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Overcoming Emetophobia, a.k.a. The Fear of Throwing Up

What to do when worry bug meets (imaginary) stomach bug.

For most of us, getting sick—yes, that kind of sick— from time to time is something that we accept and frankly try to not think about any more than we absolutely have to. In fact, please allow me to apologize in advance for bringing up the subject if it wasn’t already on your mind!

If only worry adhered to the same rules of etiquette. It doesn’t. Ask the millions of children and adults with vomit phobia. For them, getting sick isn’t something they think about as little as possible, though they would love to have that liberty. Instead, it is glued to their minds 24-7.

The slightest twinge in the stomach, or even just the mere mention of the word vomit or any of its equally noxious synonyms, can send vomit phobia sufferers into a panic spiral. What is that hot feeling in my throat? Is it a sign? Am I going to get sick? What if it happens now? Did that guy just cough or was he actually gagging? What if he’s sick?! Should I eat that? What if it makes me sick?

The fear of vomiting, or emetophobia, afflicts millions. It is in fact the most common fear among the children I see in my anxiety disorders practice. Many adults come to treatment for that fear as well. They come to treatment because their life has come to a screeching halt—kids refuse to go to school, take the bus, or go to friend’s houses for fear that they (or someone else) will suddenly throw up and they’ll be left to cope on their own. Adults imagine terrible scenarios as well, and may stop eating at restaurants, going out on dates, driving, or doing public speaking all because of the fear of the surprise sickness attack (which, by the way, never materializes).

None of us would like to get sick, and getting sick far from home even less so, but picturing it vividly and preparing for it daily doesn’t change the stats. It’s still as rare and unlikely for people with this fear as it is for any one else. Worry won’t prevent us from getting sick (our body is already programmed to do an excellent job of that all by itself) but it will stress us out and make us feel as if we are taking a huge risk by simply going about our normal business as others do every day.

You might think, given the intensity of their fears, that vomit phobia sufferers are those who throw up frequently. On the contrary, these are what I call—technically speaking—“not-throw-uppy” people. They get sick even less than the typical person—which is not very often. In fact, many of them, whether age 15 or 55, are able to say the exact two times when they have gotten sick in their entire life (and what they ate, what they were wearing, and what the weather was). Basically, worry is talking to the wrong people.

So how does worry get such smart people to be frightened on a continuous basis of this fear? The power of suggestion.

Say the word “throw up” or “vomit” a few times, and you might notice your anxiety level jump slightly. Say it a few more times with the prefix—“what if you?!?” and notice that not only does your anxiety rise, but you may even start to feel queasy. This is what is called the (super) power of suggestion.

Just like thinking about poison ivy or the dreaded lice makes you reflexively itchy, even though there’s no chance you have suddenly contracted either condition, thinking about vomit—especially for hours on end—can make your stomach feel tight, queasy and on the edge of your seat anxious. But, it cannot make you sick! Your body wouldn’t waste such a big and metabolically expensive reaction on such an unreliable cause as your worry.

So, even though sufferers may experience chronic digestive uneasiness and believe that unless they are vigilant—i.e., checking their temperature, focusing on every sensation, gas bubble, carrying around a plastic bag or antacids, avoiding people who “look sick,” avoiding the one food they ate the time they threw up 10 years ago—that throwing up is perpetually imminent, the distinction that will start to set them free is that the queasiness is a temporary emotional reaction to an unpleasant thought. It's not in any way a prelude to sickness. (More on that in a second.)

Given how rare throwing up is in general, the risk of getting sick should not be the template for everyday life for anyone, but especially not for those not-throw-uppy people. How can we change that template?

Some therapists use ipecac to induce vomiting to help patients see it is survivable. (Atlantic Monthly editor Scott Stossel describes his most unfortunate experience with this in an article and memoir). I don’t. The fear with emetophobia is two-fold. Yes, it’s vomit—the look, smell and general experience of it. But the second and more regularly disabling aspect of emetophobia is the anticipation—constantly entertaining the possibility of getting sick, the ceaseless taunting that the worry brain can do.

