Emetophobia (The Fear Of Vomit And Nausea)

How’s my stomach feeling right now? I just ate, and my lunch was in my work bag for a while before it got to the refrigerator; I better not move too much or I might disrupt my stomach. I wonder how long mayo can sit out before it goes bad. I hope I don’t vom… er… get “sick.” Oh no, I just felt a gurgle. I should just go home now, to be safe. Oh, and cancel that date tonight. I’m not taking any chances.

What Is Emetophobia

Like many other phobias, or irrational fears, the fear of vomiting and nausea has its own confusion and poorly descriptive name: Emetophobia. On the surface, or to an outsider’s perspective, Emetophobia may be seen as an understandable, yet extreme, reaction to an undesired bodily function. However, Emetophobia can become a debilitating and pervasive phobia effecting all aspects of the sufferer’s life.

Woman holding her stomach in pain
Food is often to blame for stomach aches, but the anxiety about throwing up can also cause stomach pain.

Emetophobia often presents in childhood, but can develop throughout one’s life. It can also grow out of an experience with vomiting, family or cultural beliefs about vomiting, or seemingly out of thin air.

Situations that trigger the phobic response are often anticipated and strategized against at great length. Grocery shopping is an opportunity to curate “safe” foods and inspect them for signs of contamination. Social gatherings at restaurants can be an ordeal involving scrutinizing the Yelp page for comments of previous food poisoning or food mishandling, checking for food safety rating, and negotiating for a change of venue if any infractions are found.

Often the unanticipated triggers serve as the greatest obstacle. Despite following their own safety procedures, sometimes the human body will experience stomach or digestive discomfort. Simply not knowing whether a stomach ache is coming can be enough to justify cancelling plans, engaging in a more restrictive diet, overthinking previous meals and their outcomes, and constant mental and bodily checking for signs of nausea.

Pregnancy can be an especially fraught consideration given the possibility of morning sickness. Similarly, dealing with the inevitable infant spit up (the polite euphemism for baby throw-up) can be enough to make someone reconsider having children.  

Traveling long distances, or even perceived long distances from one’s home, can also be a struggle. For some, one’s home bathroom can be seen as a safe place, so being far from it in the off-chance that they need to actually vomit can be difficult. An arbitrary radius from home is sometimes set up so they are never too far from safety if and when they need to escape. A small network of safe bathrooms consisting of one’s home, place of business, family members, or trusted businesses can sometimes be established to allow for some sense of free mobility.

Saltine crackers with peanut butter on them.
The fear of vomit can lead someone to progressively excluding foods in favor of a limited but “safe” diet.

In extreme cases, further traveling by car, airplane, or any other means can simply be off the table. That said, some make it work through anticipated use of medication, limited diet, or even food restriction to avoid the possibility eating triggering foods. This usually also requires mental compulsions, checking, or reassurance to make it through.

The core fear fueling Emetophobia can vary from person to person. Of course, as a phobia, it does not require a justification to exist. The simple fact of discomfort and “gross” factor can be enough. However, for some the phobia is rooted in a feared story that vindicates the subsequent avoidance or compulsive behaviors. For example, what if their vomiting is the sign of a greater illness, but if they can control it they can confirm “it’s just nausea,” they think. Or what if they start vomiting and never stop to the point of death?

Common Compulsions:

  • Limited and restrictive eating habits
  • Avoiding saying words, such as “vomit” or “throw up.”
  • Over attention to preparation and cooking procedures
  • Over reliance on “safe” or trusted foods
  • Googling restaurant food safety ratings or reading reviews
  • Limitations on restaurants or cuisine
  • Avoiding traveling a long distance from home or a “safe” bathroom

Emetophobia Treatment

The good news is that phobias are highly treatable using several methods. Emetophobia shares similar traits to Obsessive Compulsive Disorder in its trigger, anxiety, and reinforcement cycle, so we can consider similar treatment methods, such as Cognitive Behavioral Therapy, Exposure and Response Prevention, and Acceptance and Commitment Therapy.

Cognitive Behavioral Therapy, or CBT, is a therapeutic model that helps people reconsider their thoughts and interpretations about themselves, their actions, and the world around them, then helps them re-evaluate their responses based on new, more logical thought processes. In the case of Emetophobia, we would evaluate the perceived dangers of throwing up, the likelihood of getting food poisoning, the effects of vomiting on one’s health and life, and the necessity of their compulsive “safety” measures.

Exposure and Response Prevention (ERP)Exposure and Response Prevention, or ERP, naturally follows CBT and helps the suffer intentionally change their responses to their fear, and over time helps them achieve greater functioning and freedom. In short, the sufferer works to progressively face their fears (Exposure) while resisting their compulsive behaviors and avoidances (Response Prevention).

For Emetophobia, this can look like eating at an unknown restaurant without reviewing Yelp, eating foods they previously avoided, using utensils at a restaurant or friend’s home, or eating food away from their home. Sometimes, treatment just focuses on riding the waves of stomach discomfort while continuing to stay in class, at work, or just watching tv at home. Acceptance and Commitment therapy (ACT) tools are used extensively in these cases.

Mastery Model Treatment For Emetophobia

Another effective approach to treating Emetophobia is known as the Mastery Model of treatment, and is designed specifically with Emetophobia in mind. This approach starts with the recognition that vomiting is almost universally unliked and “gross,” yet a necessary and fleeting bodily function that we can learn to live with.

Man picking up a hamburger with gloved hands
For some with a fear of throwing up, extreme caution is sometimes take to make eating possible.

Using the Mastery Model for Emetophobia, we consider what it would take to get sufferers back to their job, their relationships, and their hobbies that have been effected by the phobia and agree to continue doing what is necessary to make it functionally possible.

In other words, instead of initially reducing or eliminating washing, checking, or avoidance behaviors (i.e. compulsions), we encourage them within reason so that everyday life can continue. Then after some time, we then agree to slowly reduce compulsions while reflecting on the previous experience and success to give confidence to stop the superfluous safety measure.

The concept for this method is rooted in the idea that we get used to uncomfortable, awkward, and “gross” situations naturally when have a personally meaningful reason to do them and we continually show up for it. Think about the “gross” process of changing your child’s dirty diapers, or an EMT continually showing up to work to deal with blood. We typically do not habituation to the “grossness” of these situations. Poop and blood is, well, gross, and we do not start to like it over time. Instead, we tolerate it as a necessary evil of life.

If you would like to know more about Emetophobia treatment with CalOCD, please reach out to us here, or call us at (714) 423-3779.