Emetophobia

Emetophobia is an intense phobia that causes overwhelming, intense anxiety pertaining to vomiting. This specific phobia can also include subcategories of what causes the anxiety, including a fear of vomiting in public, a fear of seeing vomit, a fear of watching the action of vomiting or fear of being nauseated.[1] Even the thought of someone possibly vomiting can cause the phobic person to engage in extreme behaviors to escape the perceived (and sometimes very real) threat of that particular situation, in which the phobic person will go through great lengths to avoid even potential situations that could even be perceived as "threatening."

Given the fact that there are situations when this phobia and the phobic person's inherent "instinct" to escape and avoid that situation, this phobia could literally save that person's life by instinctively causing the phobic person to run away from an impending "plague" type situation, even intentionally avoiding an encampment where Ebola and other viruses are present, which just might be enough of an avoidance behavior to prevent that person from becoming ill or contracting a highly contagious, life-threatening virus through direct contact with others who are infected with the virus. Norovirus and related food borne viruses and bacteria are other situations the phobic person would avoid, if possible.

Emetophobia is clinically considered an "elusive predicament" because limited research has been done pertaining to it.[2] The fear of vomiting receives little attention compared with other irrational fears.[3] Emetophobia is not limited by age or maturity level. There are cases of emetophobia present in childhood and adolescence, as well as adulthood.[4]

Etymology and definition

The root word for emetophobia is "emesis," from the Greek word emein which means "an act or instance of vomiting"[5] with "-phobia” meaning "an exaggerated usually inexplicable fear of a particular object, class of objects, or situation."[6]

People with emetophobia frequently report a vomit related traumatic event, such as a long bout of stomach flu, accidentally vomiting in public, or having to witness someone else vomit, as the start of the emetophobia.[7] They may also be afraid of hearing that someone is feeling like vomiting or that someone has vomited, usually in conjunction with the fears of seeing someone vomit or seeing vomit.

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, almost always in childhood, but many do not. Some suggest that sufferers are victims of childhood abuse – sexual or physical. While 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.[8]

There are many factors that can cause a legitimate case of emetophobia. It can affect the minds of young children, but emetophobia can also affect a person at any age. While some emetophobics are indeed severely mentally ill, many are not and have been diagnosed as such and treated inappropriately.[9]

Dr. Angela L. Davidson et al. conducted an experiment where it was concluded through various surveys that people suffering from emetophobia are more likely to have an internal locus of control pertaining to their everyday life as well as health-related matters.[2] 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."[2]

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 severe bouts of vomiting as children and being firsthand witnesses to severe vomiting in others due to illness, pregnancy, or alcoholism.[1]

Treatments

Assessment

There are two assessment tools used to diagnose emetophobia; the Specific Phobia of Vomiting inventory [10] and the Emetophobia Questionnaire.[11] The Specific Phobia of Vomiting Inventory and the Emetophobia Questionnaire are both self-report questionnaires that focus on a different range of symptoms. There have been a limited number of studies in regard to emetophobia.[2] Victims of the phobia usually experience fear before vomiting, but feel less afterwards. The fear comes again 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 to potentially help their fear, and many in the study answered they wouldn't for fear that the drugs would make them nauseated.[1] Others, however, stated that some psychotropic medications (such as benzodiazepines and antidepressants) did help with their phobia, and some said gastrointestinal medications were also beneficial.[1]

Exposure treatments

Exposure methods, using video-taped exposure to others vomiting,[12] hypnosis,[13] exposure to nausea[14] and exposure to cues of vomiting[15] Systemic behavior therapy,[16] psychodynamic[17] and psychotherapy[18] have also shown positive effects for the treatment of emetophobia.

Effects on life

Emetophobics may also suffer from other complicating disorders and phobias, such as social anxiety, fear of flying and agoraphobia. 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 or dining out in restaurants. Emetophobics may also limit exposure to children for fear of germs. Females who suffer from this disorder delayed pregnancy or avoided it altogether because of the fear of morning sickness. People who have a fear of vomiting may avoid travel because of the worry about motion sickness or others experiencing it around them. They may also fear roller coasters for the same reason.

