Emetophobia is the fear of vomiting. Although vomit phobia may appear to be a specific phobia, it may actually be a symptom of OCD, social anxiety, or agoraphobia.
Flu season will be quickly upon us and with it comes an unfortunate increase in the likelihood of experiencing fevers, coughs, runny noses, vomiting, and the like.
Although no one enjoys being sick, this time of year poses particular challenges for individuals suffering from “vomit phobia”, or emetophobia, the fear of throwing up.
The fear of vomiting can affect individuals of all ages. It sometimes emerges in childhood and, if untreated, may follow a relatively chronic course. However, it can also develop well into adulthood, sometimes taking root after a negative health experience (e.g., after getting food poisoning or after experiencing an episode of severe or uncontrolled vomiting).
Vomit Phobia in Children and Teens
Consequences associated with the fear of throwing up can be extreme. In children, vomit phobia can lead to school refusal and avoidance. Academic performance may suffer, and children may miss out on certain developmentally important social milestones. If a child or teenager is afraid of getting nauseous or throwing up, he or she may avoid birthday parties, sleepovers, dating, and eating out at restaurants. Missing out on these activities can affect relationships and impact social development, which may lead to chronic social impairments. Even when longstanding social problems do not develop, children with vomit phobia still experience a great deal of unhappiness, fear, anxiety, and distress.
Fear of Vomiting in Adults
Adults with the fear of vomiting may also be significantly impaired by their symptoms. They may have more absences from work and may avoid work-related travel, which can affect opportunities for advancement. They will often dread meetings, during which they may feel trapped and uncomfortable, and may avoid certain job responsibilities like public-speaking or presenting. This can leave otherwise bright and capable individuals stagnating in jobs that are beneath their true capabilities. Vomit phobia also affects travel for leisure and dining out, and can wreak havoc on romantic relationships.
Women with the fear of vomiting may experience extreme distress at the thought of becoming pregnant and experiencing morning sickness. Women with the fear of morning sickness may delay starting families, and some may choose to never have children at all due to the fear of recurrent vomiting during pregnancy. Clearly, this can have profound and lasting effects on one’s life.
What is Emetophobia?
Emetophobia is defined as an excessive or irrational fear about the act, or possibility, of vomiting. However, this relatively straightforward definition belies the many, rather complex factors that may explain the development of the fear of vomiting in different individuals.
In my South Florida psychological practice (Palm Beach County, FL), I rarely encounter cases of “vomit phobia” that truly represent simple phobias.
In the individuals I typically treat who have the fear of vomiting, symptoms are often best explained by another underlying condition, such as obsessive-compulsive disorder (OCD), social anxiety, or agoraphobia. In this post, we’ll discuss these different possible etiologies. But first, let’s talk about some of the behaviors that are common to these different manifestations of vomit phobia.
Symptoms of vomit phobia are diverse and include 1) behaviors that are designed to reduce the possibility of getting sick or throwing up, 2) checking behaviors used to detect early signs of illness, 3) health-promoting behaviors used to reduce the impact of illness, and 4) avoidance of situations in which vomiting might be particularly embarrassing or distressing. Common symptoms of emetophobia include:
Symptoms of Vomit Phobia
- Avoidance of foods or smells associated with past vomiting episodes.
- Avoidance of germs, hospitals, and sick people.
- Holding one’s breath when around other people.
- Refusing to shake hands with others.
- Avoidance of garbage and other foul-smelling or dirty things.
- Excessive handwashing or bathing.
- Excessive use of vitamins.
- Excessive cleaning of foods.
- Excessive cleaning of food prep surfaces.
- Avoidance of non-packaged foods.
- Throwing away food before it has reached its expiration date.
- Checking other people for signs of illness.
- Excessive smelling and checking of food.
- Overcooking food to kill potential pathogens.
- Avoidance of eating new foods (or extreme anxiety when eating new foods).
- Eating the same (limited) foods over and over again to avoid stomach upset.
- Avoidance of foods that look “weird.”
- Anorexia, i.e., the complete avoidance of eating or severe restrictions in eating.
- Preemptive use of antacids.
- Avoidance of eating foods when away from home.
- Checking for the locations of bathrooms (when away from home).
- Restricting travel away from home (staying at home, avoiding social activities).
- School avoidance or work avoidance.
- Taking one’s temperature excessively or monitoring one’s body for other signs of illness (e.g., checking lymph nodes).
