Fear of Vomiting: Emetophobia + Anorexia

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Emetophobia, or fear of vomiting, is surprisingly common. The phobia can begin at any age, although many adults have suffered for as long as they can remember. Emetophobia may be related to other fears, such as fear of food, as well as conditions such as eating disorders and obsessive-compulsive disorder.

Causes of Emetophobia

The fear of vomiting is often, but not always, triggered by a negative experience with vomiting. Although cases of stomach flu, overindulging in alcohol and food poisoning happen to everyone, it is easy to feel alone. The risk of emetophobia may be higher if you remember vomiting in public or experiencing a long night of uncontrollable vomiting.

Some experts believe that emetophobia may be linked to worries about lack of control. Many people try to control themselves and their environment in every possible way, but vomiting is difficult or impossible to control. It sometimes happens at times and in places that are embarrassing or inconvenient, which can be highly distressing.

Symptoms of Emetophobia

Interestingly, most people with emetophobia rarely, if ever, vomit. Some sufferers report that they have not thrown up since childhood. Yet they constantly worry that it might happen.

If you have emetophobia, you may have developed certain behavioral patterns or even obsessions in an effort to keep yourself safe. You might be most comfortable in a particular room of your home, or even outside. You might sleep with a towel next to you in case you are ill overnight. You probably feel compelled to learn the most direct path to a restroom in any new building. You may be extremely anxious about long car trips. Many sufferers report that they feel safer when they do all the driving. Some are reluctant to carry passengers, who might see them vomit if they cannot reach a restroom in time.

Many emetophobia sufferers experience frequent nausea and digestive upsets. These are extremely common symptoms of anxiety, and can lead to a self-replicating cycle. You are afraid to vomit, and the fear causes nausea and stomach pain. This makes you feel like vomiting, which in turn makes you more afraid. Research indicates that this cycle may be the result in hypervigilent sensitivity to gastrointestinal symptoms and misappraisal of nausea and other GI symptoms.

Complications of Emetophobia

Over time, you might develop additional fears or obsessions. Cibophobia, or fear of food, is common among many with emetophobia. You may worry that foods are not cooked or stored properly, thus leading to possible food poisoning. You might begin to severely restrict your diet or refuse to eat until you are completely full. Many sufferers feel that being full can lead to nausea and vomiting. In extreme cases, you might even develop tendencies toward anorexia.

Many people with emetophobia develop social anxiety or even agoraphobia. You might be reluctant to spend time with people for fear of vomiting in front of them. Alternately, you may be afraid that someone will vomit in front of you. It is not unusual to become highly afraid of other people’s vomit as well as your own.

Treating Emetophobia

Emetophobia can be somewhat complicated to diagnose and treat, since many people simultaneously experience other phobias and anxiety disorders. Therefore, it is important to work with a trusted therapist with a broad range of experience. See “Finding a Therapist.”
for tips and suggestions.

Cognitive-behavioral therapy can help you confront your fears and replace your negative thoughts regarding vomiting. Hypnosis and relaxation techniques can help to reduce the feelings and symptoms of anxiety. Medications may be indicated in some cases.

Although it will take a great deal of work, emetophobia can be defeated. There is no reason that your life must be controlled by this powerful but treatable phobia.
_{Sources:
American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th Ed.). Washington, DC: Author.}
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Hypochondria

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Hypochondria symptoms include:

• Having a long-term intense fear or anxiety about having a serious disease or health condition
• Worrying that minor symptoms or bodily sensations mean you have a serious illness
• Seeing doctors repeated times or having involved medical exams such as magnetic resonance imaging (MRI), echocardiograms or exploratory surgery
• Frequently switching doctors — if one doctor tells you that you aren't sick, you may not believe it and seek out other opinions
• Continuously talking about your symptoms or suspected diseases with family and friends
• Obsessively doing health research
• Frequently checking your body for problems, such as lumps or sores
• Frequently checking your vital signs, such as pulse or blood pressure
• Thinking you have a disease after reading or hearing about it

Hypochondria vs. normal worriesNot everyone who worries about health problems is a hypochondriac. Having symptoms caused by something you and your doctor can't identify clearly can cause anxiety. In some cases, a second opinion or further tests may be in order.

However, if you start to search for ailments that seem to match your symptoms, chances are you'll find something. Minor ailments often share symptoms with more-serious disorders. It's become easier to search out health information on the Internet in recent years. Having easy access to information about every possible thing that could be wrong can fuel your anxiety.

There's nothing wrong with informing yourself. Being an active participant in your own health is an important part of staying well. However, you may be crossing the line into hypochondria if you're consumed by the idea that something is seriously wrong even though you've had appropriate tests and reassurance from your doctor that everything's OK.

When to see a doctorIf you have signs and symptoms of hypochondria, consider talking to a mental health provider such as a psychiatrist, psychologist or licensed counselor. You may decide to take the step yourself or a family member may suggest that you seek help. At some point, a doctor, nurse or other health care professional may suggest that you visit a mental health provider.

It may seem to make no sense to visit a mental health provider when you're certain that you have a medical disease. But try to keep an open mind. Be willing to consider the possibility that your worries are based on your emotions rather than fact. Listen to the opinions of your family members and friends.