Dr. Lipsitz et al.'s findings also showed that those afflicted with emetophobia often have difficulties comfortably leading a normal life.[1] Many find that they have problems being alone with young children, and they may also avoid social gatherings where alcohol is present.[1] 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,[4] and travelling becomes almost impossible for some.[1]

In Lipsitz et al.'s survey, women afflicted with emetophobia said that they either delayed pregnancy or avoided pregnancy altogether because of the morning sickness associated with the first trimester,[1][19] and if they did become pregnant, it made pregnancy difficult.[1]

Other inhibitions on daily life can be seen in meal preparation.[1] Many emetophobic people also have specific "rituals" for the food they eat and how they prepare it.[1] 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.[1] 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 that they put upon themselves.[1]

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.[4] 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."[4]

Oftentimes this phobia is comorbid 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 emetophobics to also suffer from a fear of food, known as cibophobia, where the sufferer worries that the food they are eating is carrying pathogens 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 suffer from anorexia nervosa.

Notable people with emetophobia

See also

Notes and references

  1. 1 2 3 4 5 6 7 8 9 10 11 12 13 Lipsitz, Joshua D., et al. "Emetophobia: Preliminary Results of an Internet Survey." Depression & Anxiety (1091–4269) 14.2 (2001): 149-52.
  2. 1 2 3 4 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.
  3. ↑ Boschen, M. J. (2007). Reconceptualizing emetophobia: a cognitive-behavioral formulation and research agenda. Journal of Anxiety Disorders, 21, 407-419. doi: 10.1016/j.janxdis.2006.06.007
  4. 1 2 3 4 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.
  5. ↑ "Emesis - Definition and More from the Free Merriam-Webster Dictionary". Merriam-webster.com. 2012-08-31. Retrieved 2013-01-04.
  6. ↑ "Phobia - Definition and More from the Free Merriam-Webster Dictionary". Merriam-webster.com. 2012-08-31. Retrieved 2013-01-04.
  7. ↑ Becker, E. S., Rinck, M., Türke, V., Kause, P., Goodwin, R., Neumer, S., & Margraf, J. (2007). Epidemiology of specific phobia subtypes: Findings from the Dresden Mental Health Study. European Psychiatry, 22, 69-74.
  8. ↑ Fritscher, L. (2009). Emetophobia Fear of Vomiting. About.com Health's Disease and Condition. Retrieved from http://phobias.about.com/od/phobiaslist/a/emetophobia.htm
  9. ↑ Christie, A. (2004)
  10. ↑ Veale, D., Ellison, N., Boschen, M. J., Costa, A., Whelan, C., Muccio, F., & Henry, K. (2012). Development of an inventory to measure specific phobia of vomiting (emetophobia). Cognitive Therapy And Research, doi:10.1007/s10608-012-9495-y
  11. ↑ Boschen, M & Riddell, T. (2005) Emetophobia QuestionnaireQ). (Unpublished)
  12. ↑ McFadyen M, Wyness J (1983). You don’t have to be sick to be a behaviour therapist but it can help! Treatment of a vomit phobia. Behavioural Psychotherapy 11, 173–176.
  13. ↑ Wijesinghe B (1974). A vomiting phobia overcome by one session of flooding with hypnosis. Journal of Behavioural Therapy and Experimental Psychiatry 5, 169–170.
  14. ↑ Lesage A, Lamontagne Y (1985). Paradoxical intention and exposure in vivo in the treatment of psychogenic nausea: report of two cases. Behavioural Psychotherapy 13, 69–75.
  15. ↑ Hunter PV, Antony MM (2009). Cognitive-behavioral treatment of emetophobia: the role of interoceptive exposure. Cognitive and Behavioral Practice 16, 84–91.
  16. ↑ O’Connor JJ (1983). Why can’t I get hives: brief strategic therapy with an obsessional child. Family Process 22, 201–209.
  17. ↑ Ritow JK (1979). Brief treatment of a vomiting phobia. American Journal of Clinical Hypnosis 21, 293–296.
  18. ↑ Manassis K, Kalman E (1990). Anorexia resulting from fear of vomiting in four adolescent girls. Canadian Journal of Psychiatry 35, 548–550.
  19. ↑ Nelson-Percy, C. "Treatment of Nausea and Vomiting in Pregnancy: When should it be Treated and what can be Safely Taken?" Drug Safety 19.2 (1998): 155-64.
  20. ↑ Brooker, Charlie (2008-01-14). "Guardian". The Guardian (London). Retrieved 2009-12-31.
  21. ↑ "Contact music". Retrieved 2009-09-17.
  22. ↑ "Ashley Benson Interview In Complex-Type A". June–July 2014.
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