This Anxiety Disorder Makes People Afraid of Vomit
For as long as she can remember, Rachel has been afraid of vomit. And not just afraid in the way that everyone finds vomit unpleasant. She has a diagnosable fear of vomiting known as emetophobia.
“The first moment my parents and I really realized I had a more significant reaction than most people to vomit was when I was very young," she says. "We were driving through a Christmas light show. The finale was a tunnel of flashing lights, and my little cousin was sick next to me in the car. I started panicking, and I even opened the car door while we were still driving in an attempt to get away from the situation as quickly as possible.”
Years of vomit anxiety followed, whether she was sick herself, saw someone else who was ill, or even saw vomit on the ground or on TV. “While some people might say, ‘ew, gross,’ but then move on with their lives, the scene replays in my head for a long time after,” she says.
Fear is totally normal, but a phobia—of vomit, flying, heights, snakes, and more—is problematic. “A phobia is a diagnosable disorder that impacts people’s lives negatively,” says clinical psychologist Brenda K. Wiederhold, PhD, MBA, president of the Virtual Reality Medical Center in California, where she treats people with anxiety disorders using VR. “Pretty much everyone has fears, but [phobias can get] to the point of avoiding people, places, and things.”
A phobia is a type of anxiety disorder, she explains, and it can develop from what starts out as a perfectly healthy fear. There doesn’t have to be a traumatic or triggering event—although sometimes a patient does not entirely remember, Wiederhold says.
Experts aren't sure exactly how many people have emetophobia, but it seems to be more common in women. One Dutch study estimated up to 7% of women and 1.8% of men are afraid of vomiting. Here’s what anyone with a fear of throwing up should know about emetophobia—and how to overcome it.
RELATED: 10 Signs You May Have OCD
There isn’t a specific known cause of emetophobia, but people often have a genetic predisposition for anxiety in general. “Anxiety tends to run in families, but the manifestation of the anxiety might be different,” Goodman says. For example, a parent may have panic attacks and feel fine around vomit, but their child could develop emetophobia, he says.
“Just like we often have a disposition for things like diabetes or heart disease, anxiety is partly genetic too,” Wiederhold agrees. “It may never manifest, or it may manifest during a particularly stressful part of life.”
Nothing traumatic has to happen for anxiety to manifest, although there can be environmental triggers of emetophobia, usually an unpleasant past vomit-related experience, Goodman says. “Maybe one day they saw someone throw up and the same day they ate something and felt kind of nauseous. They put the two together and started worrying about throwing up.”
Such triggers or traumatic events can cause an anxious and imaginative person to want to avoid any and all situations that could potentially involve vomit. That’s when a phobia “takes on a life of its own,” Goodman says.
In order to ease some of that anxiety, people with a fear of throwing up often go to extremes to avoid vomit. “Emetophobes will do whatever it takes to protect themselves from the possibility of vomiting or witnessing someone else vomiting,” Goodman says. “They will avoid bars because drunk people vomit. They will avoid restaurants because of the possibility of food poisoning. They will avoid boats, planes, and cars because of motion sickness. They are vigilant about protecting themselves from getting the flu so they avoid going to doctors and hospitals and are constantly on the look out for potential threats. They are looking at their environment much differently than the average person.”
Online comments submitted to the Anxiety and Depression Association of America detail people with emetophobia who avoid alcohol entirely or are afraid to go to college or take road trips. Rachel, now 25 and living in New York City, has been diagnosed with anxiety and takes anti-anxiety medication to treat panic attacks; she says she avoids big crowds and travels with her dog to stay calm when people around her reach for sick bags. “I can be triggered by someone on the subway simply looking pale or saying, ‘I don’t feel well.’ The smell or sound of someone being sick is equally as triggering.”
Wiederhold remembers a patient who developed emetophobia after getting sick on an airplane. It became difficult for this woman to fly—not because she was scared of turbulence but because she didn’t want to get sick. “She would start getting anxious days before the flight,” Wiederhold says.
