Emetophobia

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Emetophobia
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Emetophobia is a phobia that causes overwhelming, intense anxiety pertaining to vomit. This specific phobia can also include subcategories of what causes the anxiety, including a fear of vomiting or being vomited on or seeing others vomit. [1] Emetophobes might also avoid the mentions of "barfing", vomiting, "throwing up", or "puking." [2]

Contents

It is common for those who suffer from emetophobia to be underweight or malnourished due to strict diets and restrictions they make for themselves. The thought of someone possibly vomiting can cause the phobic person to engage in extreme behaviors to escape from their anxiety triggers, e.g. going to great lengths to avoid situations that could be perceived as "threatening".

Emetophobia is clinically considered an "elusive predicament" because limited research has been done pertaining to it. [3] The fear of vomiting receives little attention compared to other fears. [4] [5]

Etymology

The root word for emetophobia is emesis , from the Greek word emein, which means "an act or instance of vomiting", [6] with -phobia meaning "an exaggerated usually inexplicable fear of a particular object, class of objects, or situation." [7]

Overview

The event of vomiting may make anyone with this particular phobia flee the scene. Some may fear other people throwing up, while others may fear themselves throwing up. Some may fear both. Some may have anxiety that makes them feel as if they will throw up when they actually might not. Other possible fears that may come with emetophobia is not being able to locate a restroom in a timely manner, not being able to stop throwing up, choking on vomit, being embarrassed due to the situation, or having to seek medical attention. [2] People with emetophobia usually experience anxiety; they often may scream, cry, or if it is severe, pass out when someone or something has vomited.

Causes

People with emetophobia frequently report a vomit-related traumatic event, such as a long bout of stomach flu, accidentally vomiting in public or having to witness someone else vomit, as the start of the emetophobia. [8] They may also be afraid of hearing that someone is feeling like vomiting or that someone has vomited or the mention of any word relating to the act of vomiting, usually in conjunction with the fears of seeing someone vomit or seeing vomit.

Presentation

Complications

Emetophobics may also have other complicating disorders and phobias, such as social anxiety, fear of flying and agoraphobia. These three are very common, because people who fear vomiting are often terrified of doing so or encountering it in a public place. Therefore, they may restrict their social activities so they avoid any situations with alcohol or dining out in restaurants. Emetophobics may also limit exposure to children for fear of germs. People who have a fear of vomiting may avoid travel because of the worry about motion sickness or others experiencing it around them. They may also fear roller coasters for the same reason.

Lipsitz et al.'s findings also showed that those with emetophobia often have difficulties comfortably leading a normal life. [1] Many find that they have problems being alone with young children, and they may also avoid social gatherings where alcohol is present. [1] Retaining an occupation becomes difficult for emetophobics. Emetophobia can also affect a person's social life. The phobia can cause people to miss out on everyday events or requirements. It is common for children to miss school, teens/adults to miss work, and for people to go great measures of not socializing with others. [9] Professions and personal goals can be put on hold due to the high anxiety associated with the phobia, [5] and travelling becomes almost impossible for some. [1]

In Lipsitz et al.'s survey, women with emetophobia said that they either delayed pregnancy or avoided pregnancy altogether because of the morning sickness associated with the first trimester, [1] [10] and if they did become pregnant, it made pregnancy difficult. [1]

Other inhibitions on daily life can be seen in meal preparation. [1] Many emetophobic people also have specific "rituals" for the food they eat and how they prepare it. [1] They frequently check the freshness of the food along with washing it several times in order to prevent any potential sicknesses that they could contract from foods not handled properly. [1] They might overcook food products in fear of getting a foodborne illness [2] Eating out may also be avoided and when asked Lipsitz et al.'s survey, many felt they were underweight because of the strict diets that they put upon themselves. [1] In addition, many emetophobes avoid certain foods all together due to negative memories they may have with it relating to vomiting, and often eat a limited number of foods due to feeling like a vast majority of foods aren't 'safe'. [11] Those who suffer from emetophobia might avoid anything that has an unpleasant smell or aroma, in fear of vomiting. [2] This includes eating anything that might have a bad smell. [12] They might also avoid any sight that may induce vomiting in them or other people. [12]

Emetophobia and anorexia

There are some cases where anorexia is the result of a fear of vomiting instead of the typical psychological problems that trigger it. [5] In Frank M. Datillio's clinical case study, a situation where anorexia results from emetophobia is mentioned. Datillio says, "...in one particular case report, atypical anorexia in several adolescent females occurred as a result of a fear of vomiting that followed a viral illness as opposed to the specific desire to lose weight or because of an anxiety reaction.". [5] It is not clear that this should be termed "anorexia", however. In cases such as this, many emetophobes may also have avoidant/restrictive food intake disorder (ARFID), which is characterized by a general disinterest in food, sensory issues with food (taste, texture, look, smell) or a fear of adverse consequences from eating (vomiting or choking).

