Emetophobia: Definition, Symptoms, & Treatments

What Is Emetophobia?

Emetophobia is an extreme fear of throwing up. Even though people usually feel relief after vomiting, individuals may develop emetophobia if they have a genetic predisposition to phobias. Emetophobia is one of the more common specific phobias, with as much as 8.8% of the population experiencing a fear of vomiting.²

Emetophobia involves a self-fulfilling reinforcement process. People with this phobia often use unhealthy coping strategies that increase their anxiety, further exacerbating many of the physiological symptoms by which they are triggered.

Is Emetophobia an Eating Disorder?

Emetophobia is not an eating disorder because the concern is not body image. However, the phobia can lead to behaviors associated with eating disorders to prevent the individual from throwing up. For example, some people with emetophobia may practice anorexia-like behaviors, such as restricting foods perceived as risky to digest.¹ Individual may also exhibit orthorexia and set rules around food purity. They may compulsively read labels for ingredients, determine expiration dates, and examine the condition of packages.

Symptoms of Emetophobia

The primary symptom of emetophobia is anxiety. People with emetophobia experience a crippling fear of throwing up, which often begins to limit their functioning. Emetophobia can also involve symptoms of social anxiety if individuals worry about calling negative attention to themselves.

Emetophobia can also have characteristics of obsessive-compulsive disorder (OCD), such as uncertainty about food safety, seeking reassurance about food purity from others, or throwing food away “just in case.” They may also excessively hand wash, overwash food, or overuse chemicals/cleansers in food preparation areas. When in public, individuals with emetophobia may pack “safety bags” with items like antacids, mints, water, wet wipes, and hand sanitizer.

Common signs of emetophobia include:

• Hyper-awareness and monitoring of physical symptoms related to vomiting or illness
• Avoiding new foods, restaurants, or alcohol
• Avoiding eating leftovers
• Avoiding getting full
• Avoiding places associated with a vomiting episode
• Being triggered by saying or hearing words related to vomit (i.e., throw up, barf, puke, hurl,  or retch)
• Cooking food until overdone
• Not trusting how food is cooked in restaurants
• Fear of seeing or hearing others vomit
• Label reading to check for “unsafe” ingredients and expiration date
• Avoiding pregnant women
• Rejecting invitations to parties or other social events
• Avoiding vomiting scenes on television or in movies
• Avoiding people who are or are perceived to be sick people
• Avoiding taking out or being around garbage
• Avoiding disgusting smells
• Avoiding long car rides
• Sensitivity to and avoidance of people who wear cologne or other scents
• Checking where bathrooms are located when out in public

Complications of Living With Emetophobia

Psychological, emotional, social, vocational, and physical complications come from living with emetophobia. Living in fear, social withdrawal, and malnourishment contribute to developing a severe fear requiring psychological or medical attention.

Untreated emetophobia may lead to the following conditions:

• Social anxiety disorder
• Agoraphobia (fear of being in public)
• Cibophobia (fear of food)
• Anorexia nervosa
• Obsessive-compulsive disorder
• Panic disorder

How Is Emetophobia Diagnosed?

Emetophobia is diagnosed the same as all specific phobias via an assessment from a medical or mental health professional. The professional will consult the DSM-5 (Diagnostic and Statistical Manual, 5th Edition) criteria for a specific phobia.

Diagnostic criteria for emetophobia includes:³

• Intense, irrational, disproportionate fear of vomiting
• Anticipatory anxiety about being in triggering situations that might cause vomiting
• Avoidance of being in situations or being exposed to material that triggers the fear of vomiting
• The fear has interfered with daily functioning and responsibilities

What Causes Emetophobia?

Emetophobia can result from trauma related to intense, severe, or uncontrollable vomiting episodes. It may also stem from an instinct that prevents individuals from eating or drinking undigestable items. People may have a genetic predisposition to anxiety or have other biological or psychological vulnerabilities that could trigger this phobia.