Goodman recalls a patient who was afraid of morning sickness. “When she was a lot younger, she got pregnant and was so afraid of the potential for nausea and vomiting that she had an abortion.” Other women may not realize how uncomfortable they are around vomit until they become mothers, Wiederhold adds. "A fear of seeing other people sick is difficult for women who have children. Little kids do vomit, and [mothers] want to help, but they can’t see their children vomit.”
Some people with emetophobia may avoid reading, hearing, or saying words like “vomit,” “puke,” “throw up,” and “barf.” Others develop compulsions like excessive hand washing or avoiding touching door handles in fear of catching a bug that could lead to vomiting, Goodman says.
A fear of vomiting can also easily be mistaken for other issues, including panic disorder, obsessive-compulsive disorder, and anorexia, Wiederhold says. A person’s fear of vomiting may cause them to be so selective about what they eat that they end up being underweight, she explains.
Anxiety can cause a racing heart, sweating, and nausea, which doesn’t bode well for people with emetophobia. “Someone might be so worried about throwing up that they are actually causing themselves to feel nauseous,” Goodman says. “But there’s an overestimation of the possibility of throwing up and an exaggeration of the discomfort,” he adds. “If you talk to someone with emetophobia, they almost never throw up.”
“For me, it feels similar to a panic attack,” Rachel says. “Racing heart, worried feeling in the pit of my stomach, and in extreme cases, my hands shake and I can feel faint. The situation is typically worse for me if I can’t escape the situation.” Usually, she tries to remove herself from a vomit-related situation as quickly as possible.
Fortunately, Goodman says, even though anxiety can make you feel nauseous, it’s unlikely it will actually make you vomit—and there’s where coping tools and treatment can make all the difference.
Emetophobia help and treatment
The gold standard for emetophobia treatment is cognitive behavioral therapy (CBT) and exposure with response prevention (ERP), Goodman says. If you’re looking for a therapist who can help, you’ll want to find an anxiety specialist, he adds, since some generalists may not have the expertise required to address a phobia. The process involves “helping the patient change the way they think about the problem and changing their behavior, slowly desensitizing them to what makes them anxious or afraid,” he explains.
CBT involves teaching coping skills like understanding and addressing automatic thoughts, Wiederhold explains. Someone who is afraid to eat a certain food out of the fear it may make them sick can rationally remind themselves, “I’ve only been sick once before when I ate that,” for example.
ERP involves "exposing yourself to what makes you anxious without having [the anxious] response,” Goodman says. That might entail building up to looking at a cartoon of a person vomiting and then a photo of a person vomiting; writing down and saying words like vomit, barf, and puke; eating foods once avoided; taking a trip by bus or a ride at an amusement park; or cutting back on handwashing, he explained in an ADAA webinar. CBT coping skills help limit the anxious response, Wiederhold says.
Goodman recalls a patient with emetophobia who wouldn’t use public restrooms out of fear that someone would be sick there or she could pick up vomit-causing germs. “She went to Disneyland and avoided restrooms for over 6 hours,” he says. To work on gently exposing her to her fear without inducing anxiety, he had her go into the restroom at his office without touching anything and come out without washing her hands.
Wiederhold conducts exposure therapy using virtual reality, a treatment option she calls life-changing for both her practice and her patients. It’s allowed her to help patients progress more “slowly and systematically” than having to introduce them to real-world scenarios that can be retraumatizing or even dangerous. (She once had to take over driving from a patient who had a panic attack during exposure therapy on a freeway, she says.)
Other techniques that can be used to treat anxiety disorders can help with emetophobia too, like breathing and relaxation exercises, yoga, meditation, and mindfulness.
So far, Rachel—who says she considers herself to have a relatively mild case of emetophobia—hasn’t opted to try exposure therapy. “College was a bit of watered-down exposure therapy for me, as drinking and vomiting from drinking is prevalent and in some ways unavoidable,” she says. “I don’t know if it will ever fully go away, but I have developed strategies to deal with it,” she says. “I’d like to face the fear head on someday.”