Emetophobia and Autism
The connection between autism and emetophobia (the intense fear of vomiting) is not fully understood. However, several factors suggest a potential link between the two.
Please note this article includes words that may be triggering for some people.
Autism and Sensory Sensitivities
People with autism often have heightened sensory sensitivity: labels in clothes may irritate them, they may be more sensitive to light or sound, or be super aware of texture.
If an autistic person vomits as a child or teenager, the sensations and sights - so different to normal bodily functions - may feel overwhelming and distressing.
A complex interplay of factors
Not everyone with autism will develop emetophobia of course, but the connection between autism, the operation of the vagus nerve (the parasympathetic nervous system) and emetophobia involves a complex interplay of neurological, physiological, and psychological factors that lead to increased sensitivity to bodily sensations, including vomiting.
If the sensation of vomiting is sudden or overwhelming, vomiting, the experience can embed as a trauma to the body and mind much more easily.
Anxiety and Phobias
Autism is frequently associated with higher general levels of anxiety. Emetophobia is a specific type of anxiety disorder.
Autistic people can experience an over-activation of the sympathetic "fight-or-flight" system leading to heightened anxiety levels. Research shows that people on the autism spectrum are more likely to develop intense fears or phobias related to specific situations.
A Need for Control
Many individuals with autism have a strong need for structure and control over their environment. The unpredictable nature of vomiting, which can happen unexpectedly, may trigger heightened anxiety. This fear of losing control can be a central feature of emetophobia.
Difficulty with Interoception
Interoception refers to the ability to sense and understand bodily signals, like hunger or nausea.
Autistic people often have a heightened ability to sense and perceive the internal state of their bodies, including their emotions and physical sensations.
As a consequence, some autistic people are overly aware of the feel of their bodily functions - digestion, stomach gurgling or heart beating. Any change in their internal system can therefore increase anxiety and add to the symptoms of emetophobia.
People with autism may have difficulty distinguishing or interpreting bodily sensations, leading to increased anxiety when they experience discomfort, such as nausea. This uncertainty about bodily sensations can amplify fears related to vomiting, contributing to the development of emetophobia.
Some autistic people may be unable to detect what their body is telling them, for example they may not read early signals to go to the loo or know when they are hungry. Equally, they may not read the signs of vomiting either. When they become ill, it’s sudden, unexpected and even shocking.
Social Discomfort
People with autism may feel uncomfortable in social situations and could worry about the social embarrassment or stigma related to vomiting in public, further reinforcing emetophobia.
Vagus Nerve and Vomiting
The vagus nerve - the longest cranial nerve that meanders down the spine - plays a crucial role in regulating the parasympathetic nervous system which governs involuntary functions like digestion, heart rate, and the gag reflex.
The vagus nerve is involved in the body's response to nausea and vomiting.
When the vagus nerve is over activated, for example when we are in fight or flight, it can trigger nausea and vomiting through its bi-directional connection between the digestive system and the "vomit center" in the brainstem.
Vagus Nerve and Autism
Research suggests people with autism can have irregularities in the autonomic nervous system involving the vagus nerve which can result in:
Gastrointestinal issues
Many people with autism experience gastrointestinal issues including nausea, constipation, bloating and diarrhoea. These can be linked to altered vagal tone, meaning that the vagus nerve's signals to and from the digestive system may be functioning differently.
Emotional regulation
The vagus nerve influences emotional regulation by calming the nervous system. In people with autism, the vagus nerve may not function optimally, contributing to heightened anxiety, exacerbating complex phobias like emetophobia.
Reactive nervous system
The sensation of nausea or the fear of vomiting can feel more intense for someone with autism because their nervous system is more reactive. This heightened sensitivity can make the experience of nausea, or the thought of vomiting, particularly distressing, increasing the likelihood of developing a fear of vomiting.
Fight or Flight Response
For autistic people the fear of vomiting may become tied to the body's heightened fight-or-flight response.
When the vagus nerve isn't regulating the parasympathetic system well, people can stay in a state of heightened arousal, intensifying the fear of vomiting. This can lead to a cycle of fear where the person is hyper-aware of nausea or digestive sensations, potentially leading to the development or worsening of emetophobia.
Sensory sensitivity
Dysregulation of the vagus nerve in autism affects digestive function, anxiety levels, and the body's response to nausea, all of which can exacerbate the fear of vomiting.
The dysregulated vagus nerve can cause some sensory sensitivities leading to difficulties with interoception, and anxiety make individuals more vulnerable to developing phobias like emetophobia.
Disruptions in the nervous system and emetophobia
Fear of vomiting can develop or worsen due to a combination of sensory sensitivities, anxiety, and misinterpretation of bodily signals related to nausea, which are modulated by the vagus nerve.
Together, these factors suggest that disruptions in vagus nerve function and autistic traits (such as sensory sensitivities and anxiety) may contribute to the development and maintenance of emetophobia.
Alert to every sign of change
An autistic person who develops a fear of vomiting may be more alert to looking for every signal of change in their body, and ruminate excessively, stay on high alert, and more easily develop intrusive thoughts about vomiting and anything associated with it.
Some experiences, like nausea or the sight/sound of vomiting therefore become more distressing for autistic people.
General sensitivity, or hypersensitivity, may contribute to the development of phobias like emetophobia, as the physical and emotional response to these stimuli can be overwhelming.
Working with Autism and Emetophobia
Jane adapts the Sense-Ability Emetophobia Recovery Pathway for Autistic clients, with a strong emphasis on reducing overall anxiety, toning the vagus nerve, reducing sensory sensitivity and developing a tool kit of coping strategies.
Please contact Jane to find out more about how she works with neurodiverse clients, and the adaptations she can make to support them.
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
Please Note
Jane Pendry is a Solution Focused Hypnotherapist who works extensively with more complex issues that she has recovered from herself, including complex trauma, phobias and anxiety. She specialises in emetophobia, complex phobias and trauma
* Please note Jane Pendry does not diagnose or claim to cure. Sense-Ability therapies are complementary approaches that promote and support self healing. Jane does not explore how or why traumas were created and does not offer counselling, or traditional talking psychotherapy which require different specialised training and supervision. For more on these services see The British Association for Counselling & Psychotherapy.
Jane has the right to refuse treatment where she believes there is a risk of harm or where she believes Sense-Ability therapies conflict with your current treatment programme with a medically trained professional or a clinical psychotherapist.