Emetophobia is an irrational or excessive fear of vomiting. But nobody likes to vomit. A phobia is distinguished from an ordinary fear by the irrational and excessive anxiety caused by the stimuli for the phobic individual. For example, many people would not want to explore caves because of a fear of snakes. But some people with a snake phobia, called ophidiophobia, are afraid to walk on the sidewalk in downtown Chicago because a snake might be there.
So, hundreds of millions of people may fear vomiting, but they don't alter their daily lives because of it the way emetophobics do. The fear is also all-consuming; for most emetophobics, vomiting is their single worst fear. In casual conversation, many phobics say they'd rather die than vomit. (We hope that's overstated.)
It's not an overstatement that for many phobics, anxiety about vomiting ruins almost every day. There is another phobia related to emetophobia called social phobia. (Social phobia is a general fear of being judged by other people.) People who are social phobic often have a fear of vomiting in public, but this is not the same as emetophobia. People with social phobia vomit in private with no more anxiety than a normal person would have. (Of course, emetophobics fear vomiting in public at least as much as social phobics do. And some people have both emetophobia and social phobia.)
Social phobics make sure they can get to a bathroom if they need to vomit (and this can go to an extreme as well, like insisting on an aisle seat in crowded places), but they don't do all the things that emetophobics do.
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Dietary restrictions are universal among emetophobics. Most emetophobics have a list of foods they won't eat because they suspect them of being likely carriers of food poisoning; many avoid other foods because they associate them with a childhood episode of vomiting. Some of the foods emetophobics avoid have no obvious relation to either of those. Since most food poisoning is caused by unsanitary preparation rather than tainted food, phobics are roundly meticulously hygenic cooks. (Easiest way to lose an emetophobic? Lick the spoon while cooking.)
Ironically, emetophobics are sometimes suspected by others of having eating disorders. But isn't emetophobia a kind of eating disorder? Not really. A person with even severe emetophobia will generally eat enough to stay healthy, although it is not unheard of for emetophobics to be hospitalized for malnutrition. This is different from anorexia nervosa in as much as the emetophobic is not particularly concerned about weight gain or loss.
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At the grocery store, the emetophobic may verge on obsessive-compulsive, carefully examining each of a dozen oranges going into the bag (they might actually wash those oranges before eating them too); reaching back in the cooler to get "colder" items; hounding the deli personnel for certain items to be selected or cut; and our favorite, hand-washing following a visit to the meat department.
It is not unusual for emetophobics to have a particularly stringent set of criteria for eating out. Some avoid restaurants altogether. Some will order an entree but will never eat from a buffet or salad bar. Some claim to have a 6th sense that tells them not to eat in a particular restaurant. Some emetophobics are uneasy being in public places, especially restaurants, because they are afraid that other people will vomit. Some will go hungry rather than eat in public places.
Besides eating habits, emetophobia affects the lives of its sufferers in many ways. Many female emetophobics shun pregnancy because they fear morning sickness and other vomiting that frequently happen during pregnancy. (Many emetophobics report surviving pregnancy without vomiting.)
Others stay away from children altogether due to the fact that children become ill more often than most adults. Nearly all emetophobics report being unable to care for their children and other family members when those people fall ill. Some will sleep in another room when a family member is ill. One phobic reports sleeping with the window open in winter in an effort to kill the virus. Some even fear catching illness from animals, making pets an uneasy choice for them.
A good many emetophobics avoid travel, especially to foreign countries. (Some emetophobics report vomit- free foreign vacations.) Nearly all emetophobics avoid water travel; some refuse to fly as well, and a few even stay out of land vehicles. (Others insist on being the driver. This has a legitimate basis, as it is nearly impossible for a driver to become carsick.)
Of course, few emetophobics will get on amusement rides. Many emetophobics exclude themselves from social activities, and some of these report that the social restriction is one of the worst things about the phobia.
They're afraid to go to places where people may be drunk, and so avoid parties, pubs and other social occasions. Many are afraid in the theatre, the movies, sporting events, and other places where crowds gather.
Emetophobia affects career choice as well, with many otherwise-qualified (and perhaps even interested), intelligent sufferers eschewing fields that they see as high-risk for vomiting, such as health care, the military, teaching, laboratory research, aviation, and space.
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A good many cases of emetophobia were triggered by a particularly traumatic episode of vomiting that occurred between the ages of 6 and 10. Most of these incidents came on unexpectedly. After the frightening emetic incident, most phobics were very careful to avoid vomiting. If they experienced it at all, it was with a tremendous amount of fear and anxiety. So they never came to experience vomiting as something normal or routine.
Some emetophobics say their parents were not supportive of them when they vomited as children, and some say that their parents even made them vomit.
However, many emetophobics have no idea why they have this phobia. Many people believe it's an issue of control. Some say emetophobics want maximum control over their bodies, or that they are making up for a lack of control they had over situations as children.
