Emetophobia and Eating Disorders

What is Emetophobia?

Emetophobia is a specific phobia that involves an intense fear of vomiting. It can occur in people of any age or gender, although it tends to occur more often in women and more acutely in adolescents. Sufferers may fear vomiting altogether, fear vomiting in public, or fear witnessing someone else vomit. For many sufferers, it is not vomit per se of which they are afraid; rather, they fear some sort of loss of control, such as being unable to stop vomiting or even dying as a result.

People who experience emetophobia tend to get caught in an emetophobic “cycle.” The cycle begins with a sufferer being triggered by something that reminds her of vomiting—for instance, she sees a movie character vomit, or a coworker calls in sick. The trigger causes the sufferer to begin checking herself for symptoms of vomiting, or even feeling psychosomatic symptoms such as nausea or gagging. The worry that she herself might be about to vomit sets off intense anxiety, which she may try to assuage by leaving the public space, skipping a meal, or doing some other action that she believes will prevent her from vomiting.

Signs and Symptoms of Emetophobia

Like many phobias, this condition can severely impair the quality of one’s life. In severe cases emetophobia can affect a sufferer’s job, social life, and relationships. Emetophobics may eventually begin to avoid situations that they associate with vomiting, such as eating certain types of food or being around sick people. They may be afraid to use public bathrooms, to travel, or to be around small children and animals, all because these may involve the possibility of vomiting or seeing vomit.

Other symptoms include:

  • Excessive cleanliness
  • Fear of eating outside one’s home or eating food that one hasn’t prepared herself
  • Fear of prescription medications that list vomiting as a side effect
  • Fear of drinking alcohol
  • Experiencing somatic symptoms of anxiety, such as nausea, stomach cramps, and diarrhea
  • Avoiding amusement parks

What ISN’T Emetophobia?

People with emetophobia may be misdiagnosed with a number of psychiatric conditions before receiving the correct diagnosis, because the behaviors associated with their phobia mimic the symptoms of many other conditions. For example, they may be diagnosed as having obsessive compulsive disorder if they engage in excessive hand-washing—however, this behavior serves only to prevent germs that cause sickness. They may also be diagnosed with social anxiety disorder if they avoid being in public, when in fact their avoidance is strictly due to their fear of vomiting in public or witnessing others vomiting.

They may also be diagnosed with anorexia nervosa.

Emetophobia and Eating Disorders

EmetophobiaSome people with emetophobia resort to restricting their food intake, because they believe that they won’t vomit if their stomachs are empty. This may mean eating only foods they deem “safe”—that is, foods they believe will not induce vomiting—or skipping meals altogether.

Emetophobics who restrict their food intake to the point of extreme weight loss may ultimately develop anorexia nervosa, which in its most basic definition is an eating disorder that leads to greater weight loss than is considered healthy. However, anorexics and emetophobics differ with regard to their psychological symptoms. A key feature of anorexia is the intense fear of weight gain, which means that people with anorexia restrict calories specifically to lose or to not gain weight. The key feature of emetophobia, on the other hand, is the fear of vomiting. For emetophobics, any weight loss is usually unintentional.

Even though they don’t exhibit the psychological symptoms of anorexia, people with emetophobia can experience the same medical consequences to restrictive eating and starvation as people with eating disorders do. Consequences include slowed heart rate and low blood pressure, fainting and dizziness, thinning hair, osteopaenia and osteoporosis, depression, social withdrawal, and other symptoms of anorexia.

Treatment

Like other phobias, typical treatment for emetophobia is exposure therapy. This does not necessarily involve putting sufferers in the presence of vomit, but rather exposing them to situations that they have avoided to forestall their exposure to vomit. For instance, they may be asked to use a public bathroom, sit in the back seat of a car, or watch a movie in which a character vomits.

In severe cases or for cases in which the patient has comorbid psychiatric disorders, anti-anxiety medication may be warranted. Medication can help to reduce the most intense symptoms of anxiety during the initial phases of treatment. However, because patients may fear that these medications will cause vomiting as a side effect, some clinicians advise also prescribing an anti-emetic so that the patient can be reassured that they will not vomit.

 

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Written by Joanna Kay – 2015

Additional Reading:

Anxiety Coach: Emetophobia

ADAA: Specific Phobias

Emetophobia Fact Sheet

MedlinePlus: Anorexia