I should begin by saying that I am not a fan of using words that have a Greek derivation to describe phobic states. Indeed, some years ago I was attending a quiz night, when the topic of fears and phobias came up. Those at my table, recognising my expertise in this area, played a Joker card – i.e. double points in this particular round. My team only answered three out of ten questions correctly because, much to my embarrassment, I did not recognise the Greek terminology! Having said that, I did study Latin at school and had a superficial knowledge of Greek, but this was to no avail and I spent the rest of the evening in deep embarrassment. Therefore, a simple message – tell it as it is – in plain English!
Vomiting phobia (emetophobia) is not a simple phobia, far from it. It often presents a great challenge for professionals like myself. Having said that, many presentations of vomiting phobia can be managed by self-help methods, the point being that the phobia presents in various degrees of complexity and severity.
Vomiting phobias basically come in two categories, i.e. the fear of someone else vomiting or the fear of vomiting oneself. More often than not, people present with both fears for reasons that I will explain below.
If the person has a fear of someone else vomiting, but does not worry about vomiting themselves, this phobia is usually rooted in feelings of great disgust and people will avoid various situations where they might come across people who vomit – for example, hospitals or late night trains. Sometimes this fear is linked a worry about other people losing control and there may be some reality in the proposition that travelling alone on a tube, late at night, may have some inherent dangers, other than seeing someone being sick. When such phobias present, the first treatment strategy that comes to mind is exposure and one can do this with a graduated process, keeping in mind the principle that one should try to face up to one’s fears in graduated doses of difficulty, i.e. always doing what is difficult but manageable. The principle of difficult, but manageable steps is one that underpins all exposure treatment. While it might be tempting to explore feelings of disgust by some form of discussion or cognitive therapy, the evidence from clinical practice and, indeed, clinical research is that exposure should be the first line of treatment. These days exposure can be easily facilitated by use of the Internet and there are many still and moving images available and the addition of sound to the moving images adds to the complexity. If one is trying to conquer this fear on one’s own, it is wise to have someone else who is sympathetic to the problem to undertake the initial searching for images. I say this because there are some truly horrendous films on the Internet that I think would be completely unmanageable for many sufferers.
I will return to the topic of fear of someone else vomiting below.
With regard to fear of oneself vomiting, this is often linked to obsessive compulsive disorder and individuals with this particular fear may often call themselves “control freaks” and, thus, want to keep everything around them in order and within their sight and knowledge. Thus, it is not uncommon to see such individuals as very house-proud and having very high standards for themselves and others. However, this is a generalisation: not all afflicted with this particular fear have this personality type.
The fear of vomiting oneself is underpinned by various features. There may be a fear of losing control, there may be a fear of doing something that leads to disgust among others, or there may be a fear of being humiliated. Sometimes, the fear is that of the unknown. It may be that the prospect of vomiting is sometimes linked with a long past experience of being sick at school and being taunted or told off. More often than not there is no particular reason that one can identify for this fear to arise.
Those who present to me in my clinical work often have a very wide range of avoidance behaviours and checking rituals. These individuals will see the prospect of being infected by a virus or bacteria that will make them sick in a wide range of situations. Thus, there is a fear that children may bring home a bug from school and, because of this, children may be questioned and cross-questioned when they come home about the presence of any vomiting among their classmates. Sometimes children and/or other family members may be subject to disinfecting when they enter the house and, in the days of hand gels and wipes, the use of these tends to be prolific.
It goes without saying that patients who present with a fear of vomiting themselves will often have several items in their bags and pockets that can serve to disinfect. I will often observe patients coming and going from my consulting room, trying to leave the room without touching a door handle or, if they do, sometimes using a tissue, or (as in a recent case) wearing gloves throughout the consultation. Individuals with this fear are notorious “sell-by date” checkers and it is not uncommon to hear of complete fridge contents and freezers full of food being discarded because of a fear of contamination. There is often a worry about eating out or buying sandwiches – even from the highest quality establishments. A number of foodstuffs are commonly avoided and there is certainly an aversion to taking holidays in countries where gastrointestinal infections are common.
I have only here begun to scratch the surface of what one might see in vomiting phobias and I am sure that some readers can think of yet other signs and symptoms. Suffice it to say that, in the severe cases, the fear of oneself vomiting may be overwhelming and may cause massive levels of disability to the person and their family.
As I have noted above, the fears of someone else vomiting and the fears associated with oneself vomiting may often come in combination. Usually, though not always, the fear of someone else vomiting signals the possibility that the person might be the source of infection.
In the most serious cases, treatment for fears of oneself vomiting may involve many hours of cognitive behaviour therapy. However, many cases can be helped with a reasonable programme of self-help and, once more, there is a need to reduce avoidance behaviours and to begin a process of “taking risks.” Thus, I have come across many people who have been able to help themselves by extending their range of eating out, allowing others to do the shopping and not to check sell by dates, and getting rid of the ubiquitous hand gels and wipes.
I always make the point that being overly vigilant and going through regular disinfecting routines may eventually make one more vulnerable to infection! Our immune system is a wonderfully protective resource; just think back to the days before hand gels (or indeed back to the days when a weekly bath was the norm). It is clear that while the “good old days” were perhaps not so good from a health point of view, on the other hand the nation did not succumb endemic diarrhoea and vomiting illnesses – unless of course one goes back to the era of typhoid and cholera and before modern sanitation and clean water.
In this article I have only touched upon the nature and treatment of this condition. Suffice it to say that recognising that there is a problem and then dealing with the problem in graduated doses of difficulty, must underpin any attempt to overcome the problem. While I have, above, illustrated my account with some of the more severe aspects of the condition, I need to emphasise once more that a majority of people can help themselves to overcome this difficulty. However, like any fear or phobia, this requires facing your fears.
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