Struggling to explain how emetophobia impacts you? Here’s an article for family, friends, carers, teachers and medical practitioners.

Kindly note this article may contain trigger words

By Jane Pendry

Jane Pendry is a Solution Focused Hypnotherapist and Trauma therapist specialising in emetophobia, the fear of vomiting, complex phobias, misophonia and trauma recovery.

Emetophobia is the most complex phobia. Recovery takes courage, persistence and commitment.

The Sense-Ability Emetophobia Recovery Programme is a painless process founded on Solution Focused Hypnotherapy, Rewind Trauma Therapy, EMDR, with elements of mindfulness, NLP and somatic modalities.

The Emetophobia Recovery Programme is the result of working successfully with dozens of emetophobes and supporting them through a journey to recovery. To find out more:

Emetophobia Recovery Programme

Why is Emetophobia so Complex?

Vomiting involves our own bodily functions and autonomic nervous system; something we can’t generally control.

Phobias are sometimes called ‘little t traumas’ even though the impact of them can be intense and debilitating. Most phobias concern things outside our bodies e.g. insects, birds, dogs, spiders. Most of the time we can avoid the thing we fear.

Emetophobia, however, is the most complex of complex phobias. The fear is, in effect, a fear of the body’s own autonomic nervous system response to getting rid of toxins and bugs from the body.

We can’t walk away from our own bodies, nor ask someone else to take care of the thing we fear.

The impact is that emetophobia can operate like a trauma. Intense fear can be frequently triggered by language, images, sounds, events, intrusive thoughts and sensations in the body.

This complex phobia is an extremely debilitating condition that dominates the thoughts, feelings, actions and interactions of the sufferer, making day-to-day life challenging and exhausting.

Emetophobia is usually caused by trauma in childhood. Sometimes more complex traumas from childhood worsen symptoms further.
Photo (c) Unsplash

Emetophobia and Trauma

Trauma is less about the event or events that happened and more about how our nervous system processed that event.

Many factors can come together so that our nervous system becomes so overwhelmed we are traumatised and struggle to recover. The experience of vomiting - sudden, dramatic and intense as it can seem – can overwhelm young, not yet fully formed, minds, bodies and nervous systems.

For most of us, vomiting is a short-lived experience that leaves no lasting distress.

But for many the experience, can become embedded in the body as trauma.

Feeling out of control

Under certain circumstances, the process of vomiting appears to be random, out of control, noisy, smelly and just a bit gross. The combination of suddenness, speed and sensory overload can be just too much for the mind and body.

Even witnessing vomiting can feel overwhelming to a child.

Feels life-threatening

To a small child, or neurodivergent person with sensory issues, vomiting may even cause them to fear they might die. The sensations are alien and disturbing to them.

If it’s a first experience, a child may not understand it will end soon. They have no knowledge that the experience is temporary, and that relief will shortly follow.

Avoidance

When the feelings were so intense and overwhelming, we never want to experience that complex mix of feelings again. Naturally, we start to become pre-occupied with avoiding the possibility of that happening ever again. That’s when avoidance, safety behaviours, obsessing and ruminating can begin - the core symptoms of emetophobia.

Inherited fears

Emetophobia can be linked to inherited fears – parents are frightened of vomiting so the fear is passed on to their children. The child learns that vomiting must be dangerous and embeds the learning.

Childhood and adolescence

A fear of vomiting usually becomes embedded in childhood or adolescence.

Sudden, dramatic and gross

As vomiting can be so sudden, dramatic and frankly, gross, many children don’t understand what is happening to them. They are rarely prepared for the possibility of vomiting so for some it comes as a shock and a surprise.

The experience - whether heard, witnessed or experienced - can completely flood a young body and mind. To the child it is a traumatic event. Children may also perceive the sudden dramatic nature of vomiting as life threatening, disgusting or humiliating.

Feeling abandoned and alone

Children rely on their parents to filter their most intense experiences as their minds and central nervous systems mature. During their first experiences of vomiting, many children may feel in some sense abandoned or alone. They may believe they are in danger, and fear the loss of control. Mostly likely, they don’t have the language to explain what’s happening to them or what they feel.

Parents or carer’s absence

Sometimes parents or carers were unable to offer comfort, explanation or sympathy when a child was physically sick or witnessed someone else being sick. For some adults, being sick was simply no big deal and they didn’t realise their child was so distressed.

The child may have had a bad experience of vomiting at a friend’s house or at school or on a school trip so parents and carers weren’t there to support them, to soothe, reassure and explain that it will pass soon, adding to a child’s alarm. Perhaps they weren’t reassured that it’s a short-lived experience that soon passes.

There is no-one reading the level of distress, soothing, reassuring or explaining what is happening, then the feelings of overwhelm become all the more intense.

Feeling exposed and alone

If a child is at school or away from home when they experience their first episode of vomiting, they may also be impacted by how other children react eg laughing at them or another child being sick, reacting with disgust, or reeling away from the incident in horror.

The child then associates being sick with shame, humiliation and ridicule.

