Emetophobia is a

phobia A phobia is an anxiety disorder defined by a persistent and excessive fear of an object or situation. Phobias typically result in a rapid onset of fear and are usually present for more than six months. Those affected go to great lengths to avo ...

that causes overwhelming, intense

anxiety Anxiety is an emotion which is characterized by an unpleasant state of inner turmoil Turmoil may refer to: * ''Turmoil'' (1984 video game), a 1984 video game released by Bug-Byte * ''Turmoil'' (2016 video game), a 2016 indie oil tycoon video ...

pertaining to

vomit Vomiting (also known as emesis and throwing up) is the involuntary, forceful expulsion of the contents of one's stomach through the mouth and sometimes the nose. Vomiting can be the result of ailments like food poisoning, gastroenteri ...

. This

specific phobia Specific phobia is an anxiety disorder, characterized by an extreme, unreasonable, and irrational fear associated with a specific object, situation, or concept which poses little or no actual danger. Specific phobia can lead to avoidance of the o ...

can also include subcategories of what causes the anxiety, including a fear of vomiting or seeing others vomit.Lipsitz, Joshua D., ''et al''. "Emetophobia: Preliminary Results of an Internet Survey." ''Depression & Anxiety'' (1091–4269) 14.2 (2001): 149-52. Emeteophobics might also avoid the mentions of "barfing",

vomiting Vomiting (also known as emesis and throwing up) is the involuntary, forceful expulsion of the contents of one's stomach through the mouth and sometimes the nose. Vomiting can be the result of ailments like food poisoning, gastroenteri ...

, "throwing up", or "puking." It is common for those who suffer from emetophobia to be

underweight An underweight person is a person whose body weight is considered too low to be healthy. A person who is underweight is malnourished. Assessment The body mass index, a ratio of a person's weight to their height, has traditionally been used ...

malnourished Malnutrition occurs when an organism gets too few or too many nutrients, resulting in health problems. Specifically, it is "a deficiency, excess, or imbalance of energy, protein and other nutrients" which adversely affects the body's tissues a ...

due to strict diets and restrictions they make for themselves. The thought of someone possibly vomiting can cause the phobic person to engage in extreme behaviors to escape from their anxiety triggers, e.g. going to great lengths to avoid even potential situations that could even be perceived as "threatening". Emetophobia is clinically considered an "elusive predicament" because limited research has been done pertaining to it.Davidson, Angela L., Christopher Boyle, and Fraser Lauchlan. "Scared to Lose Control? General and Health Locus of Control in Females with a Phobia of Vomiting." ''Journal of Clinical Psychology'' 64.1 (2008): 30-9. The fear of vomiting receives little attention compared with other irrational fears. The event of vomiting may make anyone with this peculiar phobia flee the scene. Some may fear someone throwing up, while others may fear themselves throwing up. Some may have both. Some may have anxiety which makes them feel like they will throw up when they actually might not. People with emetophobia usually experience anxiety; they often may scream, cry, or if it is severe, possibly pass out when someone or something has been sick.

Presentation

Complications

Emetophobics may also have other complicating disorders and phobias, such as

social anxiety Social anxiety is the anxiety and fear specifically linked to being in social settings (i.e., interacting with others). Some categories of disorders associated with social anxiety include anxiety disorders, mood disorders, autism spectrum diso ...

fear of flying Fear of flying is a fear of being on an airplane, or other flying vehicle, such as a helicopter, while in flight. It is also referred to as flying anxiety, flying phobia, flight phobia, aviophobia, aerophobia, or pteromechanophobia (although ae ...

and

agoraphobia Agoraphobia is a mental and behavioral disorder, specifically an anxiety disorder characterized by symptoms of anxiety in situations where the person perceives their environment to be unsafe with no easy way to escape. These situations can in ...

. These three are very common, because people who fear vomiting are often terrified of doing so, or encountering it, in a public place. Therefore, they may restrict their social activities so they avoid any situations with

alcohol Alcohol most commonly refers to: * Alcohol (chemistry), an organic compound in which a hydroxyl group is bound to a carbon atom * Alcohol (drug), an intoxicant found in alcoholic drinks Alcohol may also refer to: Chemicals * Ethanol, one of sev ...

or dining out in

restaurants A restaurant is a business that prepares and serves food and drinks to customers. Meals are generally served and eaten on the premises, but many restaurants also offer take-out and food delivery services. Restaurants vary greatly in appearance ...

