Emetophobia (Fear of Vomiting) Therapy in Bergen County, NJ

Understanding Emetophobia

Emetophobia is the intense fear of vomiting or seeing someone else vomit. People with emetophobia may go to great lengths to avoid situations where they think they might vomit or see someone else vomit, even if it means restricting their life significantly.

Is It a Phobia, or Could It Be OCD?

Emetophobia is sometimes diagnosed as a Specific Phobia. However, for many people, it has strong similarities to obsessive-compulsive disorder (OCD). If you experience:

• Irrational connections between events (e.g., “I wore shorts when I saw someone vomit, so now I avoid wearing shorts”),
• Constant intrusive thoughts about vomiting and responding with excessive behaviors like washing, checking, avoiding certain places, or carrying safety items like water bottles,
• Or obsessive thinking combined with compulsions, avoidance, and rituals,

…then it might be more accurate to think of your emetophobia as a form of OCD.

Symptoms of Emetophobia

As with OCD, emetophobia symptoms can be debilitating and affect the client’s quality of life in various ways.

• Typically, people with emetophobia are only able to eat a few “safe” foods, and the patterns of avoidance may not make sense to the casual observer. For instance, an emetophobic may avoid bread products due to a fear of mold, yet may be perfectly fine eating fried, fatty foods, which most people would think of as more likely to lead to nausea or vomiting.
• Consumption of other things may also be avoided, such as alcohol or over-the-counter and prescription medications, the latter of which often have written right on the label that nausea may be a possible side effect.
• Emetophobics may avoid eating too quickly or eating later in the day, and food intake of any kind, including water, may be restricted to the home to avoid the possibility of vomiting in public.
• Adults with emetophobia may avoid social venues, such as bars or parties, where they expect significant amounts of alcohol will be consumed.
• An individual with emetophobia’s work may suffer because they avoid travel, work-related social activities, or the employee cafeteria.
• Avoiding pregnancy due to the fear of morning sickness.
• Children may avoid their school’s cafeteria, gym, or the bathroom, or may experience complete school refusal due to their fear of vomiting or seeing someone who may vomit.
• There may be hyper-vigilance and hyper-reactivity in response to a person burping, coughing, looking pale, or even people placing their hand on their stomach.

Treatment of Emetophobia

The task of the clinician is to ultimately trace the client’s symptoms to the fear of vomiting. As with other forms of OCD, once identified as a case of emetophobia, Exposure and Response Prevention (ERP) can be applied as the core treatment.

In emetophobia treatment, ERP is best applied to three different areas of the emetophobic symptoms:

1. Physiological Symptoms: The first area is the physiological symptoms associated with nausea and vomiting itself, which trigger anxiety. To address the physiological symptoms, we engage in interoceptive cue exposure (sometimes called symptom cue exposure). The client purposely creates physical symptoms associated with nausea and vomiting through self-controlled exercises such as spinning in place or hyperventilation, which can cause nausea, dizziness, and light-headedness.
2. Environmental Triggers: A second area is the environmental triggers of emetophobic anxiety. This may include going to avoided places such as bars, lunchrooms, or public bathrooms. Another focus is exposure to avoided foods. Once well tolerated, these exposures are often combined — for example, hyperventilating to create nausea and then immediately eating a previously avoided food in a previously avoided environment, such as a restaurant.
3. Simulated Vomiting: A final area involves exposure to the act of vomiting itself. I do not recommend actual vomiting, as I do not think it is necessary for recovery. Instead, we use simulated vomiting — replicating vomit with something like canned beans mixed with corn and peas, taking a mouthful, and spitting it into the toilet repeatedly while flushing. Equally effective is watching vomiting videos online (e.g., www.EmetophobiaResource.org).

Moving Forward — You CAN Overcome This

Emetophobics reading this may be shocked and even frightened off at what I am suggesting. Exposure to our fears sounds terrible, but believe it or not, ERP — including interoceptive exposure, environmental exposure, and simulated vomiting exposure — has helped people with emetophobia move forward in confronting fears and lead to greater freedom and lowered anxiety.

In my experience, when a motivated and disciplined client is engaged, this combination of interventions can result in substantial improvement and often a complete elimination of symptoms.

The idea of facing your fears may seem scary, but ERP has helped many people with emetophobia regain their freedom. The goal is not to force yourself into panic but to gradually train your brain to stop reacting with fear. With the right guidance, support, and structured approach, you can break free from the cycle of fear and start living a more open and fulfilling life.