Oftentimes, this phobia is comorbid with several others, making it necessary to deal with each phobia individually in order for the patient to recover fully. For example, it is common for people with emetophobia to also have a fear of food, known as cibophobia, where they worry that the food they are eating is carrying pathogens that can cause vomiting. As such, people will develop specific behaviors that will, in their minds, make the food safe to eat, such as a ritualistic type of washing or the intentional overcooking of meat to avoid the intake of harmful pathogens. In time, these fears can become so ingrained that the person who has them can begin to experience anorexia nervosa. Again, it is not clear that this should be deemed "anorexia" rather than, for instance OCD, given this different presentation.

Emetophobia and obsessive-compulsive disorder

There are many cases of emetophobes that also suffer from obsessive–compulsive disorder. Both emetophobia and obsessive–compulsive disorder have similar symptoms and behaviors according to Allen H. Weg, EdD. This includes: "obsessional thinking, hyper-awareness and reactivity, avoidance, compulsive rituals, and safety behaviors". [12] Emetophobia is often misdiagnosed as obsessive–compulsive disorder. [12]

Causes and signs

There is a strong agreement in the scientific community that there is no specific cause of emetophobia. Some emetophobics report a traumatic experience with vomiting, always in childhood. Some experts believe that emetophobia may be linked to worries about lack of control. Many people try to control themselves and their environment in every possible way, but vomiting is difficult or impossible to control which can lead to anxiety or in other cases severe anxiety. [13]

There are many factors that can cause a legitimate case of emetophobia. Dr. Angela L. Davidson et al. conducted an experiment where it was concluded through various surveys that people with emetophobia are more likely to have an internal locus of control pertaining to their everyday life as well as health-related matters. [3] A locus of control is an individual's perception of where control comes from. Having an internal locus of control means that an individual perceives that they have their own control over a situation, whereas an external locus of control means that an individual perceives that some things are out of their control. She explains how this phobia is created through the locus of control by stating, "Thus far, it seems reasonable to stipulate that individuals with a vomiting phobia deem events as being within their control and may therefore find it difficult to relinquish this control during the act of vomiting, thus inducing a phobia." [3]

In an internet survey conducted by Dr. Joshua D. Lipsitz et al. given to emetophobic people, respondents gave many different reasons as to why they became emetophobic. Among some of the causes listed were several severe bouts of vomiting as children and being firsthand witnesses to many severe vomiting in others due to illness, pregnancy or alcoholism. [1]

Some possible signs may include not consuming certain foods or alcohol, not being able to watch vomit scenes during movies or shows, avoiding people that are not feeling well, regularly washing hands, steering clear from traveling and crowds, making sure bathrooms are near, consistently checking signs of illness, avoiding certain smells, or pitching food before the expiration date. [14]

Treatments

Assessment

There are two assessment tools used to diagnose emetophobia: the Specific Phobia of Vomiting inventory [15] and the Emetophobia Questionnaire. [16] They are self-report questionnaires that focus on a different range of symptoms.

There have been a limited number of studies in regard to emetophobia. [3] Victims of the phobia usually experience fear before vomiting but feel less afterwards. The fear comes back, however, if the victim fears they will throw up again.

Medications

Also noted in the emetophobia internet survey was information about medications. People were asked whether they would consider taking anxiety medication to potentially help their fear, and many in the study answered they wouldn't for fear that the drugs would make them nauseated. [1] Others, however, stated that some psychotropic medications (such as benzodiazepines and antidepressants) did help with their phobia, and some said gastrointestinal medications were also beneficial. [1]

Cognitive behavioral therapy

Cognitive behavioral therapy (CBT) is a psychological treatment that can be used to help calm anxiety. [17] It is most commonly used to treat certain behaviors by changing people's actions and thoughts by using a variety of different techniques to figure out why the fear is occurring. [18] Speaking to a therapist can also be beneficial and develop possible coping mechanisms. [14]

Exposure treatments

Exposure methods, using video-taped exposure to others vomiting, [19] hypnosis, [20] exposure to nausea [21] and exposure to cues of vomiting, [22] systemic behavior therapy, [23] psychodynamic [24] and psychotherapy [25] have also shown positive effects for the treatment of emetophobia. However, in some cases it may cause re-traumatization, and the phobia may become more intense as a result.

