Facts About Emetophobia & Treatment

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Much of the published research on emetophobia opens with something like, “Emetophobia is an under-researched disorder.” That is, of course, unfortunate for those who suffer with it. Especially, given the fact, it is one of the most debilitating anxiety disorders. Nevertheless, anxiety disorders in general are very well researched and much of what has been learned can be applied to understanding and treating emetophobia.

Determining the prevalence (how many people have it) is difficult for various reasons. Because there is so much symptom overlap with other disorders, such as OCD, panic disorder, health anxiety and eating disorders, it is likely to remain frequently un- or misdiagnosed. The reported rates in European samples range from 2% to 8.8%. (Wu, M., Rudy, B., Arnold, E., & Storch, E. , 2015) That may not seem like so much until you translate it into actual human beings, and you are talking about millions of people. Most of these studies don’t even include children because, well, they are minors and gathering data on them is difficult. Compared to other phobias, emetophobia may be less common but the impact is profoundly debilitating, and sufferers may be more inclined to seek treatment (Keyes, A., Gilpin, H., & Veale, D., 2018).

Some studies suggest the onset is most common in adolescence. That may be true, for many it begins in childhood. An internet survey found the average age for onset was just over 9 years (Lipsitz, J., Fyer, A., Paterniti, A., & Klein, D., 2001). I have treated children as young as six. Unfortunately, without treatment, it tends, for most people, to be chronic and persistent. (Stubborn stinking phobia, arg...)

For most people, the focus of the phobia is that they will personally vo**t. For others, the focus is themselves and/or someone else getting sick. If it is about someone else being sick, the sufferer fears it is likely that they would be exposed to a contaminant from that other person that would make them sick. For some the thought of vo**ting around others is terrifying. That is less common in children because the ability to imagine what others are thinking and feeling is still developing. Unfortunately, most people with emetophobia report some sort of gastric (digestive) discomfort or nausea almost every day (Keyes, et al., 2018).

It is considered by many clinicians to be difficult to treat. In my own experience, if a patient complies with treatment and continues until the symptoms are reduced or in remission the success rate is very good. 

Here is the truth of it. Going through treatment for an anxiety disorder is hard. A significant part of the treatment is being anxious on purpose. No need to panic over this, a good therapist or program will help keep that anxiety level in a range that is tolerable. For most people, it isn't substantially different from the distress they experience daily, it is just structured and planned.  

That treatment is called exposure and response/ritual prevention. It is subset of the treatment called Cognitive Behavioral Therapy. As far as consistent effectiveness, there is no other treatment even close particularly if combined with the suitable medication. In the first published randomized treatment trial using Cognitive Behavioral Therapy, the report was that at least 2/3 of the participants could expect to be less distressed and more able to function in their lives. (Riddle-Walker, L., Veale, D., Chapman, C., Ogle, F., Rosko, D., Najmi, S., Walker, L., Maceachern, P., & Hicks, T., 2016).

The fact is that no treatment (for anything) is always successful and that some people might need longer, more intensive treatment, or additional approaches to get results. Here is what I tell my clients. You are anxious anyway. During treatment, we will just add structure, planning, and practice/repetition to it. My point is that there is reason to be hopeful but don’t expect it to be easy or quick.

Not everyone is willing to go through that treatment. In the same survey I mentioned earlier, only 10% of respondents would be willing to do exposure, 54% said they would definitely NOT try that and 36% were on the fence (Lipsitz, et al., 2001). Who knows if that is the case universally? It was at the moment of the survey, with a specific sample, and presented a certain way, however, things change. If the survey was the first time I heard about exposure I would respond with a hard, "NO," as well. I have seen other studies that suggest about 1/3 of people are not willing to do exposures when offered the possibility of treatment but that means 2/3 were willing. That study was not for emetophobia specifically.

The idea of exposure for emetophobia may be more difficult to consider because it is not just going to trigger anxiety but possibly some sort of GI discomfort as well. On some level, to be willing to do exposure you need a sense that what you fear has a reasonable chance of not happening. For example, if you have an elevator phobia, part of you needs to realize it is probably safer than it feels or you won’t get on it. It may be a very small part of you…but still needed. This could be more difficult with emetophobia because the nausea is often present during exposure. At least on the elevator when you are doing the exposure you are not crashing to the ground. That being said, never in the many years of treating emetophobia has anyone come remotely close to actually vo**ting during exposures nor is it ever part of the treatment. This is an anxiety problem, not an emesis problem. 

I see more kids with this than adults. Hardly any kids drop out of treatment (not that any of them want to go through it). I suppose that is because they have less choice in the matter. You can’t make an adult come to treatment for anxiety. Even if you could a willingness to try is an absolute necessity. Reminds me of an old joke. “How many psychologists does it take to change a lightbulb? Only one, but the lightbulb has to really want to be changed.” I don’t know why a significant number of my adult clients drop out of treatment. It may be that I did a poor job of connecting with them or explaining the process. Maybe there are expectations that I failed to clarify. Maybe because adult clients have had this phobia for so long that it would require too many changes or the fear has gotten too entrenched. I don’t know but sticking out the process is absolutely essential.

We have written a bit more about it on our comprehensive site and here is the link. 

Anna Christie (world-renowned clinician for emetophobia-seriously-and I have written a book for providers printed by Jessica Kingsley Publishers. It is available through several booksellers. The cover image below has a link embedded and it will take you to the Amazon page if you click on it. 

Keyes, A., Gilpin, H., & Veale, D. (2018). Phenomenology, epidemiology, co-morbidity and treatment of a specific phobia of vomiting: A systematic review of an understudied disorder. Clinical Psychology Review, 60, 15-31.

Lipsitz, J., Fyer, A., Paterniti, A., & Klein, D. (2001). Emetophobia: Preliminary results of an internet survey. Depression and Anxiety, 14(2), 149-152.

Riddle-Walker, L., Veale, D., Chapman, C., Ogle, F., Rosko, D., Najmi, S., Walker, L., Maceachern, P., & Hicks, T. (2016). Cognitive behaviour therapy for specific phobia of vomiting (Emetophobia): A pilot randomized controlled trial. Journal Of Anxiety Disorders, 43, 14-22.

Wu, M., Rudy, B., Arnold, E., & Storch, E. (2015). Phenomenology, Clinical Correlates, and Impairment in Emetophobia. Journal of Cognitive Psychotherapy, 29(4), 356-368.