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.
22 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…
Something unfortunate about emetophobia specifically is that many people suffering from emetophobia don’t even realize that their condition is a real phobia, and then fail to ever seek treatment such as cbt.
I need something that’s gonna cure me cause at the moment it has got to the point were everynight I sit and cry my eyes out I start having panic attacks cause I am terrified of being sick. I need help but wanna know if it will work for me.
I had emetophobia since I was 6 years old. If someone was sick, I was cry, hide, leave the house. As I got older, I started having a hard time focusing in school, because I was too concerned about the person not feeling good 2 desks down from me. I eventually dropped out of high school.
I wouldn’t listen to songs that played when I was sick, I wouldn’t eat foods that I had at one point been sick after eating. I refused to vomit, ever. I trained myself not to. I avoided going anywhere someone might be sick and I even stopped pursing my dream of being a nurse.
I had children; and would run if they were sick. I couldn’t comfort them because I would panic. Unfortunately, this behavior has caused my daughter to be an emetophobe as well. However, with CBT and hard work and dedication; I am beyond it.
Does it still bother me, yeah. It’s gross..but I’m not going to die and I”m not automatically going to catch something if someone is sick. I can hold a basin at work if someone is ill and I’m fine. I can mop up if my kids are sick, wash my hands and go eat dinner. It’s taken a long time. I still think about it.. I still worry if I am in public about “what if I’m going to be sick”. You know, I make sure I know where the bathrooms are and I always have water with me or gum in my mouth and I can enjoy being out with my family. It will get better, if you put in the hard work and dedicate yourself to the process…you can get through it.
Hi Steph,
Thanks for sharing your experiences with Emetophobia. I am glad to hear that you have had success using CBT. This is a very treatable condition, and hopefully your story will encourage others to seek treatment.
My 19 year old son suffers from emetophobia. I am not sure which path of therapy he should take; EMDR or CBT. He has an appointment tomorrow with a pshychiatrist to be put on an anti anxiety med and then both a sched. appt with a CBT therapist and a EMDR therapist at later dates.
As one who is trained in both CBT and EMDR, I can say with confidence that CBT is by far the best approach. EMDR is actually considered a type of CBT, and it has become popular with therapists because its developer markets it as a quick fix for PTSD. Unfortunately, many therapists have taken to offering it as a miracle cure for just about everything. But here’s the thing…there are no miracles. Effective treatment for emetophobia is work, and there is no miracle cure. I strongly advise you to seek treatment with a CBT specialist.
My 11 year old daughter has had emetophobia for 2 years now. We’ve been with 3 different therapists now. Our current one is wonderful. The first used CBT on her…it didn’t work. We used another one that used EMDR…that was a joke. Our current therapist used some CBT and exposure therapy. It was wonderful. Our daughter graduated from the program. Unfortunately she has gone back to some of her bad habits and we are back in therapy. I would say, find a GREAT therapist if you can. It seems that some sort of slow exposure is key (cartoons and words to start). Learn that the things that we avoid aren’t going to harm us in the end and we aren’t in danger…that sort of thing. Good luck. It takes time and constant monitoring as we’ve found out.
Hi Amber,
Thank you for your comments. It sounds like you are doing a great job of staying on top of your daughter’s Emetophobia.
You are absolutely correct that “slow exposure” is the key to effective Cognitive Behavioral Therapy (CBT) for Emetophobia. The formal term is “graduated exposure”, and it is almost always a necessary component of therapy when treating children (and adults) with phobias. Being too aggressive in forcing kids to face their fears often leads to a significant worsening of the problem.
As for EMDR, I completely agree with your assessment of its value. I was trained in EMDR back when it originated in the early 1990’s, and I never use it. Unfortunately, many therapists have been trained in EMDR because its training seminars are so heavily marketed. As a result, many therapists offer it to clients as a quick fix, but its utility in treating phobias is quite limited in my experience.