Notable people with emetophobia

See also

Related Research Articles

<span class="mw-page-title-main">Cognitive behavioral therapy</span> Type of therapy to improve mental health

Cognitive behavioral therapy (CBT) is a form of psychotherapy that aims to reduce symptoms of various mental health conditions, primarily depression, PTSD and anxiety disorders. Cognitive behavioral therapy focuses on challenging and changing cognitive distortions and their associated behaviors to improve emotional regulation and develop personal coping strategies that target solving current problems. Though it was originally designed to treat depression, its uses have been expanded to include many issues and the treatment of many mental health and other conditions, including anxiety, substance use disorders, marital problems, ADHD, and eating disorders. CBT includes a number of cognitive or behavioral psychotherapies that treat defined psychopathologies using evidence-based techniques and strategies.

An eating disorder is a mental disorder defined by abnormal eating behaviors that adversely affect a person's physical or mental health. These behaviors include eating either too much or too little. Types of eating disorders include binge eating disorder, where the patient keeps eating large amounts in a short period of time typically while not being hungry; anorexia nervosa, where the person has an intense fear of gaining weight and restricts food or overexercises to manage this fear; bulimia nervosa, where individuals eat a large quantity (binging) then try to rid themselves of the food (purging); pica, where the patient eats non-food items; rumination syndrome, where the patient regurgitates undigested or minimally digested food; avoidant/restrictive food intake disorder (ARFID), where people have a reduced or selective food intake due to some psychological reasons; and a group of other specified feeding or eating disorders. Anxiety disorders, depression and substance abuse are common among people with eating disorders. These disorders do not include obesity. People often experience comorbidity between an eating disorder and OCD. It is estimated 20–60% of patients with an ED have a history of OCD.

<span class="mw-page-title-main">Anxiety disorder</span> Cognitive disorder with an excessive, irrational dread of everyday situations

Anxiety disorders are a group of mental disorders characterized by significant and uncontrollable feelings of anxiety and fear such that a person's social, occupational, and personal functions are significantly impaired. Anxiety may cause physical and cognitive symptoms, such as restlessness, irritability, easy fatigue, difficulty concentrating, increased heart rate, chest pain, abdominal pain, and a variety of other symptoms that may vary based on the individual.

<span class="mw-page-title-main">Agoraphobia</span> Anxiety disorder

Agoraphobia is a mental and behavioral disorder, specifically an anxiety disorder characterized by symptoms of anxiety in situations where the person perceives their environment to be unsafe with no easy way to escape. These situations can include public transit, shopping centers, crowds and queues, or simply being outside their home on their own. Being in these situations may result in a panic attack. Those affected will go to great lengths to avoid these situations. In severe cases, people may become completely unable to leave their homes.

Specific phobia is an anxiety disorder, characterized by an extreme, unreasonable, and irrational fear associated with a specific object, situation, or concept which poses little or no actual danger. Specific phobia can lead to avoidance of the object or situation, persistence of the fear, and significant distress or problems functioning associated with the fear. A phobia can be the fear of anything.

<span class="mw-page-title-main">Bulimia nervosa</span> Type of eating disorder

Bulimia nervosa, also known simply as bulimia, is an eating disorder characterized by binge eating, followed by purging or fasting, as well as excessive concern with body shape and weight. This activity aims to expel the body of calories eaten from the binging phase of the process. Binge eating refers to eating a large amount of food in a short amount of time. Purging refers to the attempts to get rid of the food consumed. This may be done by vomiting or taking laxatives.

<span class="mw-page-title-main">Claustrophobia</span> Fear of small spaces

Claustrophobia is a fear of confined spaces. It is triggered by many situations or stimuli, including elevators, especially when crowded to capacity, windowless rooms, and hotel rooms with closed doors and sealed windows. Even bedrooms with a lock on the outside, small cars, and tight-necked clothing can induce a response in those with claustrophobia. It is typically classified as an anxiety disorder, which often results in panic attacks. The onset of claustrophobia has been attributed to many factors, including a reduction in the size of the amygdala, classical conditioning, or a genetic predisposition to fear small spaces.

