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Emetophobia – What is it?

Emetophobia is the fear of vomit, the fear of vomiting or the fear of being sick.

It is reckoned to affect nearly 5% of the (UK) population and represents about one fifth of ALL clients we see at the Tranceform Psychology Clinic in the West Midlands.

It is a particularly problematic phobia because the object of fear (being sick) can occur in both the sufferer (“I worry about being sick”) as well as in other people (“I cannot cope with other people being sick near me”).

ANYBODY can be sick, and most people will be sick at least once in their lifetime.

People are often sick when they:

  1. Drink too much alcohol.
  2. Become Pregnant.
  3. Eat food that has gone-off.
  4. Catch germs that lead to sickness.
  5. Take medications with sickness as a side-effect.

Babies will often be sick when they being fed or are being weaned onto solids.

In fact, there are literally hundreds of reasons why a person might vomit, sometimes it can be self-inflicted and other times it can simply be down to ‘chance’.

Emetophobia banner - germs floating next to a females face.

Emetophobia is “All Around, All the Time”

This is why Emetophobia seems to be so problematic.

The Emetophobia sufferer could be ‘exposed’ to somebody being sick at any time when they are in public and therefore perceive the ‘threat’ as being present whenever they are around people.

Clearly this is going to be seriously limiting as it is almost impossible to lead a ‘normal’ life without social interaction.

What this means is that the Emetophobia sufferer becomes ‘hyper-vigilant’ and is constantly on ‘high-alert’ for any signs that people in their environment might be feeling ill and therefore likely (from their perspective) to be sick.

This hyper-vigilance manifests itself as a constant feeling of Anxiety and Stress.

Emetophobia safety behaviours banner - disinfecting airborne germs

Emetophobic Safety Behaviours & Coping Mechanisms

Because Emetophobia sufferers perceive ‘danger’ to be around them almost all of the time, and particularly when in public, they have a tendency to develop a range of ‘coping mechanisms’ and ‘safety behaviours’ that they believe helps to mitigate the threats, but in reality only serve to keep the phobia ‘alive’.

These coping mechanisms and safety behaviours often include strategies such as:

  • The avoidance of alcohol altogether.
  • The avoidance of pubs and clubs where people often get drunk.
  • Reluctance to eat-out at restaurants or friends houses for fear of incorrectly cooked foods.
  • Avoidance of chicken (associated with Salmonella).
  • Avoidance of friends and family who might have been ill recently.
  • Drinking or taking ‘stomach settlers’ frequently to try and keep sick feelings at bay.
  • Refusal to take any medications that might cause feelings of nausea as a side-effect (even medication that might be medically necessary for them).
  • Frequent hand washing and use of anti-bacterial gels throughout the day (exacerbated by the Coronavirus pandemic of course).
  • And so on……..

Whilst these behaviours might seem completely logical to the Emetophobia sufferer in their quest to minimise their chances of being sick (or encountering sick people), they do very little to reduce the high levels of Anxiety they experience.

Let’s face it, if these safety behaviours ACTUALLY worked, the Emetophobia sufferer would not feel anxious at all would they (because they would feel safe!!) but this is almost never the case.

In fact, the more safety behaviours that the sufferer utilises, the more anxious they are likely to be.

In this self-help CBT course we try to help Emetophobia sufferers to develop a better understanding of just how unhelpful and counter-productive their safety and avoidance behaviours actually are.

Catastrophic thinking in Emetophobia banner - nuclear mushroom cloud

Emetophobic Thinking (Cognition)

Another aspect of Emetophobia dealt with in this self-help course, are the types of cognition and thinking styles that are associated with the fear of vomit.

There is one particular ‘thinking style’ (way of making sense of things) that is almost always a component part of Emetophobia that is known as ‘catastrophic’ thinking, or a tendency to ‘catastrophise’ about otherwise ‘benign’ events or experiences.

When people catastrophise they lose any sense of proportionality about what has happened which creates a range of exaggerated emotions (highly anxious, really sad, really angry, and so on).

