What is emetophobia
Emetophobia is an intense, irrational fear of vomiting including fear of feeling nausea, seeing or hearing another person vomit, or seeing vomitus itself 1). Emetophobia can include a fear of vomiting in public, a fear of seeing vomitus, a fear of watching the action of vomiting or fear of being nauseated. Emetophobic symptoms can be mental, emotional, and physical 2). Emetophobia may occur at any age. Literature shows that emetophobia usually starts in the childhood and has a chronic course 3). According to some studies, the prevalence rate of fear of vomiting in the community sample is 8.8% (Female:Male ratio = 4:1) 4).
Emetophobia is a relatively understudied phobia with respect to its cause, clinical features and treatment 5). There is no available data on the prevalence in the general population and little is known about the cause. Most clinical data come from research with self‐described fear of vomiting. Estimates of prevalence of emetophobia in a Dutch community sample were established at 1.8% for men and 7% for women 6). Most studies describe emetophobia predominance in females, early (childhood) onset and chronic course 7). The most important differential diagnoses are: panic disorder with agoraphobia, social phobia, anorexia nervosa and obsessive-compulsive disorder 8). An emetophobic child may be nonresponsive to conventional systematic desensitization therapy 9).
Emetophobia is a specific phobia (other type) according to the current edition of the American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders, DSM-5 10). According to American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders, DSM-5, specific phobias usually develop in early childhood and if they persist into adulthood they are unlikely to remit 11). Specific phobias not only have an early onset, but additionally pose a risk for developing a second mental disorder 12). Emetophobia can begin in childhood with mean ages of onset reported as 9.2 13) and 9.8 14) years. Comorbid mental disorders include anxiety and depression 15). Impairment in functioning in those that suffer from emetophobia can be debilitating.
Evidence suggests that fear of vomiting is a chronic and disabling condition that may cause significant impairment in daily functioning. The anxiety and fear can go from mild feelings of apprehension to a full-blown panic attack. Emetophobia is implicated in social, educational, and occupational impairment and it causes significant restrictions in leisure activities 16).
The cause of specific phobias is theorized to fall into associative experiences learned through conditioning or/and non-associative mechanisms that lend support to biologically encoded processes 17).
Currently, there are only a handful of case reports that discuss children and adolescents with emetophobia that support the efficacy of cognitive and exposure techniques in their treatment 18).
Knowledge on how emetophobia should be treated is limited, partly because of the lack of any controlled trial on the (relative) efficacy of treatment strategies for this condition 19). In fact, there are only a few published cases in the literature. Treatments that have been reported include the use of (combinations of) hypnotherapy 20), cognitive behavior therapy including stimulation of nausea or vomiting 21), the use of counter conditioning 22), interoceptive exposure 23), exposure in vivo to cues of vomiting, re-scripting of past aversive experiences of vomiting, behavioral experiments, dropping of safety-seeking behaviors, and role play of vomiting using the smell of vomit 24).
Emetophobia symptoms
Emetophobia is an intense, irrational fear of vomiting including fear of feeling nausea, seeing or hearing another person vomit, or seeing vomitus itself 25). Emetophobia can include a fear of vomiting in public, a fear of seeing vomitus, a fear of watching the action of vomiting or fear of being nauseated. Emetophobic symptoms can be mental, emotional, and physical 26). Emetophobia may occur at any age. Literature shows that emetophobia usually starts in the childhood and has a chronic course 27). According to some studies, the prevalence rate of fear of vomiting in the community sample is 8.8% (Female:Male ratio = 4:1) 28).
Emetophobia treatment
There are no treatment protocols and randomized controlled trials for the treatment of emetophobia, and exposure-based therapies are the most commonly used approaches for vomit phobia as described in literature 29). These approaches include simulated exposure 30), interoceptive exposure 31) and graduated exposure to feared situations 32). Other treatments that have been reported include the use of (combinations of) hypnotherapy 33), cognitive behavior therapy (CBT) including stimulation of nausea or vomiting, the use of counter conditioning 34), exposure in vivo to cues of vomiting, re-scripting of past aversive experiences of vomiting, behavioral experiments, dropping of safety-seeking behaviors, and role play of vomiting using the smell of vomit 35).
Research shows that some psychotropic medications (such as benzodiazepines and antidepressants) do help in emetophobia and some said gastrointestinal medications are also beneficial 36).
The most comprehensive treatment study used repeated exposure to film footage of people vomiting among a group of 7 patients 37). Up to 13 sessions were conducted in which the participants were asked to repeatedly view video sequences. The author noted that a subgroup of patients required a greater number of sessions because fear returned between the exposure sessions. This observation is in line with the results of an internet survey among 56, mostly female, individuals which showed that those who suffer from emetophobia are likely to have undergone a wide range of previous treatments but with fairly limited success 38).
Eye Movement Desensitization and Reprocessing (EMDR) is a recommended treatment for post-traumatic stress-disorder (PTSD) 39). Given that emetophobics frequently report a childhood onset, often following exposure to distressing experiences of vomiting or seeing others vomit 40) and that Eye Movement Desensitization and Reprocessing (EMDR) is capable of resolving disturbing memories of a wide variety of events, including those that explain the onset of phobic conditions 41), de Jongh argues 42) that emetophobia is also responsive to eye movement desensitization and reprocessing (EMDR). Among the types of phobias that have been reported as being successfully treated by using Eye Movement Desensitization and Reprocessing (EMDR) (e.g. phobias of traffic, snakes, moths, spiders, mice, injections, dental treatment, and choking) 43), there is one case report in the literature in which Eye Movement Desensitization and Reprocessing (EMDR) was used to treat a fear of nausea and vomiting 44). This approach led to complete remission of complaints following only one session of Eye Movement Desensitization and Reprocessing (EMDR).
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