Behaviour therapy or behavioural psychotherapy is a broad term referring to clinical psychotherapy that uses techniques derived from behaviourism and/or cognitive psychology. It looks at specific, learned behaviours and how the environment, or other people's mental states, influences those behaviours, and consists of techniques based on behaviorism's theory of learning: respondent or operant conditioning. Behaviourists who practice these techniques are either behaviour analysts or cognitive-behavioural therapists. They tend to look for treatment outcomes that are objectively measurable. Behaviour therapy does not involve one specific method, but it has a wide range of techniques that can be used to treat a person's psychological problems.

<span class="mw-page-title-main">Intrusive thought</span> Unwelcome involuntary thought, image or idea

An intrusive thought is an unwelcome, involuntary thought, image, or unpleasant idea that may become an obsession, is upsetting or distressing, and can feel difficult to manage or eliminate. When such thoughts are associated with obsessive–compulsive disorder (OCD), Tourette syndrome (TS), depression, body dysmorphic disorder (BDD), and sometimes attention deficit hyperactivity disorder (ADHD), the thoughts may become paralyzing, anxiety-provoking, or persistent. Intrusive thoughts may also be associated with episodic memory, unwanted worries or memories from OCD, post-traumatic stress disorder (PTSD), other anxiety disorders, eating disorders, or psychosis. Intrusive thoughts, urges, and images are of inappropriate things at inappropriate times, and generally have aggressive, sexual, or blasphemous themes.

Mysophobia, also known as verminophobia, germophobia, germaphobia, bacillophobia and bacteriophobia, is a pathological fear of contamination and germs. It is classified as a type of specific phobia, meaning it is evaluated and diagnosed based on the experience of high levels of fear and anxiety beyond what is reasonable when exposed to or in anticipation of exposure to stimuli related to the particular concept. William A. Hammond first coined the term in 1879 when describing a case of obsessive–compulsive disorder (OCD) exhibited in repeatedly washing one's hands.

Exposure therapy is a technique in behavior therapy to treat anxiety disorders. Exposure therapy involves exposing the patient to the anxiety source or its context. Doing so is thought to help them overcome their anxiety or distress. Numerous studies have demonstrated its effectiveness in the treatment of disorders such as generalized anxiety disorder (GAD), social anxiety disorder (SAD), obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD), and specific phobias.

Avoidant restrictive food intake disorder (ARFID) is a feeding or eating disorder in which individuals significantly limit the volume or variety of foods they consume, causing malnutrition, weight loss, and/or psychosocial problems. Unlike eating disorders such as anorexia nervosa and bulimia, body image disturbance is not a root cause. Individuals with ARFID may have trouble eating due to the sensory characteristics of food ; executive function disregulation; fears of choking or vomiting; low appetite; or a combination of these factors. While ARFID is most often associated with low weight, ARFID occurs across the whole weight spectrum.

Mental health professionals often distinguish between generalized social phobia and specific social phobia. People with generalized social phobia have great distress in a wide range of social situations. Those with specific social phobia may experience anxiety only in a few situations. The term "specific social phobia" may also refer to specific forms of non-clinical social anxiety.

Social anxiety is the anxiety and fear specifically linked to being in social settings. Some categories of disorders associated with social anxiety include anxiety disorders, mood disorders, autism spectrum disorders, eating disorders, and substance use disorders. Individuals with higher levels of social anxiety often avert their gazes, show fewer facial expressions, and show difficulty with initiating and maintaining a conversation. Social anxiety commonly manifests itself in the teenage years and can be persistent throughout life; however, people who experience problems in their daily functioning for an extended period of time can develop social anxiety disorder. Trait social anxiety, the stable tendency to experience this anxiety, can be distinguished from state anxiety, the momentary response to a particular social stimulus. Half of the individuals with any social fears meet the criteria for social anxiety disorder. Age, culture, and gender impact the severity of this disorder. The function of social anxiety is to increase arousal and attention to social interactions, inhibit unwanted social behavior, and motivate preparation for future social situations.

<span class="mw-page-title-main">Obsessive–compulsive disorder</span> Mental and behavioral disorder

Obsessive–compulsive disorder (OCD) is a mental and behavioral disorder in which an individual has intrusive thoughts and feels the need to perform certain routines (compulsions) repeatedly to relieve the distress caused by the obsession, to the extent where it impairs general function.

