety symptoms also exhibit emetophobic tendencies. Like Kylie, many individuals who develop emetophobia have an existing anxious temperament. The phobia can be triggered by a specific event, such as a personal experience of vomiting or witnessing others vomit, especially during childhood. This could be from seeing other children sick at school or experiencing a bout of illness themselves.
These initial experiences can lead to the development of associations between environmental cues and vomiting. Dr. Jerry Bubrick, a former clinical psychologist at the Child Mind Institute, explains, “They start to associate cues in the environment that they remember with vomiting, and then start to become fearful with those cues.” Gradually, individuals may begin to avoid places, foods, or situations they associate with nausea or vomiting. This avoidance can extend to refusing to use the word “vomit” itself, indicating the escalating nature of the fear. Dietary restrictions often become a prominent feature, with individuals becoming increasingly strict about what they eat, often avoiding unfamiliar foods or those perceived as potential triggers for illness. Compulsive checking of food expiration dates is also common, and in severe cases, these restrictive eating habits can lead to malnutrition.
The Escalation of Emetophobia: From Discomfort to Disruption
Emetophobia often starts subtly and can escalate over time if left unaddressed. A seemingly minor incident, like food poisoning, can act as a catalyst, transforming a general anxiety into a focused phobia. Dr. Bubrick recounts an example of a young patient whose food poisoning experience on Thanksgiving led to a widespread avoidance of not just Thanksgiving leftovers, but any food associated with the holiday. This avoidance quickly expanded to include clothes worn during the illness and even rooms where she had been before and after vomiting, illustrating the phobia’s capacity to generalize and impact various aspects of daily life.
Parents may initially underestimate the severity of emetophobia, often dismissing early signs as phases that children will outgrow. However, without intervention, the phobia tends to intensify, becoming increasingly disruptive. Dr. Bubrick notes, “Normally, like all phobias, it starts out kind of small, and it builds, and builds and builds. But when it’s kind of small, parents are like, ‘Well, it’s not that big of a deal. They’ll grow out of it. They’ll come around.’ But then, over time, it just gets to the point where parents are like, ‘This is crazy. We can’t live like this anymore.’”
A common parental response is to comfort and reassure their child, but while well-intentioned, this reassurance can inadvertently worsen the phobia. Similar to scratching an itch, reassurance provides temporary relief but reinforces the anxiety in the long run. Avoidance of triggers and seeking constant reassurance are counterproductive, strengthening the phobia instead of diminishing it.
The Dismissal and Shame Surrounding Emetophobia
The lack of understanding surrounding emetophobia extends beyond parents. Healthcare professionals, unfamiliar with the phobia, may also misinterpret symptoms, attributing them to defiance, control issues, or attention-seeking behaviors, as was the case with Kylie. This misunderstanding can lead to significant delays in diagnosis and appropriate treatment.
Furthermore, shame plays a significant role in why emetophobia often goes untreated, sometimes persisting into adulthood. Anna S. Christie, a counselor specializing in emetophobia, shares her personal experience of suffering from the phobia since childhood and facing dismissal from adults. This dismissal led to feelings of shame and secrecy, preventing her from seeking help for decades. “Even with my own mom, I would just be told it’s ridiculous, so very quickly I stopped telling anybody about it,” Christie explains. It wasn’t until her mid-forties that she found information online and finally sought therapy. This highlights the importance of recognizing and validating emetophobia as a legitimate and treatable condition, rather than dismissing it as irrational or attention-seeking.
The Connection Between Emetophobia and OCD
While classified as a specific phobia, emetophobia shares significant overlap with Obsessive-Compulsive Disorder (OCD). Dr. Bubrick estimates that a substantial percentage, between 30 to 50 percent, of children with emetophobia also exhibit OCD symptoms. In Kylie’s case, her emetophobia was intertwined with severe OCD, manifesting in intrusive thoughts and fears of harming herself or others.
The link between emetophobia and OCD lies in the underlying anxiety and the compulsive behaviors developed to manage that anxiety. In OCD, compulsions are rituals performed to reduce anxiety caused by obsessions. In emetophobia, avoidance behaviors and strict routines around food and hygiene can be seen as compulsions aimed at preventing the feared outcome of vomiting. This connection underscores that emetophobia is often more complex than a simple phobia and may require treatment approaches that address both phobic and obsessive-compulsive elements.
Effective Treatment: Exposure and Response Prevention Therapy for Emetophobia
The primary and most effective treatment for emetophobia is Exposure and Response Prevention (ERP) therapy. ERP is a type of cognitive behavioral therapy (CBT) that involves gradually exposing individuals to the source of their fear in a safe and controlled environment, while preventing their usual avoidance or safety behaviors (response prevention).
In ERP for emetophobia, a therapist works with the individual to create a fear hierarchy, ranking anxiety triggers from least to most distressing. Treatment begins with the least anxiety-provoking situations and progresses incrementally. For someone with emetophobia, this might start with writing the word “vomit,” then talking about vomiting, looking at cartoon depictions, then photographs, and potentially even being around simulated vomit. The key is to experience the anxiety in these situations without resorting to avoidance behaviors.
Dr. Bubrick explains the process: “When we expose patients systematically to things that they’re afraid of, without allowing them to push it away, their anxiety will go up and up and up, peak, and it’ll come down by itself.” Through repeated exposure, individuals learn that their anxiety naturally subsides over time and that the feared outcome is not as catastrophic as they imagined. This repeated exposure leads to a “cognitive shift,” where the phobia’s grip weakens. ERP helps break the cycle of avoidance and reassurance-seeking that maintains and strengthens emetophobia.
Kylie’s successful treatment involved ERP therapy over a couple of years, alongside medication. While she still manages her emetophobia, she has made remarkable progress, attending overnight camp and venturing out with confidence. Her story illustrates the potential for recovery and improved quality of life with appropriate treatment.
Frequently Asked Questions About Emetophobia
What exactly is emetophobia?
Emetophobia is the phobia specifically related to vomiting. This fear can encompass vomiting oneself or seeing others vomit and can lead to significant avoidance behaviors and anxiety.
Is emetophobia common?
Yes, emetophobia is surprisingly common in both children and adults. It is often underreported and misunderstood, but many individuals struggle with this phobia.
How can you overcome emetophobia?
Exposure and Response Prevention (ERP) therapy is the recommended treatment for emetophobia. This therapy helps individuals gradually confront their fears in a safe setting and learn to manage their anxiety effectively. Cognitive Behavioral Therapy (CBT) and medication may also be used in conjunction with ERP.