. Emetophobics may also limit exposure to children for

fear of germs Mysophobia, also known as verminophobia, germophobia, germaphobia, bacillophobia and bacteriophobia, is a pathological fear of contamination and germs. The term was coined by William A. Hammond in 1879 when describing a case of obsessive–c ...

. Women with this disorder delayed

pregnancy Pregnancy is the time during which one or more offspring develops ( gestates) inside a woman's uterus (womb). A multiple pregnancy involves more than one offspring, such as with twins. Pregnancy usually occurs by sexual intercourse, but ...

or avoided it altogether because of the fear of

morning sickness Morning sickness, also called nausea and vomiting of pregnancy (NVP), is a symptom of pregnancy that involves nausea or vomiting. Despite the name, nausea or vomiting can occur at any time during the day. Typically the symptoms occur between th ...

. People who have a fear of vomiting may avoid

travel Travel is the movement of people between distant geographical locations. Travel can be done by foot, bicycle, automobile, train, boat, bus, airplane, ship or other means, with or without luggage, and can be one way or round trip. Travel ...

because of the worry about

motion sickness Motion sickness occurs due to a difference between actual and expected motion. Symptoms commonly include nausea, vomiting, cold sweat, headache, dizziness, tiredness, loss of appetite, and increased salivation. Complications may rarely include ...

or others experiencing it around them. They may also fear

roller coasters A roller coaster, or rollercoaster, is a type of amusement ride that employs a form of elevated railroad track designed with tight turns, steep slopes, and sometimes inversions. Passengers ride along the track in open cars, and the rides are o ...

for the same reason. Lipsitz et al.'s findings also showed that those with emetophobia often have difficulties comfortably leading a normal life. Many find that they have problems being alone with young children, and they may also avoid social gatherings where alcohol is present. Retaining an occupation becomes difficult for emetophobics. Professions and personal goals can be put on hold due to the high anxiety associated with the phobia,Frank M. Dattilio. "Emetic Exposure and Desensitization Procedures in the Reduction of Nausea and a Fear of Emesis." ''Clinical Case Studies'' 2.3 (2003): 199-210. and travelling becomes almost impossible for some. In Lipsitz et al.'s survey, women with emetophobia said that they either delayed pregnancy or avoided pregnancy altogether because of the morning sickness associated with the

first trimester Pregnancy is the time during which one or more offspring develops ( gestates) inside a woman's uterus (womb). A multiple pregnancy involves more than one offspring, such as with twins. Pregnancy usually occurs by sexual intercourse, but ...

, and if they did become pregnant, it made pregnancy difficult. Other inhibitions on daily life can be seen in meal preparation. Many emetophobic people also have specific "rituals" for the food they eat and how they prepare it. They frequently check the freshness of the food along with washing it several times in order to prevent any potential sicknesses that they could contract from foods not handled properly. They might overcook food products in fear of getting a

foodborne illness Foodborne illness (also foodborne disease and food poisoning) is any illness resulting from the spoilage of contaminated food by pathogenic bacteria, viruses, or parasites that contaminate food, as well as prions (the agents of mad cow ...

Eating out is also avoided, if possible, and when asked Lipsitz et al.'s survey, many felt they were underweight because of the strict

diets The Low Countries comprise the coastal Rhine–Meuse–Scheldt delta region in Western Europe, whose definition usually includes the modern countries of Luxembourg, Belgium and the Netherlands. Both Belgium and the Netherlands derived their ...

that they put upon themselves. In addition, many emetophobes avoid certain foods all together due to negative memories they may have with it relating to vomiting, and often eat a limited number of foods due to feeling like a vast majority of foods aren't 'safe'. Those who suffer from emetophobia might avoid anything that has an unpleasant smell or aroma, in fear of This includes eating anything that might have a bad smell. They might also avoid any sight that may induce vomiting in them or other people.

Emetophobia and anorexia

There are some cases where anorexia is the result of a fear of vomiting instead of the typical psychological problems that trigger it. In Frank M. Datillio's clinical case study, a situation where anorexia results from emetophobia is mentioned. Datillio says, "...in one particular case report, atypical anorexia in several adolescent females occurred as a result of a fear of vomiting that followed a viral illness as opposed to the specific desire to lose weight or because of an anxiety reaction.". It is not clear that this should be termed "anorexia", however. In cases such as this, many emetophobes may also have avoidant/restrictive food intake disorder (ARFID), which is characterized by a general disinterest in food, sensory issues with food (taste, texture, look, smell) or a fear of adverse consequences from eating (vomiting or choking). Oftentimes, this phobia is

comorbid In medicine, comorbidity - from Latin morbus ("sickness"), co ("together"), -ity (as if - several sicknesses together) - is the presence of one or more additional conditions often co-occurring (that is, concomitant or concurrent) with a primary ...

with several others, making it necessary to deal with each phobia individually in order for the patient to recover fully. For example, it is common for people with emetophobia to also have a fear of food, known as

cibophobia Anorexia nervosa, often referred to simply as anorexia, is an eating disorder characterized by low weight, food restriction, body image disturbance, fear of gaining weight, and an overpowering desire to be thin. ''Anorexia'' is a term of Gre ...

