Emetophobia (Fear Of Vomiting): Causes And Treatment

Emetophobia is a severe and persistent fear of vomit. Individuals with this condition experience anxiety around vomiting or witnessing someone else vomiting. Research suggests this phobia is generally associated with an overwhelming fear of losing control, being extremely sick or being the target of disgust. It’s relatively common, affecting 3.1% to 8.8% of the population, and is more common in women^[1]de Jongh A. Treatment of a woman with emetophobia: a trauma focused approach. Ment Illn. 2012;4(1):e3. Published 2012 Feb 3. . Research suggests average symptom onset begins in puberty.

Emetophobia typically leads to avoidance behaviors as affected individuals seek to steer clear of situations or experiences they associate with vomiting, such as bars, restaurants and hospitals. When left untreated, emetophobia can impact a person’s ability to function at home, socially or in the workplace. People with this condition may struggle with everyday tasks such as cooking and eating and may even avoid experiences—such as pregnancy—due to a fear of being ill.

While there is no known singular cause of emetophobia, like any anxiety disorder, a combination of biological and environmental factors may be at play, says Amy Braun, a licensed clinical professional counselor and a certified clinical anxiety treatment professional in Chicago. Emetophobia may even be a learned response to the general unpleasantness of vomiting, she suggests, noting that repeated avoidance behaviors over time may strengthen an individual’s fear of sickness.

Life experiences may also factor in, notes Lauren Cook, Psy.D., a clinical psychologist in Los Angeles. “While many people can have emetophobia without a distinct cause, many folks have had traumatic experiences surrounding vomit, whether it was a loved one being ill, a situation where they were embarrassed or they or someone else got sick and it induced strong feelings of disgust,” adds Dr. Cook.

Emetophobia is categorized as a specific phobia in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the standard text used by U.S. clinicians to make mental health diagnoses. This is a type of phobia in which an individual’s fear of an object or situation impairs daily functioning, and is out of proportion to the danger the object or situation actually poses.

However, sometimes, individuals are diagnosed with obsessive compulsive disorder (OCD) instead of—or in addition to—a specific phobia diagnosis, because some of the prominent symptoms of emetophobia meet criteria for an OCD diagnosis.

Symptoms of emetophobia may include:

• Avoidance behaviors, such as refusing to visit hospitals and sick people
• Excessive handwashing
• Excessive cleaning of food prep areas
• Refusing trying new foods or foods you associate with past vomiting
• Refusing to shake hands with others
• Hypervigilance about checking yourself or others for symptoms of sickness
• Refusing to eat food when not at home
• Hypervigilance over locating restrooms
• Avoiding sick scenes in movies or television
• Avoiding travel
• Nausea
• Anxiety
• Panic attacks, characterized by symptoms such as dizziness, difficulty breathing and a racing heartbeat

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It’s unlikely that symptoms of emetophobia will ease on their own. Fortunately, there are evidence-based approaches for treating this condition. Here’s a look at available treatment options.

• Exposure and response prevention (ERP): This is a type of cognitive behavioral therapy (CBT) aimed at reducing the anxiety response produced by certain triggers. When treating emetophobia, ERP may include watching videos of vomiting or listening to vomiting sounds, says Dr. Cook, who has undergone ERP herself to successfully treat her own emetophobia.
• Medication: Medications may be prescribed to treat anxiety symptoms associated with emetophobia.

One 2012 case study also suggests that eye movement desensitization and reprocessing (EMDR) may be successful in treating emetophobia. EMDR is a therapeutic method that uses eye movement to ease the emotions linked to traumatic memories.

While living with emetophobia may come with its share of difficulties, there are a number of ways to alleviate your symptoms and cope with this condition. Some strategies include:

• Professional help: Finding a mental health clinician can help you live more comfortably with emetophobia, says Braun. If you don’t know where to begin your search for a therapist, the American Psychological Association has a searchable directory that offers a good starting point. You might also contact your primary care doctor for a list of referrals.
• Support: Finding support groups or opening up to a friend or loved one can remind you that you don’t need to navigate emetophobia alone.
• Try reframing your thoughts: “Rather than seeing vomiting as disgusting, a lack of control or an opportunity to be ashamed, we can see getting sick as the body’s way of trying to heal itself when [exposed to] something unhealthy,” says Dr. Cook.

Without proper treatment, emetophobia can feel debilitating. If you’re experiencing any of the following, Dr. Cook recommends seeking professional support:

• You have panic attacks related to your fear of vomit
• You avoid certain places, such as restaurants, airplanes and bars
• You avoid major life events, such as pregnancy

As someone who treats people with phobias and who has experienced emetophobia herself, Dr. Cook says, “I know how debilitating this phobia is, and I’m here to say it can get better.”