Vomit phobia

Dr David Veale FRCPsych

Vomit phobia is a condition that is often misunderstood. It is also known as emetophobia. This webpage aims to help you understand vomit phobia - its causes, effects and treatments.

What is a vomit phobia?
Vomit phobia is a condition where an individual fears vomiting or others vomiting (but commonly both). You may often feel sick but vomit phobics are not actually sick any more than someone without a vomit phobia. It may become a preoccupation and the only thing you think about. It may be linked to a fear that you will lose control, become very ill, faint or that others will find you repulsive. As a result you try too hard to avoid a wide range of situations or activities that you might believe might increase of risk vomiting. These include being near drunks; going on a fairground ride; being near people who are ill; travelling by boat; going on holidays abroad; travelling by aeroplane; drinking alcohol; going into crowded places or using public transport; or eating certain foods. Some people with vomit phobia have avoided general anaesthetic for surgery. Many women with vomit phobia have avoided getting pregnant or terminated a pregnancy. Women with babies might experience a great deal of distress about their child vomiting.

You might excessively check the sell-by date of foods in a shop or eat only small amounts of food. You might be excessive hygienic; check the health of yourself & others; use superstitious behaviours; seek reassurance about whether others are ill or could be sick; or excessively clean the kitchen area. If you think you are going to vomit, then might look for an escape route; try to keep tight control of your behaviour, take anti-nausea medication or suck a sweet. All these are called safety seeking behaviours and maintain your fear as you never find out whether you need to use them or not and increase your fear.

When does a concern with vomit become a phobia?
Many people are concerned with vomiting to a certain extent, but to be diagnosed with vomit phobia it must be very distressing and have an important effect on your life. For example, it may interfere with an important relationship or your social life.

How common is a vomit phobia?
It's hard to say as there have been no large-scale surveys conducted. Many people with vomit phobia are also too ashamed to talk about their problem or feel very misunderstood.

What causes vomit phobia?
There is virtually no research into the cause of vomit phobia. Causes are thought to be psychological and biological. There might be a genetic influence in vomit phobia. It usually develops in childhood, sometimes after a bad experience of vomiting. Once a phobia develops it is maintained by the way avoid anything linked to vomiting. It is much more likely to occur in women.

Is vomit phobia linked with other illnesses?
You may feel demoralised or clinically depressed. Some sufferers restrict their food believing that a range of food may cause vomiting. You may then become very underweight and be misdiagnosed with anorexia nervosa.

How is the illness likely to progress?
No long term follow studies have been done. Many people with vomit phobia have a chronic condition. If left untreated, then the condition is likely to persist.

What treatments are available?
If you feel that you or a close relative are affected by vomit phobia and would like help or more information, contacting your GP is often the easiest way to get help and further treatment. He or she may refer you to cognitive behaviour therapy for further assessment. This may lead to outpatient treatment or, if more serious in-patient treatment. Details of obtaining an private appoitment to see me at The Priory Hospital North London are here or an NHS appointment at the Maudlsey are here.

The British Association of Behavioural and Cognitive Psychotherapists on 01254 875277 (www.babcp.org.uk) who can provide a list of accredited private cognitive behaviour therapists.

If you're worried about talking to your GP, consider writing down your concerns and questions. You can:

· take a friend or family member with you;

· see another doctor in the practice; or

· join a new GP practice.

NHS Direct can offer you advice on moving to a new practice. You can visit the website at www.nhsdirect.nhs.uk or phone them on 0845 4647.

There has been very little research or controlled trials on the treatment of vomit phobia. Treatments that have been described include cognitive behaviour therapy, hypnotherapy and medication.

What is CBT?
Cognitive behaviour therapy (CBT) is based on a structured programme of self-help, which focuses on the way you think and act. Vomit phobia is best treated by "graded exposure" or learning to face up to the situations or activities you are avoiding and to drop all the excessive safety behaviours and rituals, which you believe reduces the likelihood of vomiting. You can learn to accept that you are very unlikely to vomit but nothing is guaranteed in life and that you have a limited influence in stopping yourself from vomiting. The main side effect is learning to tolerate the anxiety in the short term. However, it will get easier and easier to face up to your fear and your anxiety will tend to reduce.

What about medication?
Medication may be prescribed that is anti-nausea. This is usually unhelpful in the long term as it reinforces the idea that you can control yourself from vomiting. Sometimes a type of anti-depressant called an SSRI may be prescribed that can reduce anxiety or treat other problems such as depression. There is no evidence from controlled trials that medication is of any benefit in vomit phobia.

Does treatment work?
Treatment works for many sufferers if they are prepared to do the homework and to test out some of their worries. Some sufferers may feel well for a time then go back to old behaviours, while others remain chronically ill.

Self-help
Self-help may be useful as the first stage of treatment or alongside other treatments. There are a number of websites for individuals with a vomit phobia.

Gut Reaction http://www.gutreaction.freeuk.com/
EmetOnline http://www.emetonline.co.uk/
National Phobic Society http://www.phobics-society.org.uk (Tel: 0870 7700 456)
All the groups can help sufferers and families understand that they are not alone, and offer valuable support and practical advice.

1st August 2005