- Superstitious rituals designed to avoid getting sick.
- Only eating foods after other people have already eaten them.
- When eating in public, monitoring other people’s reactions to their food.
- Excessive concern about non-documented food allergies.
- Avoidance of public speaking responsibilities or other situations in which one is the center of attention.
- Avoidance of meetings or other situations in which one might feel trapped, or situations in which one could not easily escape if they became ill.
- Avoidance of planes, cars, and/or public transportation in order to avoid feeling trapped.
Vomit phobia may develop spontaneously, or it may develop following a traumatic vomiting experience. Ironically, some of the rituals and avoidance behaviors that people develop in response to the fear of vomiting may actually lead to increased nausea sensitivity.
In many cases, emetophobia is a sign of another underlying condition. To clarify the underlying cause of your vomit phobia (if any), you might ask yourself this simple question:
What would be so bad about vomiting?
Your answer to this question might help you determine if your vomit phobia reflects underlying OCD, agoraphobia, or social anxiety. See if your answer to the above question is similar to any of the answers below:
A) What could be worse? Vomiting could be the sign of something seriously wrong with me. People die of influenza every year.
B) It would be humiliating. What if I can’t make it to a bathroom in time, and my friends or co-workers see me throw up? It would be too embarrassing, and I don’t know how I could face them again.
C) I could get trapped somewhere. What if I couldn’t find a bathroom in time?
D) Vomiting is just too awful, and I just couldn’t handle it.
Fear of Vomiting as Agoraphobia
People with agoraphobia would most likely relate to options B and C. Remember that although most people think about agoraphobia in the context of panic attacks, agoraphobia can also be conceptualized more broadly as the fear of having a physical symptom attack in a setting in which escaping or getting help would be difficult. If your primary fear is not focused on the act of vomiting itself but rather on the possibility of getting sick in a situation in which escape would be difficult, embarrassing, or impossible, then agoraphobia might underlie your vomit phobia. As such, people with agoraphobia might cope well with vomiting when at home but would be fearful of vomiting when outside of their own household.
OCD & Vomit Phobia
People with OCD may be more likely to endorse items A and D. People whose vomit phobia is driven by OCD may consider vomiting as a sign of something dangerous and may also underestimate their ability to cope with the act of vomiting itself. People with OCD-related emetophobia may tend to exhibit more global fears about vomiting relative to those with agoraphobia or social anxiety. Vomiting may be experienced as equally dangerous or distressing regardless of the setting in which it occurs. Other characteristics of OCD-related fear of throwing up may include a greater variety of cleaning and checking rituals, as well as avoidance behaviors. Individuals with OCD often recognize logically that their rituals are excessive and yet feel powerless to reduce them.
Fear of Throwing Up Associated with Social Phobia (Social Anxiety)
People with social anxiety are more likely to select B and C, which can make it hard to differentiate from agoraphobia. This is understandable, given that many individuals with the fear of throwing up have symptoms consistent with both social anxiety and agoraphobia. The difference between these two possibilities is that individuals with vomit phobia related to social anxiety would be relatively okay with the idea of getting sick in a remote or secluded place (e.g., when walking alone in the forest). People with agoraphobia would likely find this possibility distressing because it might be difficult to get help (if needed). Thus, social anxiety-related vomit phobia is primarily concerned with the social consequences of being sick in public rather than the availability of help/escape.
Please note that the above descriptions are oversimplifications of complex phenomena. OCD, agoraphobia, and social anxiety are not mutually exclusive, and individuals may have symptoms consistent with several different forms of anxiety at the same time.
Treatment of Vomit Phobia
Treatment of emetophobia is best accomplished through cognitive behavioral therapy (CBT), which uses specific tools to reduce symptoms of vomit phobia. Treatment of vomit phobia involves correcting faulty beliefs about illness and disease, reducing avoidance behaviors, confronting challenging situations, and ultimately overcoming your fears.
For more information about cognitive behavioral treatment of emetophobia, please contact my South Florida psychological practice in Palm Beach Gardens, Florida.
Questions? Comments? Struggling with the fear of throwing up? Sound off below.
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Agoraphobia – Symptom Attacks, Triggers, Panic, & Avoidance Behaviors
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I fear vomiting because of the contamination issues–with my contamination OCD, I want to avoid situations where I have to clean up after a vomiting episode.
Tina, until I just read your comment, I did not think that I feared vomiting. Oh, but you are right!!! The idea of touching the toilet totally grosses me out, and then there are the germs of the vomit itself. Ugh. I’m cringing just typing about it!