Some experts think that anxiety over separation from a parent or other loved one during childhood contributes to emetophobia. And some therapists, not emetophobics themselves, suggest a link to childhood sexual abuse. (The majority of emetophobics were not abused and even some who were doubt this connection.)
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For many phobics, vomiting is something unknown. They're much like the child of three or four who has no recollection of ever vomiting. Most children vomit fairly regularly throughout childhood; they come to realize that it's a rather routine happening for them and most other people. Not the emetophobic. They may have vomited as a small child, but then did not do so again until the episode that brought on their phobia.
They never learned that vomiting is a normal part of life. But of course, for them, it never was.
Other emetophobics did experience vomiting fairly often during childhood but for some reason came to believe it to be particularly unpleasant and have never gotten used to it.
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The fact most surprising to non-phobics is that the great majority of emetophobics rarely, if ever, vomit. An emetophobic is a person who has been in car collisions more often than they have vomited. Most phobics can count the number of times they have vomited on the fingers of one hand.
Some emetophobics have survived pregnancy and childbirth, appendicitis, and gall bladder operations without as much as a single retch. Even when they did, they typically had only a single episode of vomiting with each illness, in contrast to many non-phobics who can attest to vomiting repeatedly over the course of an illness. (Some phobics say the main reason they vomited is because they were so tired of feeling nauseated that they "gave in" and let themselves vomit.)
Many adult emetophobia sufferers can claim to have been vomit-free for 10 or 20 years or more. Phobics who have actually vomited since their trigger experience frequently say that they realized at the time that vomiting isn't so bad, but they went back to fearing it later -- often the very same day.
Although they're not apt to vomit, emetophobics can work themselves up into frenzies of anxiety or even actual nausea simply by being exposed to people with gastrointestinal trouble. At the merest suggestion that someone with whom they are breathing common air has a GI complaint, the emetophobic will get panicky. They will watch for symptoms which are all too easily psychosomatic. This tends to snowball as panic attacks get much worse as the phobic experiences real or imagined nausea.
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The answer is not clear. Most emetophobics have great skill at fighting nausea. They will tell you that they felt very ill but lay down until the nausea passed. Some use prescription anti-nausea drugs like Tigan or Compazine. Others use tricks like ice cubes.
Some claim that their years of fear have left them unable to vomit. Many try to bolster their immune systems through vitamins and herbal remedies. The most likely reason is this: Since these people became phobics because they had high thresholds for vomiting as children, they naturally should have been expected to have even higher thresholds as adults. Different people experience illness in different ways.
Some people who get gastroenteritis (often erroneously called "stomach flu") or food poisoning tend to vomit. Others similarly infected will only have diarrhea. Emetophobics nearly always fall in the latter class. (Emetophobics don't generally fear diarrhea, except by its association with vomiting.)
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This is what some phobics have conjectured as to their great vomitory continence. The act of vomiting is controlled by the brain. Specifically, there is a vomiting center, located in the medulla oblongota of the brain. Vomiting is a more primitive function of the brain.
Some phobics believe that as a result of years of fear and daily cogitation, the conscious part of their brain has overridden the vomiting center. So, if something happens which would normally cause vomiting, the brain ignores it. These phobics see this as an explanation because they breathe the same viruses and eat (a lot of) the same food as everyone else but never vomit.
Beyond this neural hypothesis (which is without scientific basis), nearly all phobics are able to resist an urge to vomit for a very long time, until the nausea passes. (There are even some phobics who have actually tried to vomit and couldn't.) This leads them to question whether vomiting is an entirely involuntary bodily action.
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"The Doctors Book of Home Remedies" has these suggestions: taking powdered ginger root; drinking only clear liquids or flat, warm 7-Up; eating some light carbohydrates, like crackers or toast; keeping the head still; distracting the mind from the nausea; applying accupressure to the wrist; and use of some over-the-counter preparations. (The book also suggests allowing yourself to vomit, an approach not often in vogue with emetophobics.)
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It sounds as if some people have found a way to never vomit. The problem is that emetophobia consumes a great deal of the time and energy of the person who suffers from it. There is the constant mental stress of worrying when one will vomit next. It is a load that is never off the mind of the phobic.
It is amazing that someone who has not had an emetic experience in 20 years can be unable to enjoy a meal because they fear vomiting. Frequently, the first item on the prayer list of a religious emetophobic is continued protection from the dreaded malady.
Some emetophobics report spitting in the toilet after each use as an offering to the "vomit gods."
It is telling that most emetophobics envy those who vomit freely without anxiety.
Most phobics suffer terrible panic attacks when they have nausea or imagine that they do. These panic attacks are much worse for them than vomiting is for an ordinary person. Yet the act remains unthinkable.
The phobia interferes with educations, careers, marriages, and family relationships. Many phobics take time away from work or school unnecessarily because they fear either vomiting themselves or being exposed to people who can pass germs that will cause them to vomit.
