Symptoms and treatment of emetophobia

Each person experiences the situation in their own way, and the symptoms of fear of vomiting may vary according to your own experience. However, there are similarities in each case. 

What are the symptoms of anxiety related to the fear of vomiting?

The symptoms of fear of vomiting include, in the first instance, it is found that every gastrointestinal sign (noises, movement etc.) is perceived as a danger and may lead to an anxiety attack. These sensations can be physical or psychological.

Physical sensations

Therefore, the panic attack may cause an increased heart rate, breathing difficulties (hyperventilation or hypoventilation), tingling, muscle tension, dizziness, chest pain, trembling, sweating, a drop in heart temperature, feelings of tightness, chills, and nausea.

This nausea reinforces the difficulty and anxiety of the situation. Indeed, the fear of vomiting is already present, and symptoms include nausea. You therefore enter a vicious circle where the anxiety of the situation reinforces the symptoms of the fear of vomiting.

Psychological sensations

It is possible that some of your physical sensations bring about psychological sensations or thoughts related to your feelings.

Indeed, you may feel, for example, a sensation of suffocation or even strangulation that worries you. You also sometimes have the feeling that you are no longer yourself, that you are a spectator of your life, that you no longer control anything. You have the feeling that the situation is completely out of your control and that you are no longer in control of your body, your thoughts or your ideas, which gives you a feeling of unreality of the situation, sometimes to the point of feeling like you are going crazy.

Finally, you have this strong feeling of not being able to manage anything anymore that it can go as far as the feeling of dying.

What are the consequences of emetophobia on daily life?

The fear of vomiting is all around you, and brings various symptoms and consequences. This inevitably has consequences in your daily life, in the longer or shorter term, with varying degrees of intensity.

Avoiding outings

Going out of the house means running the risk of meeting people coming home from a party, or running into someone who is ill and can infect you (with a stomach bug for example). You therefore limit your activities, so that you are not regularly in the company of other people. In short, you avoid all places where there is a risk of people coming together and where you could possibly vomit or see someone vomiting. This implies a risk of de-schooling or de-professionalisation.

Distancing yourself from all potentially “dangerous” situations

Anxiety about nausea is so great that all situations that could possibly generate nausea are avoided: transport, places with unpleasant smells, and for women even avoiding getting pregnant for fear of nausea or seeing their baby vomit once it is born.

Social isolation

You are afraid of many situations, so you no longer dare to take part in certain activities proposed by those around you or by your colleagues. Firstly, because you are afraid of having anxiety attacks with these people. Secondly, because you don’t dare talk about it around you. You are afraid that people will find out, that they will judge you, that they will not understand you. So you prefer to decline proposals, avoid situations and stay in places where you feel safe. But as time goes by, you realise that you are losing friends, that those close to you are offering you fewer activities, and you feel increasingly alone.

Constant fears

Today, you fear many situations. Whether it is outside, inside, or even your own. In fact, you are even afraid of your own body. You don’t always trust it, you fear it will fail. You are afraid that at any moment it will reject the food you have ingested, that it will fall ill, that it will not resist alcoholic drinks sufficiently… This fear limits you greatly in your activities but also in your hopes of recovery. These anxieties and all the consequences they have can lead you to have negative or even black ideas, and tend towards depression or even suicidal thoughts.

Professional or educational consequences

While emetophobia affects all spheres of life, symptoms of the fear of vomiting necessarily impacts on your job or schooling. Being in the workplace means that you run the risk of someone getting sick in front of you or passing on their illness. It also means having to eat in the canteen or self-service restaurant when you don’t know where the food comes from. It is also possible that the toilets in the school are not perfectly clean and make you sick. Your diet is affected, your body changes, you are afraid of other people’s judgement and also prefer to avoid them at all costs.

What other conditions can be linked to emetophobia?

Emetophobia is often associated with four phobias: agoraphobia, anxiety disorder, hypochondria or social phobia. It is true that for a long time, emetophobia was considered ‘only’ as a comorbidity linked to these anxieties. But, little by little, researchers have realised that it is an anxiety in its own right and that the other associated phobias are the consequence of this suffering from vomiting.

Agoraphobia

Indeed, since you avoid all situations where people or yourself are likely to vomit, you avoid many public places and create anxiety in many similar situations. You avoid being in crowded places, because this increases the risk of running into a sick person. You avoid empty spaces, because you don’t know how to get out of this situation and go to a place that reassures you. You hate places that are too closed, because you feel trapped in situations that make you feel uncomfortable.

Social phobia

In the same way as agoraphobia, social situations make you anxious. You worry about any situation that might lead you to see vomit or to vomit yourself. So you avoid people because they are ‘dangerous’ and a risk to you. You also fear that they will notice your anxiety. You do not want to have a panic attack in front of others. So you prefer to avoid all places where people are likely to be present.

Eating disorders

In addition to phobias, eating disorders may accompany this phobia. Indeed, you tend to control all the food you eat. At first, you avoid eating out, because you don’t have enough knowledge about what you might eat. Then you make your own food, making sure you don’t put in heavy food and checking the expiry dates. Ideally, you try to eat frozen food to maximise the chance that the bacteria are dead. Finally, you hardly ever eat, if at all, because you are far too afraid of eating something that might make you vomit. So you pay particular attention to your food in all its forms, whether it is prepared, preserved or eaten. All this is a great source of anxiety for you.

Hypochondria

Similarly, your anxiety can also lead to hypochondria. This is because you are so afraid of getting sick and risking vomiting. So you have obsessive thoughts about hygiene, and even have health rituals that make you feel safer.