So how can sufferers of emetophobia overcome their fears? Not by stopping the thoughts (there’s no “off” switch that does that directly) but rather by changing their reaction when the thoughts come along. Why should they under-react to vomit thoughts? Because vomit isn’t the problem; the worry is.

Instead of taking the bait and relentlessly seeking an elusive guarantee every time worry speaks, they can see that this isn’t a sick moment; it’s a worry moment. They don’t have to check their forehead and take antacids; they need to take charge and fact-check their thoughts! They can’t help that the first thought barges in…. What if I get sick?! but they can resist piling 10 more catastrophic thoughts on top of it. They can realize that the thought has no real connection to that moment—that nothing is actually wrong in their body (it’s all anticipation). Nothing is happening now, their body is fine—then they can train the brain to filter these thoughts out and not bother sending them.

Worry thoughts about throwing up are like “the boot in the fridge.” Imagine if you were to open up your fridge and see a boot in there. You wouldn’t say, “Hmmm, I guess I have to have sautéed boot for dinner,” you’d say, “What is that doing in there? It doesn’t belong there!” Even if it happened over and over, you wouldn’t have to settle for boot! Same here: Just because an “Am I going to get sick?” thought has landed in the middle of your otherwise fine day (you weren’t sick before it landed, and you aren’t going to be sick when it leaves) you don’t have to settle for it. See that it doesn’t belong. Don’t reorganize your life around your fears—throw out the boot!

In a nutshell, the solution is help people with vomit phobia not trust their worry thoughts, but rather to test them out. The way to open the door to that process is through empathy. When your child or partner says urgently, “I don’t feel well, am I okay?” rather than reassuring, taking the temperature or arguing with them that they’re fine, agree with them. Lean in to the feelings and say, “I know you’re feeling worried right now," or, "I know you don’t feel well right now,” or even, “I know this feels really real for you, and you feel really bad right now, it’s not fair that you are dealing with this every day, but I want to help you, can we work together on this?”

By connecting with your child or partner, they will trust that you are on their side, then you can then get strategic by saying: “Let’s fact-check. Let’s ask the million dollar question—is this worry bug again or stomach bug?”

How do you help folks tell the difference? Here are some strategies to get you started.

Understand how your body works. Our bodies are built to keep us safe all the time. That means that we don’t throw up the majority of the time and only do get sick that .002% of the time when we really need to. And when we do need to—it’s highly efficient, so efficient in fact, that the proverbial stomach bug and even the rare food poisoning event is blessedly a 24-48 (or less) hour affair. Imagine if they went on for weeks like common colds!

Do the side-by-side comparison of fears to facts. List the fears about getting sick on one side of a piece of paper, on the other side “fact-check” the worries and ask—do I really think this fear is going to happen and why or why not? Some people fear that throwing up will be unbearable, that it will go on forever, that they’ll have to go to the hospital because of it. Whatever the issue, worry has exaggerated and distorted the facts—catch worry and correct it. Fold the paper to leave the logical side showing and refer to your smart thoughts as needed.

Ask the million dollar question. Ask yourself (or your child if they are the one’s struggling): “If you could win a million dollars by guessing right whether it’s worry bug or stomach bug—i.e., whether you’re actually going to get sick now or not—could you be the big winner?” Chances are, they know.

Ask your two detective questions. Help yourself or your child tell the difference between sick and scared of sick by asking these questions when they're feeling sick.

1. What happens next? After a few minutes of these worry thoughts or feelings, do you feel more nervous or more sick? If more and more worried, catastrophizing and spending time analyzing your symptoms, then you know it’s a false alarm. If instead, you feel more and more sick, like you have to go right to the nurse, or lie in bed and not even watch TV, or that you have to run to the bathroom and nothing would make you feel better—not even a trip to Disneyland or dream date with George Clooney—then you’re sick.

2. What makes it better? If distracting yourself by watching TV, going home (if you are out) or doing something otherwise fun, then you know it’s just worry bug. Distraction won’t help if you are really sick. So for example, if you had your million dollar question—if Mom said she’d take you to the mall or to a friend’s house, would you go?—and the answer is yes, then it’s worry. After a while, you and your child don’t have to think through the answers so specifically. Instead, you can just say, "Ask your two questions," and fast-forward to the relief.