Many phobics suffer panic or anxiety attacks when they imagine the slightest hint that they may vomit. These attacks can be quite severe. Phobics exclude themselves from the activities mentioned above. All this can contribute to the development of other phobias such as agoraphobia and social phobia as well as other health problems like insomnia. (This is often because some emetophobics feel the only safe place from vomiting, or barring that, the only safe place to be if they can't keep from vomiting, is home. This feeling can lead to isolation and even agoraphobia.)
Emetophobia can lead to bad eating habits as well; some sufferers' unusual food intakes are perhaps not well balanced and nutritious; standard fare, perhaps only slightly more likely to cause food poisoning, would be considerably healthier.
Most phobics abstain from any food that has ever caused them illness. Some even shun any foods that they ate and then vomited even if they believe the food was not to blame.
Emetophobics are usually incapacitated when it comes to taking care of sick family members. Some feel guilty that they are unable to be supportive of their children. Some fear their child is confused because the parent seems to be more worried about his or her potential illness than about the child's actual illness.
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There isn't a ready, out-of-the-box cure for emetophobia or any other phobia. Some people suggest desensitizing phobics to vomit. Densensitization supposedly culminates with the phobic inducing vomiting. But that isn't the best option. This is because many phobics are already around vomiters (usually their children; additionally, phobic health care workers are exposed to their patients, and phobic teachers are exposed to their students).
And as noted above, many phobics have vomited since developing their phobia, and it didn't cure them. (To make matters worse, many phobics have anxiety about losing their 10 or 20 year records.)
Another solution being discussed of late is neuro- linguistic programming (NLP). This is a relative of hypnosis. NLP is probably too new a therapy for any concrete data to be availabile about its suitability in treating emetophobia.
The best solution is probably for phobics to gradually resume the activities they exclude themselves from. That way they can have their fear of vomiting, but it won't interfere with their daily lives as much.
Talking about it with other emetophobics seems to help these steps come more easily. Another thing that helps is developing new interests and activities which engage the mind, take time, and don't cause anxiety about vomiting. Anything that gets phobics to take their minds off their fear is helpful.
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You wouldn't know one if you saw one. The people who live with them sometimes have no idea. Some emetophobics are secretive. Some fear that if they mention their lack of vomiting, it will "jinx" them. (Many emetophobics "knock wood" when they mention how long since their last vomit, especially in e-mail.) Others worry that revealing their fear would leave them in a vulnerable position.
If one did "come out" to you, there is a good chance that the phobic is your significant other or a member of your family. (A few emetophobics report that everyone who knows them knows.) Be supportive. Try to understand their fear, but don't try to reason them out of it. You're better off putting up with their idiosyncrasies than forcing them to do things your way.
They've had their fear for a long time. They might decide they're more comfortable with it in their life than you. As to who they are, no census has been done. Anecdotal evidence suggests that more women than men suffer from this phobia.
Many emetophobics say that they and others they have met with the condition are highly intelligent, but this might tell you more about those individuals than it does about emetophobics in general. :)
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At least 50 percent of the personality is inherited. It is well established that phobias cluster in families. Perhaps the tendency to develop a phobia is what is actually inherited, and the emetophobic individual happens to attach this tendency to vomiting.
The environmental cause of emetophobia is even more striking. Many emetophobics claim the lack of support from their parents during childhood vomiting episodes precipitated their phobia. It would not be surprising to find that an emetophobic parent is unable to be supportive of a vomiting child, and thus helps the child become emetophobic as well.
On the other hand, most emetophobics will tell you that their brothers and sisters and parents and children are not emetophobic.
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Emetophobics are probably healthier, on average, due to the great diligence they put into preventing vomiting. Many emetophobics are quite careful when it comes to using alcohol and stand very little chance of ever becoming alcoholic.
I notice you keep saying "vomit." Don't you know that there are a lot of synonyms? Yes, we know them. We use the clinical "vomit" here because it is the least judgmental and because being able to say the word can be empowering to an emetophobic. Many people have unpleasant associations with some of the popular euphemisms, although many emetophobics use those words themselves. (Our favorite is the airlines' euphemism for in-flight vomiting, "motion discomfort.")
And "throwing up" sounds like something children do, much as they would have an "owie."
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One can always consult a professional, particularly one specializing in phobias. This is an especially good idea if the phobia is accompanied by depression, severe anxiety or other debilitating disorders. Some people have found medication to be helpful and it has enabled them to live a more 'normal' life, whereas others find they don't need it. While not a substitute for professional help, there are occasional online chat discussions on the subject. There have also been periodic discussions in the Usenet groups alt.support.anxiety-panic and alt.support.social- phobia.
There is also an electronic mail discussion group. (To subscribe, send the message "Subscribe Emetophobia" to listserv@maelstrom.stjohns.edu or see the web site at http://rdz.stjohns.edu/lists/emetophobia) Some phobics are reluctant to talk about vomiting because they are superstitious that if they talk about it, it will happen. (Many sufferers can attest otherwise.) They need to realize that talking about vomiting can greatly reduce their anxiety about it. It also helps them to know that they're not alone. "Nothing is to be feared. It is only to be understood."
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