Emetophobia Treatment & Assessment

Effective emetophobia treatment is available. Cognitive behavioural therapy (CBT) can help you understand what maintains the fear and gradually change the patterns of avoidance and safety-seeking behaviour that keep the problem going.

Much of the information on this page is taken from our self-help book on emetophobia, Free Yourself from Emetophobia by Alexander Keyes and David Veale.

A phobia of vomiting 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 phobia of vomiting. 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.

The symptoms of emetophobia vary from person to person. They may include persistent thoughts about not knowing if you are going to vomit,, feeling sick or nauseous, avoiding situations associated with vomiting, checking food and other people for signs of illness, seeking reassurance, and using behaviours intended to prevent vomiting.

As a result you try too hard to avoid a wide range of situations or activities that you might believe might increase your risk of 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
• Eating certain foods

Some people with emetophobia have avoided general anaesthetic for surgery.

Some women with emetophobia 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 excessively 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 you might look for an escape route; try to keep tight control of your behaviour, take anti-nausea medication or suck a sweet. All of 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.

Many people are fearful of vomiting to a certain extent, but to be diagnosed with a phobia of vomiting 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 and cause significant handicap.

It’s hard to say as there have been no large-scale surveys conducted. Many people with a phobia of vomiting are often too ashamed to talk about their problem or feel very misunderstood. The best estimate is about 0.1 to 0.2% of the population. This is different to a fear of vomiting which is more common in about 8% of the population.

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 emetophobia. It usually develops in childhood, sometimes after a bad experience of vomiting. Once a phobia develops it is maintained by the way to avoid anything linked to vomiting. It is much more likely to occur in women.

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.

No long term follow studies have been done. Many people with emetophobia have a chronic condition. If left untreated, then the condition is likely to persist.

If you feel that you or a close relative are affected by emetophobia 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 at your Talking Therapies service.

Details of obtaining national specialist treatment by NHS appointment at the Maudsley and Bethlem Royal are also on this website.
The treatments offered are cognitive behaviour therapy (CBT) and possibly medication.

Cognitive behaviour therapy (CBT) is based on a structured programme of self-help, which focuses on the way you think and act. Some work may need to be done on memories of vomiting in the past.

After this, it 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, which you believe reduces the likelihood of vomiting. Facing your fear will get easier and easier to face up to your fear and your anxiety will tend to reduce.

Anti-nausea medication 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.

Treatment can help many people with emetophobia, particularly if they are prepared to do the work between sessions, test out their fears and gradually face situations they have previously avoided.

Recovery from emetophobia involves learning to respond differently to the fear of vomiting and reducing the avoidance and safety-seeking behaviours that maintain the problem.

Progress may be gradual, and some people may feel well for a time and then return to old behaviours. Continuing to practise what has been learned during cognitive behavioural therapy (CBT) can therefore be important in maintaining improvement.

Our specialist clinics for emetophobia are at the Maudsley Hospital for out-patients and a residential unit at the Bethlem Royal Hospital, Beckenham, Kent. A specialist service for adolescents is at the Maudsley Hospital, London.

An assessment is the first step in developing an understanding of the problem and identifying the most appropriate treatment for emetophobia.
The assessment will consider the nature of your fear of vomiting, the situations you avoid, any checking, reassurance seeking or safety behaviours, and the impact the problem is having on your life.

Following assessment, I can advise on appropriate treatment and, where suitable, refer you to a cognitive behavioural therapist with specialist experience in treating emetophobia. Medication may also be considered where appropriate.

Appointments can be arranged via my PA, Natalie Fisher, on 020 3137 9911 or by email. Consultations are available by video or face-to-face in London.