Blood-injection-injury (BII) type phobia is a type of specific phobia characterized by the display of excessive, irrational fear in response to the sight of blood, injury, or injection, or in anticipation of an injection, injury, or exposure to blood. Blood-like stimuli may also cause a reaction. This is a common phobia with an estimated 3-4% prevalence in the general population, though it has been found to occur more often in younger and less educated groups. Prevalence of fear of needles which does not meet the BII phobia criteria is higher. A proper name for BII has yet to be created.

<span class="mw-page-title-main">Anorexia nervosa</span> Type of eating disorder

Anorexia nervosa (AN), often referred to simply as anorexia, is an eating disorder characterized by food restriction, body image disturbance, fear of gaining weight, and an overpowering desire to be thin.

The differential diagnoses of anorexia nervosa (AN) includes various types of medical and psychological conditions, which may be misdiagnosed as AN. In some cases, these conditions may be comorbid with AN because the misdiagnosis of AN is not uncommon. For example, a case of achalasia was misdiagnosed as AN and the patient spent two months confined to a psychiatric hospital. A reason for the differential diagnoses that surround AN arise mainly because, like other disorders, it is primarily, albeit defensively and adaptive for, the individual concerned. Anorexia Nervosa is a psychological disorder characterized by extremely reduced intake of food. People with anorexia nervosa tend to have a low self-image and an inaccurate perception of their body.

<span class="mw-page-title-main">Fear of flying</span> Fear of being in a flying vehicle whilst in flight

Fear of flying is the fear of being on a flying vehicle, such as an airplane or helicopter, while it is in flight. It is also referred to as flying anxiety, flying phobia, flight phobia, aviophobia, aerophobia, or pteromerhanophobia.

Safety behaviors are coping behaviors used to reduce anxiety and fear when the user feels threatened. An example of a safety behavior in social anxiety is to think of excuses to escape a potentially uncomfortable situation. These safety behaviors, although useful for reducing anxiety in the short term, might become maladaptive over the long term by prolonging anxiety and fear of nonthreatening situations. This problem is commonly experienced in anxiety disorders. Treatments such as exposure and response prevention focus on eliminating safety behaviors due to the detrimental role safety behaviors have in mental disorders. There is a disputed claim that safety behaviors can be beneficial to use during the early stages of treatment.

References

  1. 1 2 3 4 5 6 7 8 9 10 11 12 13 Lipsitz, Joshua D., et al. "Emetophobia: Preliminary Results of an Internet Survey." Depression & Anxiety (1091–4269) 14.2 (2001): 149-52.
  2. 1 2 3 4 "Fear of Vomiting, or Emetophobia". Anxiety and Depression Association of America. Retrieved 2022-07-15.
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  4. ↑ Boschen, Mark J. (2007). "Reconceptualizing emetophobia: A cognitive–behavioral formulation and research agenda". Journal of Anxiety Disorders. 21 (3). Elsevier BV: 407–419. doi:10.1016/j.janxdis.2006.06.007. ISSN   0887-6185. PMID   16890398.
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  11. ↑ Kay, Joanna. “Emetophobia and Eating Disorders - Mirror.” Mirror Mirror, 2015, mirror-mirror.org/eating-disorders-2-2/emetophobia-and-eating-disorders.
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  15. ↑ Veale, David; Ellison, Nell; Boschen, Mark J.; Costa, Ana; Whelan, Chantelle; Muccio, Francesca; Henry, Kareina (18 December 2012). "Development of an Inventory to Measure Specific Phobia of Vomiting (Emetophobia)". Cognitive Therapy and Research. 37 (3). Springer Science and Business Media LLC: 595–604. doi:10.1007/s10608-012-9495-y. hdl: 10072/52078 . ISSN   0147-5916. S2CID   3309152.
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  18. ↑ "CBT Protocol". Suffering from or Treating Emetophobia?. 2019-09-17. Retrieved 2022-07-15.
  19. ↑ McFadyen M, Wyness J (1983). You don't have to be sick to be a behaviour therapist but it can help! Treatment of a vomit phobia. Behavioural Psychotherapy 11, 173–176.
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  31. ↑ "The Worst Witch's Bella.Cringe Questions". YouTube . 2019-01-05.
  32. ↑ Cavna, Michael (2019-09-12). "Raina Telgemeier became a hero to millions of readers by showing how uncomfortable growing up can be". Washington Post. Retrieved 2023-12-30.
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