Some tips for dealing with emetophobia

Don’t be afraid to talk about it

It is not always easy to talk about your emetophobia. First of all, because it is a fear that is still not well known, and that people do not talk about. Around you, you may not know anyone who has the same fear and so you find it difficult to express yourself on this subject.

It is also possible that you are afraid of other people’s judgement. People around you minimise your anxiety, comparing it to the disgust they may feel when they see vomit. You therefore feel little understood, little supported, and alone in your anxiety.

Moreover, you may not know where to turn. If you don’t feel understood or you don’t dare to talk about it to those around you, you can talk to your doctor or make an appointment with a psychologist or a psychiatrist. Talk to health professionals who will be able to refer you, if necessary, to other health professionals who are more competent to treat your anxiety. It is possible that you are talking to a professional who has little knowledge of the subject or who is not interested in it, and that he or she is not benevolent enough to reassure you about it. If you do not have a clear and reassuring answer, do not hesitate to talk to someone else.

It is also possible that you do not talk about it because you are afraid of being confronted with questions such as “What is it that scares you?” or “Why are you afraid of it? You may not be able to describe what you are afraid of or you may not have the answer. You are afraid of something that is difficult to describe by yourself and you are afraid that you will be discredited for your anxiety.

Take time to understand your anxiety

Don’t let the anxiety get to you without understanding it. Try to ask yourself: what is it that is making me anxious? Is it the fear of being afraid? Is it the fear of losing control of yourself? Can this anxiety be linked to an event that you are aware of? When does your anxiety start to appear? What are the things that are most distressing?

Asking yourself about all these elements and about your anxiety will allow you to rationalise by understanding point by point how it manifests itself.

Managing your panic attack

When you feel the panic attack coming on, take time to breathe, slowly, deeply. Breathe in calmly through your nose, then out through your mouth. Don’t be afraid of the emotions you may be experiencing, and take the time to try to see what is happening in your body and within you. Whatever you can feel physically.

Think of a pleasant moment that you have experienced, a moment that makes you feel good. Try to feel all those sensations that you could feel in that good moment.

Then try to pay special attention to some of the things you see around you, some of the sounds, some of the things you can touch or smell and taste. Take time to describe everything, and to feel everything.

How to treat emetophobia?

Early treatment prevents the symptoms of the fear of vomiting from worsening or spreading to other anxieties (social phobia, agoraphobia, eating disorders, etc.). It is therefore important to think about it, to dare to talk about it, and to treat it as soon as possible.

Think of talking about it to someone you trust (GP, psychologist, psychiatrist or any other health professional) who will be able to help you and guide you. It is possible that if your emetophobia is developed and you suffer from anorexia, you may be offered hospitalisation. This may not be the right thing for you, but this disorder is still too little known for all the professionals to be aware of your real suffering. So don’t hesitate to talk about it with your doctor.

In everyday life

Remember not to avoid all situations that may be distressing to you. Try to continue to do some activities that do not make you feel too comfortable, without generating too much anxiety. Remember to breathe well and pay particular attention to your breathing. If it makes you feel better, be accompanied.

As soon as you have the opportunity, make an appointment with a psychiatrist or psychologist to help you.

Cognitive behavioural therapy (CBT)

Cognitive Behavioural Therapy has proven to be particularly effective in the treatment of phobias and in particular emetophobia. Indeed, cognitive behavioural therapies suggest that the phobia has arisen as a result of events (traumatic or not) and that it is possible to extinguish the anxiety linked to the situation in the same way.

It is true that when one suffers from emetophobia, one will avoid situations. For example, one will not take transport, go to alcoholic parties, go to buffet restaurants, avoid fresh produce etc. This seems coherent, we will not naturally expose ourselves to situations that are difficult for us, and that make us anxious. And yet, this behaviour reinforces anxiety about the situation, as it is therefore associated with negative automatic thoughts such as “I can’t go to my colleague’s farewell party, as the team may drink to excess and one of them may vomit”. The approach should therefore be the opposite: the more we expose ourselves to a situation, the less anxious it is, as we get used to it.

The aim of cognitive-behavioural therapies is therefore to make a gradual and progressive exposure to the situation that is anxiety-provoking for you, in order to, little by little, extinguish the intensity and duration of the anxiety. In the case of emetophobia, you will first be exposed in easier contexts, before you come to see someone vomiting in the toilet after a drunken evening for example. With gradual exposure, you will get used to the situation and regain serenity.

In addition, in parallel to this “physical” work, the psychologist specialised in CBT works with you on the automatic thoughts you have about the situation and on the management of your emotions.

Virtual Reality Exposure Therapy (VRET)

Virtual Reality Exposure Therapy is part of the cognitive therapy stream. The principles and objectives are therefore similar, but with the possibility of exposure to the environments in a safe place, where the psychologist has control over the whole environment. Indeed, the gradual and progressive aspect is facilitated and feasible in all circumstances: the psychologist makes all the adjustments and chooses the environment adapted to your situation. He can remove or add certain anxiety-provoking stimuli at any time. The psychologist accompanies you, step by step, and directly in the situation, providing you with alternative strategies, techniques for managing your emotions, and tools for understanding and apprehending your automatic thoughts. This technique will allow you to replace dysfunctional thoughts with more functional ones and to overcome the anxieties linked to the situation.

Virtual reality allows you to (re)experience all anxiety-provoking situations, whatever and wherever they may be. You can therefore understand your anxiety, while decreasing its intensity and duration, until your situational or anticipatory panic attacks are completely extinguished. You see the results gradually and are aware of them. You gradually regain your self-confidence and increase your self-esteem in these situations.

Access to anxiety-provoking situations and contexts is thus facilitated, you see gradual results and you will gradually regain serenity. Virtual reality will quickly allow you to see these results. In a few weeks, you will be able to get rid of these anxieties.