, where they worry that the food they are eating is carrying

pathogens In biology, a pathogen ( el, πάθος, "suffering", "passion" and , "producer of") in the oldest and broadest sense, is any organism or agent that can produce disease. A pathogen may also be referred to as an infectious agent, or simply a ger ...

that can cause vomiting. As such, people will develop specific behaviors that will, in their minds, make the food safe to eat, such as a ritualistic type of washing or the intentional overcooking of meat to avoid the intake of harmful pathogens. In time, these fears can become so ingrained that the person who has them can begin to experience anorexia nervosa. Again, it is not clear that this should be deemed "anorexia" rather than, for instance OCD, given this different presentation.

Emetophobia and obsessive-compulsive disorder

There are many cases of emetophobes can also suffer from

Obsessive–compulsive disorder Obsessive–compulsive disorder (OCD) is a mental and behavioral disorder in which an individual has intrusive thoughts and/or feels the need to perform certain routines repeatedly to the extent where it induces distress or impairs general ...

. Both Emetophobia and

have similar symptoms and behaviors according to Allen H. Weg, EdD. This includes:"obsessional thinking, hyper-awareness and reactivity, avoidance, compulsive rituals, and safety behaviors" Often, Emetophobia will get misdiagnosed as

Causes

There is a strong agreement in the scientific community that there is no specific cause of emetophobia. Some emetophobics report a traumatic experience with vomiting, always in childhood. Some suggest that individuals with emetophobia are victims of childhood abuse – sexual or physical. Although this is occasionally true, it seems to be no more prevalent than in the general population (Christie, 2004). Some experts believe that emetophobia may be linked to worries about lack of control. Many people try to control themselves and their environment in every possible way, but vomiting is difficult or impossible to control which can lead to anxiety or in other cases severe anxiety. There are many factors that can cause a legitimate case of emetophobia. Dr. Angela L. Davidson ''et al''. conducted an experiment where it was concluded through various surveys that people with emetophobia are more likely to have an internal

locus of control Locus of control is the degree to which people believe that they, as opposed to external forces (beyond their influence), have control over the outcome of events in their lives. The concept was developed by Julian B. Rotter in 1954, and has since ...

pertaining to their everyday life as well as health-related matters. A locus of control is an individual's perception of where control comes from. Having an internal locus of control means that an individual perceives that they have their own control over a situation, whereas an external locus of control means that an individual perceives that some things are out of their control. She explains how this phobia is created through the locus of control by stating, "Thus far, it seems reasonable to stipulate that individuals with a vomiting phobia deem events as being within their control and may therefore find it difficult to relinquish this control during the act of vomiting, thus inducing a phobia." In an internet survey conducted by Dr. Joshua D. Lipsitz ''et al.'' given to emetophobic people, respondents gave many different reasons as to why they became emetophobic. Among some of the causes listed were several severe bouts of vomiting as children and being firsthand witnesses to many severe vomiting in others due to

illness A disease is a particular abnormal condition that negatively affects the structure or function of all or part of an organism, and that is not immediately due to any external injury. Diseases are often known to be medical conditions that ...

alcoholism Alcoholism is, broadly, any drinking of alcohol that results in significant mental or physical health problems. Because there is disagreement on the definition of the word ''alcoholism'', it is not a recognized diagnostic entity. Predomina ...

Treatments

Assessment

There are two assessment tools used to diagnose emetophobia: the Specific Phobia of Vomiting inventory and the Emetophobia Questionnaire. They are self-report questionnaires that focus on a different range of symptoms. There have been a limited number of studies in regard to emetophobia. Victims of the phobia usually experience fear before vomiting but feel less afterwards. The fear comes back, however, if the victim fears they will throw up again.

