OCD and Fear of Vomiting: All you need to know about Emetophobia
Emetophobia is the intense fear of vomiting. For those with this specific phobia, extreme fears surround the thought of vomiting, seeing other people vomit, or feeling nauseous.
For those suffering from this disorder, it goes beyond a typical response of disgust toward vomit (after all, who doesn’t recoil a little at the sight of it?). People with emetophobia actually fear it.
To the untrained eye, symptoms of emetophobia and OCD overlap so much that one could easily be mistaken for the other.
Both involve obsessions (disturbing thoughts, images, urges, feelings, or sensations) and compulsions (physical and mental rituals to alleviate the uncertainty and anxiety surrounding those obsessions).
But fear of vomiting is technically classed as a Specific Phobia.
For some, emetophobia may arise as a comorbid condition alongside OCD (occurring simultaneously) or may present as a symptom of OCD.
In this article, we will compare the two disorders but pay particular attention to the fear of vomiting so that you can understand how to manage and overcome this specific phobia.
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What is OCD? A Recap
OCD is the acronym for obsessive-compulsive disorder.
A common and highly debilitating mental health condition, OCD is prevalent in up to 2% of the world’s population.
The two core components of OCD are obsessions and compulsions.
Someone with this mental health condition is relentlessly plagued by disturbing and unwanted thoughts, images, urges, sensations, and feelings, known as obsessions.
Intrusive thoughts feel like they invade our mental space and leave us questioning our identity and morality. This is why OCD is considered egodystonic. This means that the very nature of this disorder goes against our values.
Our obsessions in the case of OCD attack our values and breed doubt and uncertainty about the meaning and consequences of our thoughts and therefore our actions.
Following these obsessions, sufferers battle with immense uncertainty and anxiety which they feel the need to solve and resolve.
Compulsive behaviors are done to alleviate those uncomfortable feelings and offer temporary relief. However, in engaging in these rituals they keep the OCD cycle in motion and strengthen its hold.
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OCD can feel like it robs you of the joys of the present, everyday life. And those that wake up to it every day are brave and far stronger than they think they are. The good news is that this is a highly treatable condition and our clients have seen tremendous success in their recovery.
It takes a hefty dose of courage, but the day you begin treatment with an OCD specialist in your corner, is the day that you finally start to take your life back from OCD.
What is Emetophobia?
Emetophobia is the intense fear of vomiting.
For those who struggle with this disorder, the anticipation of vomiting can be just as grueling as the act of vomiting itself. Avoidance of certain foods and excessive inspection of certain foods are two incredibly common symptoms of this disorder.
Someone with this phobia is plagued by obsessions about what might happen if they get ill, eat bad food, or inhale a foul smell… but the resulting fear is always the same, “What if any of these things happen, and I end up being sick”.
This is why emetophobia can sometimes be confused with OCD as the obsessions and compulsions can appear very similar.
Someone may see a person obsessing over foods and ruminating over how they feel and see these as symptoms of OCD. In some cases, this may indeed be an extension of OCD. However, this phobia can exist independently.
The way in which we can distinguish the two is by answering the following question:
What is the sufferer actually afraid of?
In emetophobia, fear of vomiting and fear of nausea is the core obsession.
This is very different from a person who may inspect their food because they fear germs and the possibility of falling ill. For someone with a fear of vomiting, they may want to avoid germs, but it is because the germs may cause them to vomit, not because they’re afraid of the germs themselves.
Emetophobia can be prevalent in anywhere between 0.1 and 8.8% of the population at any one time. So if you do resonate with this, you’re not alone.
Causes of Emetophobia
According to Dr. McGrath at NOCD, causes of emetophobia can vary wildly.
For some, it’s how they manage their inability to tolerate uncertainty.
Other causes may include:
- Traumatic experiences involving vomit
- Family history of mental health conditions
- Comorbid conditions such as OCD or anxiety disorder
Symptoms of Emetophobia
Common emetophobia symptoms include:
- Avoiding places they associate with vomiting (such as bars or nightclubs, for example)
- Only eating certain ‘safe’ foods and avoiding those which they consider ‘risky’.
- Avoiding medication that may have nausea as a side effect.
- Excessive inspection of new foods or anything that may have a slightly ‘funny’ smell
- Avoidance of children or anywhere where children may typically be (such as school) to reduce the risk of exposing themselves to someone who might vomit.
- Avoidance of things that may cause them to feel nauseous, like traveling on boats or trains.
- Checking other people for signs of illness and avoidance of places like hospitals or homes for the elderly where people may likely vomit.
- Overcooking food like chicken to avoid food poisoning.
- Monitor your body temperature and sensations excessively to check for signs of illness.
How can fear of vomiting affect quality of life?
Fear of vomiting can be an incredibly isolating disorder.
A lot of people with this phobia avoid going to social events where they feel unable to eliminate the risk of vomiting themselves or someone else vomiting.
For example, they may avoid going to birthday dinners for fear of eating something new that may or may not make them feel nauseous. They may avoid going to a bar with their friends for Saturday night drinks just in case someone drinks too much and is sick.
Added to this is the fear of judgment and embarrassment.
Those with this disorder recognize that the people around them likely do not understand what they are living with and may see their behaviors as odd.
They may feel subject to peer pressure from people who lack the knowledge to help them manage their symptoms in a public setting. For example, you may find it difficult to go to a restaurant with a friend where they are constantly asking you to join them in having a drink or trying new foods.
This mental health condition can be mentally, emotionally, and physically draining.
Your day-to-day existence is consumed by fears about what might happen if you eat the wrong thing or go to the wrong place at the wrong time.
