Salmonella Scare: Treating Emetophobia Or Vomiting

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Salmonella outbreaks are coming up more often than what with eggs and chicken being a staple and everything from peanut butter from Peter Ban to Wild Kitty Cat foodstuffs and Cadbury Schweppes chocolates reporting contamination that results in problems. Salmonella is not confined to uncooked eggs, it is even growing in untreated foods as well. Salmonella outbreaks are involved with bouts of vomiting and this is why those with emetophobia or fear of vomiting are in the worst possible condition. Emetophobics can suffer as a result of salmonella poisoning more severely than the normal population, what with irrational panic accompanying every bout of vomiting and making the condition may worsen.

What is Emetophobia?

Emetophobia, according to the American Diagnostic and Statistical Manual IV-R is a specific phobia. It is related to the blood-injection-injury type phobia and sufferers react every badly to vomiting bouts or observing others being sick. Phobics enter into the reality of the infected and make the assumption that they too will be unwell. The emetophobic may even fear his or her own body’s reaction and without treatment, there is trauma, rituals are used to defend against anxiety and the condition deteriorates. As gradual exposure is one form of treatment, it remains tough to deal with this condition.

Most with this phobia type fear to vomit, with a small percentage fearing seeing someone else being sick. This is a fairly recurrent phobia and it is more commonly observed in adolescents and females. Support websites abound for emetophobia.

Symptoms

Fear of vomiting or vomit phobia can occur on its own or following a traumatic experience. Once it begins, the phobia can cause patients to experience extreme states of fear. Slowly, but surely, the patient will avoid places and things linked with vomiting. They will become increasingly tense and hypervigilant and fear will soon dominate life. The more one avoids it, the more fears will grow. Dietary habits are also excessively scrutinized to avoid anything unfamiliar or likely to cause sickness resulting in compulsive avoidance and checking. Individuals who suffer this phobia experience considerable occupational and social impairment. They make all the efforts to avoid vomiting. This may include refusing to even attend school or visit a friend’s home. Adults may miss work or avoid eating out. Life changes drastically, due to the fear of vomiting. This means all the patient does is plan strategically to avoid something uncomfortable. Not knowing what will happen ahead triggers further anxiety. As one does not know what will happen, one is constantly on their guard, rearranging life to ward off chances of puking.

Protective behaviors a patient may adopt due to emetophobia range across the following:

• Avoid restaurants, alcohol, new or experimental cuisine.
• Avoid beverages, foods or restaurants associated with previous instances of vomiting.
• Closing the eyes during scenes of vomiting in movies or TV shows.
• Checking other people for signs of illness and avoiding sick people and hospitals.
• Refusing to shake hands with people.
• Avoiding garbage and foul odors or dirty things.
• Engage in excessive handwashing, cleaning food and preparation surfaces.
• Throwing away food before it nears the expiration date.
• Smell and check food continuously.
• Overcook food to kill certain impurities.
• Use antacids regularly and in a pre-emptive way.
• Avoid eating foods when you are away from home.
• Check locations of rest-rooms
• Avoid or restrict travel, school, work plus social activities.
• Take the body temperature constantly and check for signs of illness.

Most emetophobics rarely vomit. Some may report that they have, in fact, not thrown up since the traumatic incident, but are constantly worried it might happen. If one has emetophobia, certain behavior patterns or obsessions may develop in an effort to keep one safe. All sorts of preventative phobic reactions may ensue. You may feel more comfortable sleeping in a particular home or outside. Sleeping with a towel or brown bag in case you fall sick in the night is also common. Patients may also seek to discover the shortest routes to the restroom in new buildings or build anxiety about extended car trips. Emetophobics may also refuse to carry passengers when they drive, because of the fear of throwing up in the car.

Emetophobics also experience nausea and digestive issues. These common anxiety symptoms can trigger a self-replicating cycle. You may fear to vomit and this may cause fear-inducing nausea, so you feel like vomiting. Additionally, there is hypervigilance to GI symptoms and complications such as misappraising causes of nausea. Emetophobia is an excessive or irrational fear about an act of possibility of vomiting. This straightforward definition belies complex factors that may explain the development of fear of vomiting in different persons.

Symptoms are best explained by conditions like OCD, social anxiety or agoraphobia which may be co-morbid with vomit phobia.

Emetophobia symptoms are diverse and include the following:

• Behaviors geared towards eliminating sickness or throwing up.
• Checking actions designed to diagnose early signs of illness
• Health promoting behaviors used to reduce the impact of illness
• Avoidance of situations where vomiting could be distressing or public

Emetophobics are scared of vomiting, anyplace, anywhere, anytime. Others only fear to vomit in front of others or seeing an individual vomit. Symptoms range across mild disturbance to acute panic attacks. This includes rapid heartbeat, difficulty breathing, the rush of adrenalin, choking, derealization, fear of dying, dizziness, numbness, trembling and sweating. This is like a PTSD flashback where clients dissociate.

Emetophobics liken vomiting to death. For many individuals, death anxiety and vomiting are linked inextricably. Emetophobics show symptoms of OCD and agoraphobics. These patients wash their hands until raw on account of fear from germs and possible infection. They fear to see another individual or catching germs so much that they do not leave the house. Many emetophobics have symptoms of OCD such as rituals to reassure oneself that one is not sick or superstitious about dates and numbers.

