When you are Scared Sick, We can Help, by Sarah Tippit, MFT Intern

Shiva,* 30, has been struggling for years with a “sick” secret. Since she was a small child, she has experienced an intense, irrational, crippling fear that she might vomit.

To the uninitiated this may seem funny. Shiva’s family thinks it’s a ridiculous issue and Shiva should just get over her fear. However, Shiva finds herself experiencing ever more frequent intrusive thoughts and body sensations suggesting a vomiting episode is imminent, though she has not thrown up for many years. She calls friends and family members each night for a reality check, but their reassurance does not help. Her daily bouts of fear seem real. She is becoming more depressed. These days, she finds it easier to isolate herself at home and sip ginger ale (to settle her tummy), rather than engage in normal daily activities.

The debilitating condition known as “Specific Phobia of Vomiting (SPOV),” or “Emetophobia” is one of the most prevalent phobias in the world according to several researchers. Because so few studies have been conducted on SPOV the exact percentage of sufferers has not been specified. However estimates show that between 1.7 and 3.1 percept of men and 6 to 7 percent of women may be affected, with a total prevalence of 8.8 percent of people worldwide (unpublished study as cited in Philips, 1985; van Hout & Bouman, 2012).

David Veale, a London-based psychiatrist and author who specializes in Emetophobia and a related condition known as Obsessive Compulsive Disorder (OCD), states on his Web site, www.veale.co.uk, that there may be a genetic component to the condition. Unfortunately Emetophobia is considered to be chronic, yet many sufferers are too embarrassed to discuss their fears openly in order to receive much needed treatment. 

Shiva’s friends don’t know her secret and they often wonder why she acts so strangely: She chews on antacids every day as if they were breath mints. The odor of fast food sends her into a panic attack. She would rather leave a party early than use somebody else’s restroom. She won’t stand in a cafeteria line, take a road trip or fly on a plane. She eats very little, and all her friends know she will neither cook nor eat chicken. She avoids eating anything from a jar that has been opened and stored in the fridge. When she’s home she spends hours googling terms like “gag reflex” and “salmonella,” and analyzes every stomach gurgle as a possible sign of illness. She deeply desires children, yet, refuses to get pregnant because she’s afraid of morning sickness.

Her symptoms confounded several therapists she visited, who diagnosed her first with an eating disorder due to her weight loss and avoidance of food. Later they thought she had social anxiety due to her avoidance of social situations and fear of “what people might think.” She was once also diagnosed with agoraphobia because she feared leaving her home. According to an article by Emetophobia expert Lori Riddle-Walker, EdD, some people suffer for an average 25 years with Emetophobia before receiving proper treatment.

Though Emetophobia is categorized with other phobias in the DSM V, unique elements of the disorder require special treatments that address not only the cognitive processes contributing to the fear, but the physical and personal aspects of the phobia, according to Riddle-Walker. These include a form of Cognitive Behavioral Therapy known as Exposure and Response Prevention (ERP) which slowly and gradually exposes a sufferer to people, places or things that trigger the symptoms. ERP is conducted in collaboration with a client at her own pace and she is given the option to stop at any time if it feels too overwhelming. Clients might also find relief from ongoing intrusive thoughts and images of vomiting as well as somatic, or physical sensations, with a science-backed treatment involving bi-lateral stimulation of the brain known as “Eye Movement Desensitization and Reprocessing (EMDR). If you think you might suffer with Emetophobia, we understand, and we are here to help. For more information, call Sarah at 619-272-6858, ext. 707

*Shiva is not an actual client. Shiva represents a compilation of typical symptoms associated with emetophobia that we encounter during treatment. 

References:

Phillips, H. D. (1985). Return of fear in the treatment of a fear of vomiting. Behaviour Research and Therapy, 23(I), 45-52.

van Hout, W. J. P. J., Bouman, T. K. (2012). Clinical Features, Prevalence and Psychiatric Complaints in Subjects with Fear of Vomiting. Clinical Psychology and Psychotherapy, 19, 531–539.

Veale, D. “Emetophobia (Specific Phobia of Vomiting).” Retrieved from: http://www.veale.co.uk/resources-support/public-information/vomit-phobia/

Riddle-Walker L, Veale D, Chapman C, Ogle F, Rosko D, Najmi S, Walker L M, Maceachern P, Hicks T (2016). Cognitive behaviour therapy for specific phobia of vomiting (Emetophobia): A pilot randomized controlled trial. Journal of Anxiety Disorders., 43, 14-15.

Riddle-Walker, L., “How to Find a Therapist for Emetophobia Even if They Don’t Know What It Is.” Retrieved from: http://www.vphobia.com/wp-content/uploads/How-to-Find-a-Therapist-for-Emetophobia.pdf