Even if you don't have all of the symptoms of hypochondria, it's not a bad idea to talk to a mental health provider about your health worries. Hypochondria or not, ongoing worries about your health can make you miserable. Seeing a mental health provider for health anxiety may help.

Helping a loved oneIf you have a loved one with signs and symptoms of hypochondria, have an open and honest discussion about your concerns and the things you've noticed. You may not be able to force someone to seek help for a mental health problem, but you can offer encouragement and support. You can also help your loved one find a qualified doctor or mental health provider and make an appointment. Offer to go to an appointment with him or her.

When you have hypochondria, you become obsessed with the idea that you have a serious or life-threatening disease that hasn't been diagnosed yet. This causes significant anxiety that goes on for months or longer, even though there's no clear medical evidence that you have a serious health problem. Hypochondria is also called hypochondriasis.

While having some anxiety about your health is normal, full-blown hypochondria is so consuming that it causes problems with work, relationships or other areas of your life. Severe hypochondria can be completely disabling.

Although hypochondria is a long-term condition, you don't have to live your life constantly worrying about your health. Treatment such as psychological counseling, medications or simply learning about hypochondria may help ease your worries.

It's not clear why some people are overwhelmed by the misguided perception that they have a major, undiagnosed health issue. It's thought that personality, life experiences, upbringing and inherited traits may all play a role.

There are similarities between hypochondria and anxiety disorders such as panic disorder and obsessive-compulsive disorder.

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Inpulse Control Behavior

There are many other disorders that have qualities involving repetitive thoughts and behaviors, akin to Obsessive-Compulsive Disorder (OCD). These disorders are sometimes called as Obsessive-Compulsive Spectrum Disorders(OC Spectrum Disorders) because of the similarities. Not only that, but some experts believe that these disorders may all have similar underlying neurobiological causes as OCD. Neuroimaging studies taken of the brain show similar activity between OCD and certain OC spectrum disorders. As well as having similarities to OCD, OC Spectrum Disorders are also very comorbid with OCD and vice versa. Many spectrum disorders are classified as impulse control disorders — where impulsivity can be thought of as seeking a small, short term gain at the expense of a large, long term loss.

OC Spectrum Disorders

Tourette's Disorder (also known as Tourette's Syndrome): A tic disorder that appears before the age of 18. Symptoms consist of multiple motor tic (such as twitching for no reason) and vocal tics (such as swearing for no reason) that occur, although not necessarily at the same time. Tics are recurrent physical movements or vocalizations with no apparent cause. Many studies have reported OCD symptoms in 50 percent of Tourette's disorder sufferers, with some studies showing rates as high as 74 percent. Studies have shown that 6 percent of OCD sufferers have Tourette's Disorder, with as many as 35 percent having some symptoms. Learn more about Tourette's...

Body Dysmorphic Disorder: Is currently classified by the DSM-IV-TR as a somatoform disorder. The main feature of this disorder is the obsession over an imagined physical defect or anomaly in a person of normal appearance. Any part of the body can be obsessed about, such as a nose or simply being unattractive, but the most common symptom is usually over a perceived facial flaw. Body dysmorphic disorder can be very debilitating — with one study showing that as many of one third of its sufferers become housebound. The sufferer becomes obsessed with worry and rituals much like a person suffering from OCD. In the same way an OCD sufferer will check the stove numerous times to see if its turned off, a sufferer of body dysmorphic disorder will repeatedly look at their appearance in the mirror. Some studies have shown a lifetime 12 percent comorbidity rate with body dysmorphic disorder for people suffering from OCD. Studies have also shown that between 37-56 percent of people with body dysmorphic disorder have some history of OCD. More about body dysmorphic disorder...

Trichotillimania: Classified as an Impulse Control Disorder. People with Trichotillimania cannot stop themselves from pulling hair from their body, which results in noticeable hair loss. People with trichotillimaia will pull hair from any part of their body, but the most common pulling takes place with scalp hair, with eyebrow and eyelash pulling also being very common. Some people will pull hair from numerous parts of their body and some people from only one part. The hair pulling is often described as a compulsion that is disturbing to the person, much in the same way as someone suffering from OCD being distressed by a compulsion. More about trichotillimania...

Eating Disorders: Made up of two categories with two specific diagnoses: the first being Anorexia Nervosa and the second Bulimia Nervosa. A third eating disorder,Binge Eating, is mentioned in the DSM-IV-TR as a diagnosis that requires further study. Anorexia nervosa is defined as a failure to maintain a healthy, normal body weight through restriction of eating, or eating then purging. Bulimia nervosa is characterized by binge eating with a feeling of no control during binge eating episodes. The person must then compensate by fasting, purging or extreme exercise to prevent weight gain. Those suffering from bulimia and anorexia have obsessions about food, body image and the preparation of food. They also have rituals about diet, exercise, eating and food preparation. Sometimes a person suffering from an eating disorder will initially have obsessions about body image or food eaten, which then change into traditional OCD symptoms such as contamination, allowing them to meet OCD criteria. The overlap of symptoms between body dysmorphic disorder and anorexia nervosa is so high that the DSM-IV-TR lists anorexia with a specific exclusion criteria if the obsession is solely regarding weight. Studies showing eating disorder patients to have OCD symptoms have been as low as 11 percent and as high as 88 percent. Studies have also shown that 7 percent of those suffering from anorexia also have OCD, and 10 percent for Bulimia. Learn more about eating disorders...