When we lose this sense of proportionality it also affects our ability to maintain ‘perspective’ on other aspects of our lives.

Catastrophisers can often be heard muttering such phrases as:

  • “This is the worst day of my life”.
  • “It was absolutely horrific”.
  • “It’s really disgusting”.
  • “They must really hate me”.
  • “There’s no way I could ever cope with being sick”.

and so on…

The inability to maintain perspective through a catastrophic thinking style is fundamental in Emetophobia.

Social anxiety and emetophobia banner - woman being pointed at by numerous hands

Social Anxiety & Self-Esteem in Emetophobia.

Two further aspects of Emetophobia that we address in this course are the degree of social anxiety, social compliance and social conditioning that play a role in the maintenance (and causation) of the phobia along with the sense of self-esteem (beliefs about the self) that the sufferer holds.

Social anxiety and self-esteem seem to exhibit an inverse relationship in which increases is social anxiety produce decreases in self-esteem (and where the opposite is also true, where improving self-esteem reduces social anxiety).

A great many Emetophobia sufferers are aware that their phobia of vomiting is regarded as completely irrational by friends and family. This can lead the sufferer to worry about what others might ‘think’ about them for having Emetophobia leading to lower self-esteem.

In some cases, the idea of being evaluated negatively by their social peers can add to their sense of anxiety on top of the anxiety associated with the phobia making matters even worse!

One consequence of this inverse relationship between social anxiety and self-esteem is that people with low self-esteem and high social anxiety almost always have a negative sense of self-efficacy – their ability to formulate positive and adaptive actions to life challenges.

This idea of negative social evaluation and worrying about what others ‘think’ is dealt with directly in the course in the module dedicated to social anxiety and social pressures.

Causality and attribution in emetophobia banner

Causality & Attribution in Emetophobia

Another key concept dealt with in this course is the concept of ‘causality’ or ‘attribution’.

These factors are often measured using the concept of the Locus of Control which gauges how people attribute the causation of their life problems (and successes).

For example, the Emetophobia sufferer attributes the way that they feel (anxious and panicky) to the physical manifestation of vomit (whether that be their own or somebody else’s). In other words, they believe that a ‘pool’ of ‘sick’ causes them to have an emotional reaction we refer to as ‘panic’ or ‘anxiety’.

We would say that they attribute the way that they feel to the external influence of the sick itself.

Now this cannot actually be ‘true’ (in a ‘real world sense’) because vomit is comprised of semi-digested food-stuffs and digestive fluids and enzymes. Non of these components has the ‘ability’ to make a person experience ANY kind of emotion – they are just bits of carbon-based chemistry.

What is actually occurring is:

  1. The Emetophobia sufferer perceives (sees/smells/imagines) the presence (or threat) of vomit in their immediate location.
  2. They interpret (based on what they believe to be factual about vomit) that this vomit is ‘dangerous’ in some way to them (it might make me sick).
  3. Their brains respond to this ‘threat’ by invoking the anxiety response, what has come to be known as the fight or flight response.
  4. They then become anxious and try to escape from the threat, usually by running away or, if they can’t run away, going into a ‘full-blown’ panic attack.

Once they have escaped the threat, or the threat has subsided, they then add this ‘experience’ to the repository of ‘evidence’ that they keep in the ‘proof that sick makes me feel anxious’ storage system.

As long as the Emetophobia sufferer continues to ‘blame’ (attributes causality to…) vomit for the way that they feel, rather than understanding that it is their own ‘subjective’ evaluation of vomit that leads to their emotional experiences, then they are highly likely to continue experiencing anxiety and panic in relation to the ‘idea’ of vomit.

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About the Course Author

Paul is an academic and practicing psychologist with both a BSc. (Hons) and a Master's MSc. (Distinction) degree in Applied Psychology.

Master Psychologist Paul Lee

He has been offering clinical psychology and counselling to private clients along with a small team of therapists from the Tranceform Psychology offices in Wombourne near Wolverhampton since 2009.

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