Fear of vomiting [hemetophobia]

Hemetophobia is defined as an excessive or irrational fear of the act or possibility of vomiting and is associated with a number of symptoms such as

  • Avoiding foods or smells associated with past vomiting episodes.
  • Holding one’s breath when around people.
  • Avoiding garbage and other smelly and dirty things.
  • Over-consumption of vitamins.
  • Excessive washing of food.
  • Excessive cleaning of surfaces where food is prepared.
  • Avoiding unwrapped food.
  • Throwing away food before its expiration date.
  • Smelling and inspecting food excessively.
  • Cooking food longer than necessary to kill potential pathogens.
  • Avoiding foods that have never been tried (or becoming extremely anxious about eating foods that have never been tried).
  • Always eating the same (limited) foods to avoid upset stomach.
  • Avoid foods that seem “strange”.
  • Use antacids and antiemetics prophylactically.
  • Avoid eating out.
  • Check where bathrooms are located (if away from home).
  • Limit travel away from home (stay home, avoid social activities).
  • Avoid going to school or work.
  • Eat only foods that other people have eaten.
  • If eating in public, monitor other people’s reactions to the food.
  • Worrying excessively about food allergies that have not yet been documented.
  • Avoid public speaking or other situations where you need to be the center of attention.
  • Avoid meetings or other situations where you might feel trapped or where it is not easy to get out if you feel sick.
  • Avoid airplanes, cars, and/or public transportation to avoid feeling trapped.

Rarely, however, are there cases of fear of vomiting (emetophobia) that are actually simple phobias.

People who are afraid of vomiting are often affected by social phobia or agoraphobia. The difference between these two conditions is that people with emetophobia associated with social phobia would cope relatively well with the idea of feeling sick in a distant or isolated place (such as walking alone in the woods).

Agoraphobic people, on the other hand, might find the same circumstance distressing because of the difficulty of asking for help (if help is needed).

Thus, social anxiety-related emetophobia is mainly about the social consequences (embarrassment, shame, etc.) of feeling bad in public, whereas agoraphobia-related emetophobia is more about the fear of not being able to get help or escape in this case.

Hemetophobia in children and teenagers

The consequences of fear of vomiting can be extreme. In children, fear of vomiting can lead to refusal to go to school and avoidance of other public places. In fact, those who fear nausea or vomiting may avoid birthday parties, sports activities or dates, and even lunch or dinner at restaurants. Missing these activities can affect relationships and have a negative impact on social development. Even if persistent social problems do not develop, the child with vomit phobia will still experience a lot of sadness, anxiety, and distress.

Childhood emetophobia itself may evolve into other anxiety disorders during adolescence, an extremely sensitive period of life, which, when combined with vomiting phobia, may also lead to

  • “emetophobia-like” anorexia (fear of vomiting and eating disorders (EDs) may be even more closely linked in adolescents than in adults);
  • panic attacks (emetophobia and panic attacks can coexist in situations where there is a strong fear of losing control); and
  • social anxiety, especially in contexts where there is a greater perceived risk of vomiting (e.g., people with emetophobia may be afraid of vomiting at the dentist).

Vomiting phobia in adults

Adults with vomiting phobia can also be significantly affected by their symptoms. They may take more time off work and avoid jobs that require travel, which can affect career advancement opportunities.

They may dread meetings where they feel trapped and avoid certain responsible activities such as public speaking. This may mean that otherwise bright and capable individuals remain in jobs below their actual abilities.

Emetophobia also affects leisure travel and eating out, and can destroy relationships.

Women with emesophobia may be extremely distressed by the thought of becoming pregnant and experiencing normal morning sickness, and some may even choose not to have children because of the fear of recurrent vomiting during pregnancy.

Clearly, this can have a profound and lasting negative impact on a person’s life.

How to recognize emetophobia

How do you know if you have emetophobia? Emetophobia has symptoms that are mainly determined by control and avoidance strategies common to other phobias or anxieties, such as thalassophobia, fear of insects (entomophobia), arachnophobia, megalophobia, tanatophobia, cardiophobia or trypophobia.

These strategies seem to be soothing at first (emetophobics do not vomit or try not to), but in fact have the predominant effect of keeping the symptom unchanged and increasingly rigid and structured over time.

Common symptoms of emetophobia include:

  • Eating slowly, very little, or only at home;
  • Holding one’s breath when around people;
  • Washing, smelling, and over-examining food;
  • Throwing out food before its expiration date;
  • Avoiding or feeling anxious about eating foods they have never tried;
  • Always eating the same foods to avoid upset stomach or fear of gastroenteritis;
  • Avoiding foods that seem “strange”;
  • Use antacids and antiemetics inappropriately;
  • Limit travel away from home;
  • Staying home; Avoiding social activities due to strong feelings of shame and fear;
  • Avoid drinking alcohol;
  • Avoiding proximity to garbage and other smelly and dirty things.

Thus, it is becoming increasingly clear that while this is classified as a specific phobia, it most often results in outcomes that also meet the diagnosis of social phobia or agoraphobia.

The causes of vomiting phobia

There are two main types of anxiety behind the fear of vomiting, which can explain why vomiting phobia exists:

  • Traumatic origin, that is, when the fear of vomiting is structured as a result of a traumatic event in which the subject was exposed to the stimulus in a distressing way. Some examples: having food poisoning, suffering from chronic and recurrent acetone, feeling sick in front of other people in a public place, seeing someone vomit, being soiled by someone’s vomit, fear of choking on vomit;
  • Environmental origin, i.e. when the vomiting phobia develops without a linear triggering cause: in these cases, there is often a family history of specific phobias or other anxiety disorders that can lead to learning a phobia “by proxy”, as can happen with emetophobia.

“Why is there so little talk about emetophobia? This may be true if we consider the lack of coverage in mainstream and digital media with a wide audience.

Fear of vomiting, on the other hand, is a hotly debated topic in the scientific community and has been the subject of a number of studies, such as that of the clinical psychologist A. Keyes and colleagues, or that of the psychiatrist D. Veale and his working group, which brings together studies on emetophobia and the testimonies of those who have suffered from it. Books on emetophobia are mostly technical and scientific texts.

How to overcome vomiting phobia

There are several solutions for treating emetophobia. Drug treatment or natural remedies such as the use of lemon, mint or ginger, as well as lime and lemon balm herbal teas, can be used to alleviate the symptoms.

To overcome the fear of vomiting by acting on the causes that triggered it, it is necessary to see a psychologist and start a therapeutic course.

Treatment for emetophobia currently focuses on gradual exposure to internal cues such as nausea, vomiting cues, or activities that have been previously avoided (Veale, 2009). Because of the heterogeneity of idiosyncratic fears in people with Specific Phobia of Vomiting, it is important to use individualized formulation to design appropriate exposure tasks and behavioral experiments. Specific phobia of vomiting may also require adapted treatment protocols compared to other phobias, as exposure to one’s own vomiting episodes is not easily achieved (Keyes, 2018). Furthermore, because disgust may play a key role in the development and maintenance of this disorder, as a universal response to vomiting that is amplified by the Specific Phobia of Vomiting itself, interventions that target disgust and anxiety may be important in reducing the symptomatology of Specific Phobia of Vomiting.

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