I also fear vomit. I am not talking about the act of vomiting, but the vomitus itself, i..e, the contents of the vomit, which usually consist of mild hydrochloric acid and pepsin, as well as other digestive enzymes.
I am afraid that they will touch my belongings and damage them. For example, I am afraid that the pepsin (a catalyst, which means that they will not be eaten up once it has reacted with the substance) will eat away my wool sweater. Or to be more general, I am afraid the hydrochloric acid will bleach the clothes.
I constantly “see” vomit everyhwere. The other day I went to Target and it was raining. And there was this puddle of liquid / mushed something on the street by the parking lot. and I might step on it. Usually, I will just throw away my shoes (I have thrown multiple shoes; albeit expensive.) This time I will keep them. I feel that now the are of where the boots are sitting is contaminated with vomit. But I determined to wearing them again tonight. I can conecentrate at the moment at work, but I guess this is what ERP is all about…
If you guys have any consoling thoughts about it, or insights, I would really appreciate it. And yes, I am going to start with a new therapist next month.
Really good for you for wearing your boots again. I’m sorry this is so hard for you. I too have thrown out TONS of stuff, including many pairs of shoes. Ugh. I can’t even tell you how much money I’ve wasted and I feel terrible about that. But with CBT/ERP, these types of things have gotten much easier. Yes, I definitely do still struggle at times, but not nearly as bad as I used to. Good luck with your new therapist and with working on ERP. You CAN do it.
Thanks for sharing, Sunny. You’ve worked very hard at this! It’s always great to hear a story of hard work that has paid off!
Thanks for sharing here. Your story provides a great example of how individualized emetophobia can be. Keeping the boots is an incredible victory! Way to go!
As you move forward, you’ll want to make sure that the fear of having your personal items damaged is reflected appropriately on your hierarchy. You would likely benefit from many of the same exposures that would be completed by someone with a fear of illness, but you’ll also want to target your feared outcome directly. To do so, you will want to determine if the consequences of clothing damage are more social (e.g., “It would be embarrassing if people noticed my bleached out clothing.”), perfectionism (e.g., “I feel like I need to look ‘right’.”) or loss-related ( “I’ll never find a shirt like that again.”). ERP can then be used to target the appropriate domain. In addition to in vivo ERP, imaginal exposure will probably be very helpful.
All the Best!
Thank you guys for your encouragement!
Yes I cannot really wait to start the new therapy!
Dr Seay, I think my fear of clothing damage is related to the three factors you mentioned;
1. Social (I feel people will regard me highly if I look nice – I am fully aware of it because I live in a superficial metropolitan city)
2. Perfectionism
3. Loss-related (Following point #1; that is too look nice, I have tendencies to buy extra expensive clothes. Plus I am petite. So if they are damaged, not only I see it as a financial loss but also another pain searching for a new replacement).
And I believe the trigger because I relocated for job. (I moved from a superficial warm city to another 4-season metropolitan city, which is dirty and need a lot of walking). I was feeling homesick. I did not have this fear before I moved here. One day my bathroom bathtub was clogged, a maintenance guy came and proceed to use chemical drain cleaner recklessly. Due to my nature, immediately I did some research online and learned the beauty of some “corrosive” chemical components. That’s when the fear became full blown. From lye (NaOH), the fear started growing into fear of any corrosive chemicals. That’s when I start reading about HCl / gastric juice, as well as pepsin.
I apologize that this respond becomes more like venting!
Thank you for this website. I really like what you write.
And pardon my grammar. I am typing as I try to finish a client’s report
Ok, I see. So in this case, you’re really targeting something more general than strict emetophobia. Think creatively about how you might develop exposures that transcend vomit content, so that you cover all the relevant domains. Exposures involving other chemicals, as well as socially-relevant situations, will be helpful. If you haven’t done much reading about OCD, you might consider doing so, as I think an OCD conceptual model will allow you to pull these different areas together.
I have to admit, that’s an interesting angle as far as where your emetophobia stems from…since it requires the vomit or other caustic material to come in contact with you, and I take it the obsession/fear stems from the overwhelming feeling that it might no matter how careful you are?
