Emetophobia and Cognitive Behavioral Therapy (CBT)
The OCD Center of Los Angeles often receives calls from people seeking treatment for various phobias. One of the most common phobias we treat is emetophobia – the intense fear of vomit and/or vomiting.
Most people who call us with emetophobia are initially quite surprised to learn that this problem has a name, and often equally surprised to learn that they are not the only person in the world to suffer with it. Often, they have secretly struggled with emetophobia for years. Some have been misdiagnosed with anorexia or depression, and as a result, have wasted years being inappropriately treated for conditions they don’t have.
While the primary fear in emetophobia seems quite simple (the sufferer is terrified by the possibility of vomiting, and/or the possibility of seeing others vomit), the individual’s response to this fear can become quite complex. Often the person with emetophobia spends hours every day focused on monitoring and controlling how their gastro-intestinal (GI) tract feels. As a result, every meal becomes a battle to ensure that they never feel any GI discomfort such as gas, cramps, fullness, nausea, etc. In practical terms, this often means having very restricted diets because the client is afraid of any food that they believe may possibly lead to any GI distress. This also often means that restaurants, parties, and family gatherings are simply off limits, as the client may fear eating even “safe” foods any place but home.
In many cases, the client has adopted numerous non-food based avoidant strategies in an effort to ensure they never experience any GI distress. This can include avoidance of television programs or movies with images they fear will cause GI distress, not driving or flying, and avoidance of socializing with friends whom they associate with the possibility of GI distress.
Unfortunately, family and friends of people with emetophobia are often dismissive of the suffering experienced by the individual with this sometimes crippling problem. Equally problematic are family members who enable and accommodate the problem, which usually results in a worsening of symptoms.
Fortunately, emetophobia responds extremely well to Cognitive-Behavioral Therapy (CBT). While this treatment requires a strong commitment on the part of the client, the results can be life changing. If one is willing to challenge their fears, they can, over a relatively short period of time, regain normal eating habits, and put an end to the avoidant strategies so commonly seen in emetophobia.
•Tom Corboy, MFT, is the director of the OCD Center of Los Angeles, a private, outpatient clinic specializing in Cognitive-Behavioral Therapy (CBT) for the treatment of Obsessive-Compulsive Disorder (OCD) and related conditions. He can be contacted director@ocdla.com.
7 Comments to Emetophobia and Cognitive Behavioral Therapy (CBT)
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I’ve used EMDR successfully with a young teen girl suffering emetophobia which was interfering with her school attendance. We replaced the initial belief “Vomit is disgusting and dangerous” with “Vomit is disgusting but not dangerous.” Treatment resolved very quickly!
Judy,
Thank you for your reply to our post about Emetophobia.
I was trained in EMDR in 1995, and I have always seen it as a type of Cognitive Behavioral Therapy (CBT). I read a study a few years ago that found that the primary factors in change in EMDR were the behavioral exposure (in this case, exposure to the thought of vomiting), and the cognitive restructuring (in your example, the reframe of “Vomit is disgusting but not dangerous.” I think that, regardless of what we call the technique, the key is to change our response to the fear, both cognitively and behaviorally.
I have a 10-year-old client with emetophobia which is very likely causally related to the death of her sister a little over a year ago from a brain tumor and very aggressive treatments. Though I am working on her case from a number of angles (grief, fear of loss of mother, difficulty expressing her sadness (it is ugly and smelly, perhaps like vomit), I do not see the possiblity of using CBT on someone this age and with this history. Any thoughts would be greatly appreciated
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Hi Judith,
There is no reason you couldn’t use CBT with this ten-year old girl. We have successfully treated children as young as six. Obviously CBT needs to be adapted to the cognitive and developmental age of the child, but that is true for all therapeutic approaches.
If a child is capable of being aware of their thoughts and actions, they can respond to CBT. The cognitive goal would be to help the girl learn to challenge the thoughts that vomit is horrible and/or dangerous. The behavioral goal would be to help her develop the ability to not avoid situations in which she fears the onset of thoughts, feelings, or sensations that are vomit-related.
Tamar Chansky has two great books about CBT for OCD and other anxiety disorders in children:
Freeing Your Child from Anxiety: Powerful, Practical Solutions to Overcome Your Child’s Fears, Worries and Phobias.
Freeing Your Child from Obsessive-Compulsive Disorder: Powerful, Practical Strategies for Parents of Children and Adolescents.
I highly recommend both.
Thanks for the feedback and recommended resources.
I think CBT can work for most people with the commitment and drive to see it through. In fact, I’d think it could be very effective with young people whose minds are less set in their ways.
P.S. I’m not a doctor…