Medications

Also noted in the emetophobia internet survey was information about medications. People were asked whether they would consider taking anxiety

medication A medication (also called medicament, medicine, pharmaceutical drug, medicinal drug or simply drug) is a drug used to diagnose, cure, treat, or prevent disease. Drug therapy ( pharmacotherapy) is an important part of the medical field an ...

to potentially help their fear, and many in the study answered they wouldn't for fear that the drugs would make them nauseated. Others, however, stated that some psychotropic medications (such as

benzodiazepines Benzodiazepines (BZD, BDZ, BZs), sometimes called "benzos", are a class of depressant drugs whose core chemical structure is the fusion of a benzene ring and a diazepine ring. They are prescribed to treat conditions such as anxiety disorders, ...

and

antidepressants Antidepressants are a class of medication used to treat major depressive disorder, anxiety disorders, chronic pain conditions, and to help manage addictions. Common side-effects of antidepressants include dry mouth, weight gain, dizziness, heada ...

) did help with their phobia, and some said gastrointestinal medications were also beneficial.

Cognitive behavioral therapy

Cognitive behavioral therapy Cognitive behavioral therapy (CBT) is a psycho-social intervention that aims to reduce symptoms of various mental health conditions, primarily depression and anxiety disorders. CBT focuses on challenging and changing cognitive distortions (su ...

(CBT) is a psychological treatment that can be used to help calm anxiety. It is most commonly used to treat certain behaviors by changing people's actions and thoughts by using a variety of different techniques to figure out why the fear is occurring.

Exposure treatments

Exposure methods, using video-taped exposure to others vomiting,

hypnosis Hypnosis is a human condition involving focused attention (the selective attention/selective inattention hypothesis, SASI), reduced peripheral awareness, and an enhanced capacity to respond to suggestion.In 2015, the American Psychologica ...

, exposure to nausea and exposure to cues of vomiting, systemic behavior therapy,

psychodynamic Psychodynamics, also known as psychodynamic psychology, in its broadest sense, is an approach to psychology that emphasizes systematic study of the psychological forces underlying human behavior, feelings, and emotions and how they might relate t ...

and psychotherapy have also shown positive effects for the treatment of emetophobia. However, in some cases it may cause re-traumatization, and the phobia may become more intense as a result.

Etymology

The

root word A root (or root word) is the core of a word that is irreducible into more meaningful elements. In morphology, a root is a morphologically simple unit which can be left bare or to which a prefix or a suffix can attach. The root word is the prim ...

for emetophobia is ''

emesis Vomiting (also known as emesis and throwing up) is the involuntary, forceful expulsion of the contents of one's stomach through the mouth and sometimes the nose. Vomiting can be the result of ailments like food poisoning, gastroenteri ...

'', from the Greek word , which means "an act or instance of vomiting", with ''-phobia'' meaning "an exaggerated usually inexplicable fear of a particular object, class of objects, or situation." People with emetophobia frequently report a vomit-related traumatic event, such as a long bout of

stomach flu Gastroenteritis, also known as infectious diarrhea and gastro, is an inflammation of the gastrointestinal tract including the stomach and intestine. Symptoms may include diarrhea, vomiting, and abdominal pain. Fever, lack of energy, and dehydrat ...

, accidentally vomiting in

public In public relations and communication science, publics are groups of individual people, and the public (a.k.a. the general public) is the totality of such groupings. This is a different concept to the sociological concept of the ''Öffentlichk ...

or having to witness someone else vomit, as the start of the emetophobia. They may also be afraid of hearing that someone is feeling like vomiting or that someone has vomited or the mention of any word relating to the act of vomiting, usually in conjunction with the fears of seeing someone vomit or seeing vomit.

Notable people with emetophobia

* Jamie Borthwick *

Charlie Brooker Charlton Brooker (born 3 March 1971) is an English television presenter, writer, producer and satirist. He is the creator and co-showrunner of the sci-fi drama anthology series ''Black Mirror'', and has written for comedy series such as ''Bras ...

Denise Richards Denise Richards (born February 17, 1971) is an American actress, television personality, and former fashion model. Her most recognized roles are Carmen Ibanez in ''Starship Troopers'' (1997), Kelly Van Ryan in '' Wild Things'' (1998) and Bond gir ...

Ashley Benson Ashley Victoria Benson (born December 18, 1989) is an American actress, model, and singer. She is known for her role as Hanna Marin in the teen mystery-drama series ''Pretty Little Liars'' (2010–2017). Benson has starred in films, including ' ...

Christina Pazsitzky Christina Pazsitzky (born June 18, 1976), known by her stage name Christina P,About Chri ...

* Bella Ramsey * Matt Watson

References

*{{cite web , last1=Goodman , first1=Ken , title=Fear of Vomiting, or Emetophobia , url=https://adaa.org/understanding-anxiety/specific-phobias/fear-of-vomiting , website=ADAA , access-date=July 14, 2022 Phobias Vomiting