I’m amazed to see my entire life listed out like that. It really demonstrates to me how much this fear has affected my life. It started in early childhood for me, and primarily answers A and D apply to me (I have health anxiety and contamination-centric OCD, so that makes sense). So…wow. Thank you for these articles, and thank you for going so in depth about these topics. So many experts and writers seem to stop short on what’s -really- going on when we’re struggling with anxiety over a particular issue.
Thanks for reading, Flower. Anxiety can certainly be astounding in all the different forms it can take. It sounds like in your case, it’s more the unpleasantness of the act itself rather than the social consequences.
Hi I’m Olivia I’m 10 years old and in sixth grade, I have a severe problem with throwing up. I don’t understand why this happens I saw a boy do it in class in 1st grade, then tested for different dieseses. All of the tests turned out negative, except for hpilory which is a stomach diesese by bacteria trapped in you intestines. I was tested in 2011 again And every thing was negative thank God. At school when ever I tend to think about it my stomach hurts and I miss my Mom. Can you tell me some tecniques on how to stop.
Exposure therapy is the best treatment for emetophobia. As the article suggests, approaches are tailored to your specific fears. Talk with your Mom about your worries and consider getting a therapist to help design a program specifically for you. Your program might include looking at pictures/videos of vomit, smelling things that smell like vomit, imagining what it would be like to throw up in class, etc.
Hi,
I have been suffering from emet for 21 years… I’ve been in and out of hospitals for eating disorders, stemming from my fear, and I’ve been on and off anti-anxiety medication since age 9. The fear has completely taken over my day to day living. I still go to work and go about my regular day, but the thought is CONSTANTLY in my mind. I work in a school district so I am constantly exposed, my daughter attends daycare so she brings a lot of lovely things home, and I am constantly aware and avoiding things because of this. I wash my hands so much they are cracked and bleeding, I will not enjoy a glass of wine, I will not eat with my fingers. I panic if there’s a flu going around for fear of catching it. As we speak, my daughter is recovering from a stomach flu and I was probably the worst mother on the planet. I relied on my mother to care for her – I was afraid to hold her, touch her and really be near her. This is a little 2 year old girl that I love with every ounce of my being…and it breaks my heart to know that I let this phobia get in the way of what she needs from me. Yet I can’t seem to stop it. IT’s awful.
I am afraid of vomiting but not so much afraid of others…. just the fact that I might catch the bug from them. If someone said that I wouldn’t catch it, I would be right in there helping them.
It’s very frustrating and I have had little to no success in therapy. i’m at my wits end and very discouraged as a mother.
Hi Lisa,
This sounds like OCD, rather than pure emet, and I suspect that you would be most likely to benefit from concentrated exposure and response prevention (ERP). You’ve been living with this for many years, and it certainly sounds like it has greatly affected your quality of life. Ocfoundation.org is a great place to find providers. If you’re willing to consider more intensive therapy, I would recommend that you check out their list of intensive outpatient programs (IOPs) for OCD.
Wishing you the best in your recovery…
Thanks. I looked at the website but nothing in my area. I’ll do some research into other therapists in the area though.
Thanks again!
Another option would be to check out the website of the Anxiety Disorders Association of America.
Hello, I’m Nadja and I had the fear of vomiting since I was 7 when my brother decided to throw up in the back seat of our car, beside me. I never screamed like that in my life. I’m 13 now, and the fear has been haunting me for these past 6 years, but it was weaker, till this summer. I started eating less and loosing kilos(I’m slightly overweight). I was always used to consuming alot of food and this suddent change really stresses me out, and it still does. I even started keeping away from food, eating really small portions and really avoiding anyone who is potencially sick(publick buses are a major problem). I am always sick and tired. My parents are refusing to belive in my fear, saying it is just a silly irrational feeling. I dont think so, and Im sick of beeing like this. Is there any way to treat this?
Wow, I KNEW emetophobia could share traits with OCD. No wonder why I’ve suffered so much before.
I’ve had emetophobia (I might as well still have, but in a lesser degree) for over 10 years of my life, and it was also linked with agoraphobia.
Great article!
hey..I am from greece,24 years old and isuffer from emetophobia .I can’t to anything,Im stuck inside my home, I stop hanging out with my friends and I can’t even attend my college lessons.I was taking tavor and lexotanil until I became a “junkie” and now im only taking antidepressants which I find useless. I will start therapy but I can;t be optimistic because I have tried everything(reiki,yoga,etc) and they seem to work for the first couple of days and then , my phobia is back. Please give me some courage because Im sick of my life, Im afraid I WILL end up all alone,a prisoner inside my home.