My youngest daughter is 8 years old.She threw up about a month ago and is still freaked out about puking.On a daily basis. The last time she threw up before this past experience was when she was 4 so she doesn’t remember it. Thing is she threw up only one time this past event and was fine the next day. But everyday she will ask us at least 30 times if she’s gonna puke. It’s disrupting her school life and the stinking counselors are asking her questions like….”Hmmm…is anything “Bad” happening at home that is making you feel like this? Is there anyone touching you?” Oh come on man……She threw up and is freaking out. That’s all. Geeze. We need help. If anyone has some they can verbally help us with it would be grateful. We live in Hawaii so resources are limited. I do not do well reading books and other peoples diagnostic papers published. I do well with bottom line information.Straight to the point information. She does not have OCD or any other issues. She was fine before she threw up a month ago and now if freaked out daily. I don;t want her loosing weight because she thinks she’s gonna puke if she eats. HELP PLEASE! Thank you
Nicole,
Thank you for your comment.
I’m sorry to hear that your daughter is experiencing difficulties. While I cannot provide a diagnosis via an online forum, I can say that the symptoms you describe suggest Emetophobia. The good news is that this is a rather recent development for her, and she will likely respond well to a brief course of Cognitive Behavioral Therapy (CBT).
Your best bet is to find a therapist who specializes in CBT. While finding a good CBT therapist may be difficult, it will be well worth it. I suggest you go to http://www.adaa.org and http://www.ocfoundation.org. Both provide searchable databases of CBT therapists who specialize in treating anxiety disorders such as Emetophobia.
I am not sure which island you are on, but you will most likely need to travel to Oahu. If you are unable to find a CBT specialist and the problem worsens, you may need to visit the mainland for a few weeks with your daughter for a short course of intensive CBT.
I hope this helps.
Thankyou so much for your site. My 10 year old has massive issues with people vomiting – whether it be a cartoon or movie or real life – and just recently wouldn’t go to the movies with my mother in case there was something on the big screen to do with vomiting. After finding your website, it seems to me that she may have Emetophobia, and to be able to pin point her issues has taken such a load off my mind. I will definitely be seeking help via CBT. Thankyou once again. I can now see there is light at the end of the tunnel.
Samantha,
Thank you for your comments. I’m glad our article helped you identify your child’s Emetophobia. This is a condition that is too often overlooked or misdiagnosed by doctors and therapists. The good news is that Emetophobia is very treatable using CBT – there is definitely light at the end of the tunnel.
I’m 44 and suffer from emetophobia. For many years I’ve had a very mild form of this condition, but it started progressing rapidly after my daughter got sick with norovirus a year ago. I can’t imagine how CBT can possibly help me. I realize that vomiting is common and not dangerous, that most other people are not bothered by it, etc., but this doesn’t make it any less significant for me.
I cope by trying to minimize exposure to situations that might result in me vomiting or witnessing others vomit. However, I find all the information about norovirus terrifying because it’s something I feel I can’t control. I’m becoming an expert on norovirus, but the more I read the more it scares me. Can’t wait for the vaccine, which I think is the only means to relieve my phobia.
Hi Lisa,
Thank you for your comment.
Your experience of having mild emetophobic symptoms that were exacerbated by a specific trigger (in this case, your daughter being sick) is quite common. Unfortunately, the behaviors you have been doing in response to your increased fears are almost guaranteed to worsen your symptoms.
Your avoidance of anything that you fear might make you vomit (or see others vomit) is a classic phobic behavior. While that may provide short-term relief, in the long term it reinforces your belief that vomiting is something you can’t handle. Additionally, you mention becoming an expert in noroviruses, which indicates that you have been researching the issue, which will only make things worse.
I encourage you to try therapy with someone who specializes in CBT for emetophobia. You will most likely see significant improvement in a very short period of time.
Hi. My daughter, who is now 11 has been suffering from emetophobia for over two years now. She is seeing a wonderful therapist and takes medication for her anxiety. She is starting to have separation anxiety during the day and we are taking it slowly. I also have had this condition since I was a kid so I know how she feels, however I had the stomach flu recently and had to vomit for the first time in over 25 years. I must say it was an awakening. I felt so much better after and I just accepted it. It’s not fun, but it was just something that I had to do to feel better. It was over in about 1 minute. I wish that my daughter could see that for all the nights she has been suffering her anxiety and thinking her “what if’s,” she has been sick only 2 times these past two and a quarter years. For those of you with loved ones or suffering it yourself, definitely seek out a good therapist that specializes in CBT for emetophobia. Invest the money. It’s worth it! Also remember, “It’s just fear. Accept it. Don’t try to make it go away. It will pass. It always does. Your job is to make yourself comfortable.”