Depersonalization disorder: Listed in the DSM-IV-TR as a dissociative disorder, it is defined by a feeling of being detached from ones mind or body (as if the person were floating outside of their body). People often feel as is they are not in control of their body or speech, and can feel a lack of affect. The actual experience of depersonalization is fairly common among normal functioning people, and also occurs during drug use. The depersonalization of someone suffering from depersonalization disorder is severe, frequent, unwanted and interferes with ones life. Depersonalization disorder frequently occurs during other disorders such as schizophrenia and depression, and therefore is not diagnosed when it appears only during these other disorders. OCD and depersonalization disorder have similar onset and a similarly chronic course. In much the way a person suffering from OCD suffers from unwanted, repetitive thoughts, so to does a person suffering from depersonalization disorder. More about depersonalization disorder...

Hypochondriasis: Involves an abnormal, excessive obsession regarding ones health. People who have hypochondriasis misinterpret bodily signals as being signs of apocalyptic events, e.g. a headache to be a sign of a brain tumor. The person will visit the doctor numerous times for reassurance, but continue to believe there's a problem despite being told they are perfectly fine. These obsessions contain similarities to OCD contamination fears and checking rituals. Read more about hypochondriasis....

Compulsive Skin Picking: Also called onychophagia, compulsive skin picking involves the picking of ones skin in a repetitive manner so that the skin is noticeably damaged. This disorder is an impulse control disorder similar to trichotillimania, and just like trichotillimania, usually centers around the face, but can involve any part of the body. People will pick at things on the skin such as freckles, pimples, sores, moles, etc., but will also pick at imagined defects. Read about compulsive skin picking and scratching and the related compulsive nail biting...

Possible OC Spectrum Disorders

Compulsive Sexual Behavior (CSB): CSB is a very broad category with many types of sexual behaviors. Generally though, CSB is divided into two categories: paraphilic and non-paraphilic. Paraphilic sexual behaviors are irregular sexual behaviors that are obsessive and compulsive (pedophilia, voyeurism, exhibitionism, frotteurism, etc.). Non-paraphilic behaviors are normal sexual behaviors taken to levels so extreme they cause extreme distress and impairment. There is great debate as to whether CSB is an addiction, an impulse control disorder, an obsessive-compulsive disorder, or even a mood disorder. But it is clear that certain types of CSB are driven by both obsessions in compulsions. Read about sexual compulsivity and medication treatments...

Olfactory Reference Syndrome: The obsessive, irrational fear that ones body is emitting a foul and unpleasant odor that may offend others. This fear can of course be obsessed about much like an OCD fear (e.g. contamination). More about olfactory reference syndrome...

Pathological Gambling: Doesn't appear in the DSM-IV-TR as its own disorder, but could be classified as an impulse control disorder. Pathological gambling is characterized by an obsessive need to gamble. More about pathological gambling...

Autism/Asperger's Disorder: Autism is a pervasive developmental disorder that begins in early childhood. It is characterized by severe deficits in the ability to communicate and interact with others. Also present in autism are repetitive behaviors and a limited range of interests, which of course is where its similarities to OCD lie. Asperger's is basically a milder form of autism   with sufferers usually having a higher level of functioning. More about autistic disorder...

Obsessive-Compulsive Personality Disorder: OCPD is a personality disorder involving an overwhelming need for organization, order, and perfectionism. A personality disorder affects a persons' thoughts and actions and negatively, compromising their ability to deal with common life issues and relate to others. This disorder has a name very similar to obsessive-compulsive disorder, but is not the same thing. More about Obsessive-Compulsive Personality Disorder...

Intermittent Explosive Disorder: An impulse control disorder characterized by episodes of uncontrollable rage and anger. Someone with this disorder will just blow up in a violent, uncontrollable rage   sometimes called a "rage attack." This behavior is out of proportion to the act that caused the response, and is not caused by any substance, such as medication or alcohol.

Pyromania: An impulse control disorder that involves intentionally setting a fire for gratification. Prior to setting a fire the person will obsess and be tense, and after compulsively committing the act, will feel relief and gratification. The fire setting is not done for any personal reasons, such as revenge, anger, monetary gain, etc., nor is it done in any sort of state of psychosis. Merely it is an obsession that must be acted upon.

Kleptomania: An impulse control disorder characterized by the impulsive need to steal. Like pyromania the act is not done for personal reasons, such as monetary gain or revenge (in fact, a person with kleptomania will sometimes replace the item they steal after the fact), nor is it done because of another disorder, such as anti-social personality disorder or bipolar disorder (a.k.a. manic depression). Similar to OCD or pyromania, the person will obsess about their thought, e.g., stealing   and feel tension and anxiety. Upon acting compulsively by stealing, a kleptomaniac feels momentary relief from their obsession. More about kleptomania...