Do on-purpose exposures to see that you don’t have to avoid life!

Have your child or partner rank the situations that are stressful or that they’ve avoided because of the fear. Have them start with the easiest, repeat till distress is significantly reduced, and then move up to the next step. For example …

  • Work on saying the synonyms for "throw up." Write them down first if you need to. Play catch while saying the words.
  • Work on gagging sounds. Put a spoon or lollipop or oatmeal or mashed potatoes on the back of your tongue, and inch it back slowly. See how you can gag a little and not throw up. You can listen to gagging sounds on the internet, or hire a family member to provide those sound effects for you.
  • Play catch with fake throw up (available from novelty stores).
  • Rehearse the sights and sounds of throw up by watching a family member fake-throw up into the sink or toilet with water or even water with a few pieces of cereal in it. When you are ready, try this yourself.
  • Make your own fake vomit with a few spoonfuls of cold canned soup. Add a splash of vinegar for pungency. Get used to being around it, and when you’re ready, “throw up” the fake throw up into the toilet.
  • Watch videos of people getting sick—Google can provide you with celebrity examples, moms and dads on roller coasters with their kids.
  • Approach whatever person, place, or thing you have avoided because of its coincidental association with throwing up—foods you don’t eat because they just happened to be what you ate last time you were sick, etc.

Use levity—find the fun!

  • With a teenager with vomit fears, we sat and named all the Beatles songs we could remember substituting the word vomit in the title. “I want to hold your, vomit.” “Let it vomit” “Vomit fields forever” “Hey Vomit.” You get the idea. This can be done with the younger set too, Row, row, row your vomit, gently down the vomit. Silly I know. But that’s the point. There is a technical reason why such an exercise of questionable taste would be useful. It’s called reciprocal inhibition. Essentially you can’t have two feelings at the same time. The two feelings of humor and fear compete and though it is difficult at first and fear is in the lead, you climb the fear mountain and then come down quickly the other side as the humor or absurdity of what you are doing takes over. This is how desensitization works.
  • Go on (yes this really exists) and look at the photos and rate how gross the vomit is, for extra exposure challenge yourself to make the sound that you think “accompanied” that vomit. Replay the segment or review pictures until there’s no distress, only normal disgust. N.B. parents need to carefully preview each entry for inappropriate language in the comments etc.

Eliminate safety measures.

Don’t carry around a “just in case” plastic bag or change of clothing. Remember, you are not a throw-uppy person, do you carry snow boots in spring or an umbrella on a sunny day? Is throw up possible, yes, but is it likely, no. Carrying around this extra equipment doesn’t offset the risk—which is minimal—but it amplifies the worry and keeps the risk (unnecessarily) on your mind.

Worrying about getting sick doesn’t change what happens, or doesn’t happen in life, but it absolutely and immediately changes our ability to enjoy and focus on what is actually happening in our lives. Worry changes our feelings, but it can never, never change the facts.

Rather than letting worry keep you on the edge of your seat in limbo land wondering, “is this about to happen now?” make peace with the fact that you don’t know exactly when it will happen and you don’t need to. Generally, we get plenty of warning for when we are going to get sick. The important thing is that it’s not happening now.

Say: "This is a hiccup in my brain—there is no reason I need to think about this now, I’m actually fine. This is the boot in the fridge. I wasn’t feeling sick, I’m not sick, I’m just worried. Worry is faking me out. My digestive track works very well and is fine. I’m not a throw-uppy person!"

Just because you don’t know for sure, you know well enough. In fact, you might just be able to win a million dollars because of it, but even if worry can’t pay up—you’ll be an instant winner by the wonderful feeling you get by taking charge of your mind.

©Tamar Chansky, Ph.D. 2015. No part may be reproduced without author permission.

Adapted from Freeing Your Child from Anxiety: Revised and Updated Edition: Practical Strategies to Overcome Fears, Worries, and Phobias and Be Prepared for Life— From Toddlers to Teens

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