Underlying anxiety or fear

Perhaps there were other intense emotions that a child or adolescent was already struggling with, like anxiety, fear or confusion when the vomiting episode happened. If anxiety is already high, and the child in that moment feels unsupported or abandoned for any reason, then the level of distress is heightened.

Life changing events like moving home, changing schools, parents divorcing or a death in the family where the child or teenager feels unsafe, can leave the child more vulnerable to becoming overwhelmed by a sickness bug or food poisoning.

The pressures of adolescence

Adolescence is a heady time, fully of hormonal and emotional changes that in themselves are often intense and overwhelming.

If a sickness bug should happen at this time, adolescents or children may not have the emotional capacity to deal with the intensity of the experience, or they may already be struggling with changes in their body that add to their feelings of loss of control or overwhelm.

Emetophobia and Classical and Operant Conditioning

There is usually, but not always, a precipitating and memorable event or events which creates a conditioned response; linking vomiting to anxiety, fear and even terror.

Subsequent events may embed fears further. That is called operant conditioning.

Classical conditioning and operant conditioning are associated with most phobias, like a fear of dogs (once bitten twice shy as it were), insects, mice or spiders. These conditioned responses are likely a contributory factor in emetophobia but not the whole story.

Autism and sensory sensitivity can make the experience of emetophobia more challenging
Photo (c) Unsplash Grief Milada Vigerova

Neurodiversity and Sensory issues

In my experience, emetophobia may also be linked to sensory issues,

Neurodiverse people have a heightened sense of interoception. They are more away of sensations in their bodies linked to bodily functions like eating, digesting, and pooing.

Sensory sensitivity

People with sensory sensitivity are often so hyper-aware of changes in sensations within their bodies, that the sudden, fast and significant change in sensations that result from vomiting, or even nausea, cause a disproportionate sense of alarm.

Usually the pay-off after vomiting - euphoriant chemicals that create a brief moment of elation followed by relief and calm - are enough to stop the general population from developing debilitating emetophobia.

For people with sensory sensitivity issues, however, the memory of the discomfort lingers and the fear of those feelings returning feels overwhelming. In this instance, supporting the client to strengthen their nervous system and tone their vagus nerve, and increasing their tolerance of sensations in their bodies, is critical to recovery.

Autism and Emetophobia

Anxiety disorders and complex phobias are more common in people with autism. The combination of sensory overload, sensory sensitivity, a need for predictability, and difficulties in emotional regulation can make the fear of vomiting more intense and harder to manage.

People with autism often prefer routine and predictability. Vomiting is often unpredictable and uncontrollable. The fear of losing control can be overwhelming, increasing the likelihood of developing a fear of vomiting.

Interoception is the ability to sense and interpret internal body signals like hunger, nausea, or discomfort. Some autistic people have difficulty interpreting these internal cues, or find them uncomfortable or distressing. Some struggle to identify early warning signs or accurately assess how their body feels which increases anxiety and fears about vomiting.

Autistic people can often engage in repetitive or obsessive thinking, or they hyper-focus on certain fears or concerns. This can cause the fear of vomiting to become magnified and more persistent.

Generalised Anxiety

Anxiety conditions like generalised anxiety or OCD affect the gut directly through the gut brain axis.

Gut brain axis

The brain and the gut are directly connected through a two-way communications process via the gut-brain axis.

The gut-brain axis operates through the vagus nerve, the longest cranial nerve in the body that meanders down the spine.

The operation of the vagus nerve

Fear, anxiety and stress affect the vagus nerve which causes the function of the major organs to slow down when the body is in fight or flight. Except the heart which pumps wildly to get available oxygen to the muscles so we can run away or fight!

When frightened, stressed or highly anxious, the gut is affected and we feel nauseous or even sick. For clients that have emetophobia this creates a negative feedback loop - fear of vomiting, rising anxiety, leading to nausea, and leading back to anxiety.

It is therefore helpful to reduce stress, anxiety and fear with somatic - body and mind - interventions and hypnosis, which help to tone the vagus nerve and build resilience and greater tolerance.

Emetophobia and IBS

It is quite common to see emetophobes with irritable bowel syndrome or IBS. The stress of living with the condition can exacerbate the symptoms of IBS, eg cramping, bloating, constipation and diarrhoea. IBS is very much affected by the two-way communication system operating between the brain and the gut. IBS symptoms can worsen emetophobia, and vice versa.

Vomiting or Nausea from Anxiety

Vomiting from anxiety can feel worse than vomiting due to a sickness bug for several reasons:

Vomiting from a sickness bug brings eventual relief as the body expels the virus or bug. However, anxiety-induced vomiting may not lead to the same physical relief because the underlying cause remains.

Anxiety-driven nausea and vomiting can be part of a cycle where fear of vomiting causes more anxiety, which in turn worsens the nausea. This loop can make the experience more prolonged and distressing than a short-term sickness bug.

Vomiting caused by anxiety is tied to emotional and psychological stress, which can make being sick feel more overwhelming. The sense of losing control, also makes vomiting even more distressing than a physical illness.