You’re often managing symptoms alone because you believe that no one would understand you; what would people think?
And, those with a fear of vomiting can live on incredibly restrictive diets – often cutting out entire food groups to remain ‘safe’ from vomiting – which can negatively impact their physical health. Malnutrition can be the result of living with emetophobia.
The difficulty here is that when we’re malnourished and feeling weak in our bodies, people can experience brain fog which makes it harder to make choices that are driven by our values rather than our fears.
Another cycle of this disorder is that when we’re avoiding certain food groups and therefore not getting the calories we need, this can cause the very nausea that we’re trying to avoid.
When we experience this nausea, it then contributes to the cycle of fear as we might then avoid eating further to avoid any risk of being sick.
If this sounds like you, you may be stuck in the belief that things may never get better. But this is your reminder that emetophobia, just like OCD, is incredibly treatable.
With a highly qualified specialist in your corner, you can revive the love you had for food and the social life you feel you’ve been missing out on. Your days do not have to be ruled by this disorder, our clients are living proof of that.
What makes fear of vomiting worse?
There are two things to take into consideration here:
- Much like OCD, those compulsive behaviors only strengthen the hold of this disorder.
When you’re in the throws of emetophobia, it can feel like your compulsive avoidance is the only way you can survive. Those repetitive rituals such as avoiding, checking, inspecting, and ruminating offer short-term relief and reassurance.
However, in not tolerating the uncertainty and doing the things you would normally do if this phobia weren’t a problem, you actually reinforce the fear.
- Our fears make us hypersensitive to our bodily sensations
When we place our attention on a certain part of our body, looking for any signs that something may be wrong, we intensify any feelings we may have.
For those with fear of choking, the focus is on the back of the throat. Because of this, the throat tends to tighten and we trigger tension where there needn’t be any.
Likewise, particular OCD subtypes suffer from similar hyper-responsiveness to bodily sensations such as in health anxiety whereby a person is looking for signs of health problems. They may check their body repetitively and in doing so become hyper-aware of any small feeling or sensation that could be perceived as a sign of a health problem.
The same goes for people with a fear of vomiting.
They want to avoid getting sick but in worrying about this, it can trigger stomach discomfort and nausea which is then perceived as a sign that something must be wrong.
Are OCD and Emetophobia the same thing?
Although they appear incredibly similar, OCD and emetophobia are in fact two distinct disorders.
Similarities
- Obsessional thinking
- Hyperawareness of bodily sensations
- Reactivity
- Avoidance
- Compulsive behaviors
- Safety behaviors
- Causes extreme uncertainty and distress
Differences
- In emetophobia, fear of vomiting is the core obsession, versus OCD subtypes, where the obsessions can vary widely.
- The compulsion for emetophobia is done to neutralize fears of vomiting but in OCD, food avoidance as a compulsion is commonly done to neutralize fears of contamination.
Treatment of OCD and Emetophobia
The most effective treatment available for both OCD and emetophobia is CBT (Cognitive Behavioral Therapy) and ERP (Exposure Response Prevention).
Before a patient begins treatment, it is vital that they are taken through a thorough and correct diagnostic procedure to identify which disorder the patient suffers from (whether it be one or both) in order to receive the most effective treatment possible.
Although these conditions are incredibly close in characteristics, knowing which fears we’re working with makes the difference between treatment that works and treatment that doesn’t.
If you’re unsure as to which condition you may be struggling with, please get in touch with a qualified mental health professional who can offer a correct diagnosis.
ERP for emetophobia
For fear of vomiting, ERP is used to maximum effect when applied over three different areas:
- Physiological
In the first instance, we would look at the physiological symptoms associated with nausea and vomiting itself. To address these symptoms, you would work together with your therapist to intentionally create the physiological symptoms associated with vomiting by engaging in self-controlled exercises. This might include, for example, spinning around in circles to cause dizziness and light-headedness. The idea is to help you become more comfortable with these feelings as they arise.
- Environmental
The environmental element involves going to specific places that would otherwise be avoided for fear of triggering the anxiety and uncertainty associated with this disorder. This may also include exposure to foods that would normally be avoided. Together with your therapist, you will create an achievable hierarchy of environmental exposures that become increasingly difficult but manageable. Your therapist will meet you where you’re at and work at your pace.
- Exposure
This final element requires the sufferer to expose themselves to the act of vomiting itself. This does not require that we purposefully make ourselves vomit but instead expose the client to vomit-like substances, watch TV programs where vomiting is present, or engage in the act of eating and chewing food before spitting the food into the toilet to mimic the act of vomiting.
Although this can feel scary to read, it is done alongside the support of a specialist who only challenges you with exposures they feel you can handle.
It is a collaborative process whereby you and your therapist work at a pace that feels manageable.
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Our clients often come to us with hesitations about starting the recovery process, which is fully understandable.
However, within weeks of starting almost all of them are glad they did. Because although the road to recovery can be tough, it takes them one step closer to a life where this fear does not rule their days.
They find food freedom again, eating the foods they love and doing so with their friends and family.
Their physical, emotional, and mental health improves and they begin to do the things they always wanted to do if this disorder wasn’t dictating every decision they make. That’s the goal. To live the life you want to live and be led by your values, not your fears.
If you are based in California or Arizona, our highly qualified and compassionate mental health therapists can support you in your recovery and do so without judgment.
If you resonate with what you’ve read here today, please do get in touch to receive a thorough diagnosis and discuss the possibility of us supporting you on this journey. Please submit an initial intake form here, we look forward to hearing from you.
