One of the more common phobias we see come through our clinics might surprise you but for many of you it will feel good to know that you are in no way alone. Emetophobia is a specific phobia or an intense fear of vomiting that has grown to the point of causing significant impairment to one's life. The root word of this condition is “emesis” which comes from its Greek counterpart “emein.” Emein refers to the “act of vomiting.” Now let’s get this straight, this is a serious condition that causes a significant amount of suffering to those who have it. It is a condition that rarely remits on its own but can be addressed effectively through Cognitive Behavioral Therapy (CBT) involving exposure and response prevention and a class of pharmacological agents called SSRIs.
So why are you suffering from this problem? The answer to this important question is complex and the truth is that we do not yet know for sure. Like many other anxiety conditions, people with emetophobia are oftentimes already genetically predisposed to anxiety. In fact, having worked with this condition for several years, I have seen it run in families. In the past year I was treating a daughter and mother simultaneously at our clinic. The biological predisposition coupled with a conditioning event (e.g., difficult vomiting spell, severe illness, nauseating pregnancy, or watching loved ones suffer from vomiting) may be sufficient to instigate the onset of emetophobia. Additionally, from a psychological perspective, people with emetophobia may have other vulnerabilities such as neurotic personality characteristics making them particularly sensitive to emotional states. Of course these are educated guesses at best. It is likely that the development of emetophobia varies as much as individual experiences.
Emetophobia can take on a number of insidious forms, including but not restricted to fear of seeing vomit, fear of watching the physical act of vomit, fear of becoming nauseated, fear of accidentally vomiting in public, fear of becoming sick with illnesses that may cause vomiting, and fear of all of the above, including any other remotely plausible vomit instigating events. Because avoiding the possibility of vomiting is so elusive, people suffering from this condition often find it difficult to live comfortable lives. In fact, people seeking treatment are often underweight and may have developed moderate to severe restrictive eating behaviors. People with emetophobia have also been observed engaging in extreme avoidant behaviors and obsessive symptom checking. However, the good news is that no matter the specific presentation, emetophobia can be treated effectively through individualized CBT, including exposure and response prevention.
If you don’t like feeling alone, the good news is that you are currently 1 of 7.4 billion people in the world who has to deal with occasional vomiting spells. Misery loves company eh? Even so, you are presumably asking yourself how on earth something as uncomfortable and repulsive as vomit could be good. In today’s age we are surrounded by food that is safe, nutritious, and abundant. However, our ancestors lived in an environment that was quite different from modern western life. We can safely assume that our ancestors of old had to make large voyages across rugged terrain to scavenge for edible plants and to spear wild beasts. That is quite different from your comfortable stroll through the supermarket isn’t it? Even so, you might be surprised to note that even today we have a real and present danger of food poisoning. Over the course of a year up to 76 million Americans get sick, over 300,000 people are hospitalized, and up to 5,000 people die from food-borne disease. So thank God we have biological systems that are equipped to deal with this very real threat and even so, it alone is sometimes not enough.
So let’s say you are not convinced that your vomiting tendencies might actually be a great evolutionary asset. There are a number of other situations nowadays where nausea and vomiting have a high likelihood of occurring. Our body is really good at detecting foreign substances because it know you could be one mistake away from disaster. If you vomited and didn't need to, the worst thing that could happen is you lose last night’s pepperoni pizza. It also appears that nausea and vomiting can work as preventative mechanisms to keep pregnant women from eating high risk foods that could jeopardize their child. It might be delicious to eat a medium-rare porterhouse when you are out on the town, but little Jimmy could pay a high cost if he is still in utero. Think about it. There is a brain region that developed for the purpose of making sure you could puke. If anything we should be thankful for it.
How does this work? So here is the spark notes version of the story. There is a little region of the brainstem called the medulla oblongata. For simplicity sake let’s call it the “life support center” (LSC for short) because it takes care of some semi important processes like breathing, heart rate, blood pressure, and, oh yes, vomiting. In the LSC there is another region of the brain called Nucleus Tractus Solitarius that is needlessly hard to pronounce. For our purposes we will call it the puke center (PC). All the areas of the body that need to identify dangerous contents send their warning signal to the PC. These include systems like the brain, gut, and inner ear (don’t ask). The PC then signals the body to respond and you start salivating to help protect your tooth enamel, you feel nauseous to make you more aware of your misery, and you expel gastric contents to your own relief.
Now that you know that. The next thing you need to ask yourself is whether or not you are ready to overcome this fear. If you are, our team at the Anxiety Center would feel honored to be able to help you on your journey towards better mental health.