Accompanying symptoms like rapid heartbeat, sweating, dizziness, or a feeling of impending doom, making the experience of vomiting more intense than the isolated physical discomfort of a sickness bug.

While a stomach bug usually follows a pattern (feeling unwell, vomiting, recovery), anxiety-induced vomiting is more unpredictable, and more frequent, causing fear and uncertainty about when it might happen again.

Other Factors

Personality traits

Some people are more prone to anxiety making them more likely to develop complex phobias in general, and emetophobia in particular.

Underlying trauma or PTSD

Women and girls are often subjected to more abuse and threats throughout their life making them more vulnerable to developing anxiety-related disorders.

Research indicates that women are twice as likely to develop PTSD, experience a longer duration of post-traumatic symptoms and display more sensitivity to stimuli that remind them of the trauma than men.

Biological or genetic factors

Throughout the years I have been developing the Sense-Ability Emetophobia Programme, I have observed that many people have sensory issues already. For example, they have problems with labels in clothes, loud noises or the texture of foods. I haven’t seen specific evidence of the connection, but it is something I now ask clients about as it slightly changes my approach.

In this instance, its unlikely that the client can get rid of their sensory sensitivity completely, but they can be supported to manage symptoms better, to reduce irrational fears and to build resilience so they can cope much better.

For people with sensory sensitivity issues it’s worth exploring how exercises with a specialist in neuro-developmental delay could help develop or integrate primitive reflexes.

Environmental factors

Sometimes clients report that when they vomit, or someone near them vomits, others were, or are, critical and unsupportive, teasing them, ridiculing them or invalidating their experience. This appears to be a factor in the development of many deep-rooted cases of emetophobia.

For anyone who has lived under an enduring set of conditions that have led to abandonment, fear, overwhelm or C-PTSD, symptoms of emetophobia will likely be worse.

The nervous system is unregulated or overwhelmed feeding into emetophobia fears and triggers. Anyone who has endured systemic racism, homophobia, child abuse, neglect and abandonment or other adverse childhood experiences (ACEs) with emetophobia may need further support and therapy to help them resolve the deeper traumas that worsen their emetophobia symptoms.

External and Social Factors

Any additional emotional pressure that push us towards fear and generalised anxiety can exacerbate the symptoms of emetophobia. That’s because anxiety, fear and stress directly affect the gastrointestinal system, creating nausea, exacerbating symptoms of IBS or GERD, and increasing our interception or awareness of sensations in our bodies.

Emetophobia in Women

Women and girls have often been brought up to please others, to be agreeable and compliant.

Conversely, some girls have not been encouraged to develop resilience and a belief in themselves that they can change their circumstances or destiny, resulting in a sense of powerlessness and even hopelessness that they cannot change their condition.

Being a woman!

Professor David Veale, a leading psychiatrist specialising in CBT for emetophobia explains: “There is some evidence to suggest that women may be more prone to the feeling of disgust,” he explains. “For example, men are more likely than women to regard vomiting as something funny (for example, it’s ‘better out than in’ after a heavy bout of drinking) rather than ‘revolting’.”

Professor Veale continues: “Women are also more likely to develop contamination fears related to obsessive compulsive disorder (OCD), but this gender split is not as big a difference as in emetophobia.”

Women and girls experience more sensory changes through hormonal cycles, which may add additional challenges and create more possible triggers for those with emetophobia.

Emetophobia in Men

Of course social factors vary hugely from individual to individual and the young men I see usually have emetophobia worse than the women.

The typical social pressures boys and men have endured have left them unable to talk about the fear, and to ‘manfully’ try to hide the condition which increases isolation and avoidance.

Supporting Someone with Enetophobia

Explaining emetophobia to family and friends can be hard. They don’t get it. They say:

“I don’t like being sick either”

“No-one likes being sick”

“You’re being ridiculous!”

But emetophobia is unlike any other phobia. It is debilitating. It involves the whole nervous system. It has physical symptoms. And it involves a feedback loop of fear-nausea-fear-nausea that makes it hard to overcome.

So be kind. Listen to the sufferer in your family. Believe them. And be there for them.

Be aware that to recover from this debilitating condition usually requires support from a professional therapist or psychiatrist, but you can find helpful resources yourselves to support and help your emetophobes.

Please Note

I don’t diagnose (only a medical practitioner can diagnose). My approach is Solution Focused, although the root causes may change the way I tailor my approach.

NB: Professor David Veale is my go to source for factual information about emetophobia, but kindly note that he is not aware of the Sense-Ability approach, which is a complementary process.

I refer you to David Veale on the causes of emetophobia for more medical facts about the causes of emetophobia. Professor Veale’s approach is more focused on exposure and desensitisation and CBT.

References:

The American Psychological Association: Facts About Women and Trauma

Professor David Veale, the Nightingale Hospital: On Emetophobia

Jane Pendry
Sense-Ability Hypnotherapy & Coaching, UK
jane@sense-ability.co.uk
+44 (0) 7843 813 883
www.sense-ability.co.uk

Online across the UK & Europe

Explaining Emetophobia to Family, Friends and Medical Professionals.