Emetophobia is the fear of vomiting. It is a type of anxiety disorder, and is also known as specific phobia of vomiting (SPOV).
Emetophobia can make someone feel severely anxious about being sick, and if they see other people vomiting.
According to the Anxiety Disorders Association of America, phobias affect 19 million people in the United States, and they are the most common type of anxiety disorder.
There is little research on the exact causes of emetophobia. Some believe this fear develops on its own, or after a traumatic experience that involves vomiting.
Another theory is that genes or other biological or psychological factors could trigger this phobia.
Additionally, anxiety can cause nausea. This increases someone’s fear of feeling or being sick, which can continue in a loop.
Stomach bugs, motion sickness, excessive drinking or eating, allergies, and food intolerances can also trigger nausea.
A person with emetophobia will experience intense fear and anxiety about being sick, or seeing someone else vomit. They may also feel extremely anxious about the following situations:
- not being able to find a bathroom
- not being able to stop vomiting
- choking on vomit
- embarrassing themselves in front of other people
- going to the hospital
Someone’s anxiety about the possibility of being sick could be worse than vomiting. However, this anticipation can severely affect their quality of life, as they feel they have to stop or avoid normal activities that might lead to being sick.
A person may try protective behaviors or avoidance strategies to reduce their risk of vomiting. These can include:
- avoiding new food and alcohol, or food and drink that have previously caused vomiting
- avoiding bad smells
- not going to restaurants
- restricting social interactions or travel
- avoiding saying, hearing, or describing vomit or associated words
- avoiding hospitals and healthcare facilities
- excessive handwashing
- excessive use of antacids
- excessive monitoring for illness in themselves and others
Emetophobia can sometimes be mistaken for germaphobia, which is the fear of bacteria and germs, or eating disorders, such as avoidant/restrictive food intake disorders.
This is because a person with emetophobia might avoid touching door handles or flushing toilets with their hands, to limit their contact with germs. They may also only eat foods that they have made, or have not been touched by their hands.
A person with the condition might also throw away food if it is near its use-by date, even if it is safe.
Someone who engages in these behaviors can experience significant weight loss, which is also a symptom of eating disorders. However, in emetophobia the fear of vomiting causes food avoidance and weight loss, and not the fear of putting on weight or anxiety over their appearance.
Treatment for emetophobia can include therapy, medication, or a combination of both.
Cognitive behavioral therapy
Cognitive behavioral therapy (CBT) aims to change the way a person thinks and behaves, and works on the belief that thoughts and physical sensations are connected.
During CBT, a therapist will support someone with emetophobia to reassess their thinking patterns or behaviors that reinforce anxiety around vomiting. They also use practical tools outside of therapy to help with their condition.
There is no extensive research on specific treatments for emetophobia. However, the first randomized control trial to study the effects of CBT on this condition suggests that it is highly effective.
In some cases, psychodynamic therapies could help people with multiple phobias.
Exposure and response prevention
Exposure and response prevention (ERP) can also treat emetophobia. It is a therapy technique specifically designed to manage obsessive-compulsive disorder. It works to gradually expose someone to their triggers without engaging in their obsessive-compulsive behaviors. Through this exposure, a person can see the risk of vomiting is lower than they believe, and less dangerous and upsetting than they thought.
ERP is a challenging type of therapy. People should feel well enough to start the sessions, as the treatment can increase anxiety once it begins.
The process of ERP involves three stages:
A person will generate the physical symptoms of nausea and vomiting in a controlled way, with the support of their therapist. This is called interoceptive cue exposure or symptom cue exposure. Exercises can include spinning or other methods of inducing nausea, and doctors will continually monitor the person’s anxiety levels.
A person will visit places they avoid and associate with a risk of vomiting, such as bars, restaurants, or public bathrooms. They will also eat foods that they normally avoid, to gradually build up their tolerance and decrease their anxiety.
Once someone is comfortable with the physiological symptoms and environmental triggers that cause anxiety, a doctor will ask them to simulate vomiting. This exercise aims to decrease the fear of being sick.
Selective serotonin reuptake inhibitors (SSRIs) and serotonin norepinephrine reuptake inhibitors (SNRIs) are types of medications designed to treat depression and anxiety disorders.
These drugs can decrease anxiety, and may help manage someone’s fear of engaging with normal life. Antidepressants can also support a person through therapy.
Emetophobia is an intense fear of vomiting or seeing others vomit. It is an anxiety disorder that may occur alongside other mental health conditions, such as generalized anxiety disorder and obsessive-compulsive disorder.
Someone will avoid parts of their daily life to manage their fear of vomiting, which may negatively affect them, as they are less likely to meet friends and family, go to public places, or socialize in bars and restaurants.
There are no specific treatments for emetophobia, but talking therapies designed to treat OCD and phobias have been effective. Antidepressant medications, such as SSRIs or SNRIs, can be used alongside these techniques to support them and lower their anxiety.