Triggers that may increase the likelihood of developing emetophobia include:

• Experiencing a bad case of food poisoning
• Vomiting during an important event/gathering
• Having a panic attack while vomiting
• Witnessing someone else vomit
• Having someone vomit on you
• Aversive smells
• Poor air ventilation

Emetophobia Treatment

Several effective psychological treatments for emetophobia follow the same practices for specific phobia treatments. The primary form of treatment is behavioral therapy, such as exposure therapy or cognitive behavior therapy. There are no FDA-approved medications to treat emetophobia, but some doctors may prescribe anti-anxiety medications.

Treatment options for emetophobia include:

Exposure & Response Prevention

Exposure and response prevention (ERP) is a form of behavior therapy that helps people face their fears while resisting urges to perform mental or physical behaviors intended to reduce anxiety. Because high anxiety cannot be sustained indefinitely, the mind will eventually habituate (get used to) the situation. Repeated practice can decrease distress and anxiety. Clients and therapists will create lists of triggering situations, thoughts, and images and rate them according to their distress levels.⁴ The exposures might start with trying an avoided food and repeating this task daily until it is normal.

Interoceptive Exposure Therapy

Interoceptive exposure therapy involves purposely provoking symptoms that trigger fear.⁵ If dizziness is one of the physiological experiences associated with emetophobia, the person might spin around, stop, and safely let the dizziness pass. Repeated practice helps the person differentiate the feeling from the fear (dizziness does not cause vomiting). The person can then practice this technique with other feared sensations.

Inhibitory Learning

Inhibitory learning (IL) is another behavioral treatment that helps people change their relationship with fear symptoms. Instead of trying to change the symptoms, people accept them, recognize them as part of life, and avoid trying to control them. IL often pairs ERP so the person develops new memories and associations that violate what is expected to happen in feared/avoided situations.⁶

Cognitive Behavioral Therapy

Cognitive behavioral therapy (CBT) involves identifying cognitive distortions, enacting cognitive restructuring, assessing the probability of perceived threats, and determining rational responses to triggering thoughts and body sensations.⁷ People may notice how they misinterpret body sensations in challenging and avoided situations.

Medication

The most commonly prescribed medications for emetophobia are benzodiazepines*, such as Xanax, Ativan, and Klonopin. However, these medications pose a risk of dependence. The advantage of behavior therapy over medication is that therapy helps the person develop internal control over their symptoms. They become less afraid of uncertainty when entering previously triggering or avoided situations. In contrast, once the medication wears off, the person returns to physiological symptoms created by the disorder.

*This medication has black box warnings, the most serious kind of warnings from the FDA for abuse or misuse, risk of physical dependence, and risk of serious side effects, including death, when combined with an opioid.

Emetophobia Self-Help Methods

The world can become increasingly smaller when individuals anticipate potential emetophobia triggers and choose to avoid them. Individuals may even avoid family or community activities if they expect intense anxiety. Developing healthy coping mechanisms can combat the intensity of symptoms and enable the person to live a less restrictive life.

Emetophobia self-coping techniques include:

• Diaphragmatic breathing: Diaphragmatic breathing regulates the nervous system and resolves many symptoms of anxiety that cause or result from the fear of vomiting
• Meditation: Meditation for anxiety allows the mind and body to focus on relaxing and observing internal experiences. With structure, time, practice, and patience, meditation is worth the effort.
• Mindfulness: Mindfulness grounds you in the here and now by using objective language to describe items in your environment. This practice competes with worry, catastrophic, past, and futuristic thoughts and experiences.
• Self-compassion (SC): This practice encourages self-kindness during difficult situations. SC is a way to support yourself as anxiety runs its course.

When to Seek Professional Help for Emetophobia

Consider professional support if emetophobia takes over your life, your fear becomes obsessive, or you constantly avoid triggering situations. An online therapist directory offers one of the best ways to find a therapist specializing in treating specific phobias. There are in-person and online therapy options, making treatment more available for everyone.

In My Experience

Emetophobia is probably more common than you think, and many people do not realize they possess this clinical and treatable problem. The good news is that phobias respond well to behavioral interventions. People can regain their lives and develop self-confidence by learning and applying healthy coping tools. Most people who recover report that attempts to avoid vomiting are worse than the experience!