• Excessive cleanliness is a concern for such patients.
• They also fear eating outside the home or eating food not prepared by them.
• Fear of psychotherapy and graded exposure is common.
• Emetophobics suffer from diarrhea, stomach cramps as well as nausea a great deal of time.
• They also fear taking medicines prescribed for nausea or vomiting as a side-effect.
• They are also afraid of others vomiting.
• They feel fear of pregnancy due to vomiting at delivery or morning sickness.
• Emetophobics also fear anesthesia due to vomiting as a side effect.
• They also fear nursing homes and hospitals.
• There’s also fear of traveling in case one is motion sick.
• Refusal or inability to vomit is common.
• Then, emetophobics also fear amusement parks and arcades where riders may get sick and vomit.
• There’s fear of TV and film shows as vomiting is depicted in the media so many times.
• There is also a fear of numerous jobs and limited career choices.
• Emetophobics have difficulty holding down a job due to sick leave.
• There’s fear of sick or injured individuals as vomiting is a sign of illness.
• Emetophobics people who cough, burp, look pale, touch their stomach or say they don’t feel well.
• Nightmares about vomiting and night terrors are also common.
• Emetophobics experience anger, despair, and frustration at not being believed, supported or understood.

When emetophobics face the traumatic stimulus i.e vomiting, here’s what they experience:

• These individuals panic at once with incredible immediacy.
• Panic attacks do not necessarily rise slowly, inserting cognitive tools is not possible.
• This depends on the severity of the disorder.
• They are dissociative and irrational, crying, screaming and harming others or themselves.
• Emetophobics feel nausea and a conviction they will vomit.
• They may even refuse to remain in a car, house or enclosed place with sick persons even if there is an own child or family member who needs help.
• If trapped, closing the eyes and plugging the ears may be a common reaction.

If emetophobics are nauseous, believing for some reason they may vomit, they will respond in the following ways:

• There should be a refusal to eat or drink if they think they can’t vomit due to an empty stomach.
• The assumption is that gastrointestinal feelings include nausea and vomiting.
• This extends to mistaken feelings about body temperature, giddiness, and headache etc.
• Refuse medical help in case one is trapped in a hospital with additional sick individuals.
• Refusing medicines in case there are side effects like vomiting and nausea may take place.
• Panicking and continuing to have panic attacks over extended time means one is unable to avoid stimulus in their own body.
• Assume that a panic attack will result in vomiting.
• Pace, cry, beg others to help, run, become dissociative or engage in self or other harm.
• Try all sorts of OTC medicines to control vomitings like Dramamine, Peppermint, Pepto Bismal, and Ginger.

Emetophobics tend to engage in the following avoidance behaviors:

• Avoidance of smells or food associated with previous vomiting episodes.
• Avoidance of sick individuals, pathogens and hospitals.
• Holding the breath around other people or refusing to shake hands with them.
• Excessive washing of hands or bathing.
• Excessive supplementation of vitamins, minerals etc, to guard against getting sick and vomiting.
• Advanced cleaning of foods and excessive cleaning of food preparation surfaces.
• Avoidance of non-packaged foods before the expiry date is reached.
• Checking individuals around them for illnesses and possible vomiting bouts.
• Excessive checking and smelling of food.
• Overcooking to destroy potential pathogens.
• Avoidance of eating new foods or extreme anxiety while consuming experimental cuisine.
• Eating limited foods over and over again to avert stomach upset.
• Avoidance of weird looking foods.
• Anorexia and other eating disorders leading to avoidance of eating.
• Preemptive use of antacids.
• Avoidance of eating foods when away from home.
• Restrictions on travel from home, staying at home or avoiding social activities.
• Work or social avoidance, avoidance of public speaking engagements or social or public gatherings.
• Constantly monitoring the body for illness signs and indications like swollen lymph nodes.
• Superstitious rituals designed to avoid getting sick.
• Only eating foods after other individuals have eaten them.
• When eating in public, monitor the reaction of others to food.
• Excessive concern about non-documentation of food allergies.
• Avoid meeting in situations where one could become ill.
• Avoidance of small enclosed spaces like planes, cars, lifts etc to avoid the sense of feeling trapped.

Those with emetophobia are frightened of puking– anytime or anywhere. Others fear a vomiting bout in front of people or seeing another person vomit. Symptoms can be graded along intensity with every type of reaction from acute panic to mild attacks. There is an increased heartbeat, an adrenalin rush, trouble breathing, choking sensations and giddiness as well as a morbid fear of death along with perspiration, trembling and numbness. There is derealisation akin the PTSD flashback. The individual becomes completely dissociated.

Many emetophobics report such a severe fear of vomiting that they would rather be dead than puke. Vomiting is linked to death anxiety. In severe cases, OCD or Obsessive Compulsive Disorder type symptoms and agoraphobia or fear of restricted and crowded places may overcome the emetophobic. Emetophobics may even wash their hands countless times just to rid themselves of “germs” and prevent vomiting. The fear can be so severe that the phobic individual may even refuse to leave home for the fear of catching a disease and vomiting.

Engaging in obsessive, ritual type behavior to relieve the anxiety, emetophobics may even be superstitious about dates on which they previously puked. Here are the characteristics of emetophobics:

• Extreme cleanliness
• Anxiety about outside food and salmonella leading to vomiting
• Nausea and stomach cramps as well as diarrhea a great deal of time
• Avoidance of prescription medication
• Fear of animals and children as well as adults who vomit
• Deep fear of pregnant women on account of vomiting during delivery or following morning sickness
• Fear of hospitals, nursing homes and anesthesia due to vomiting as an effect
• Fear of traveling on account of motion sickness
• Fear of roller coasters and heights because of which they may vomit
• Avoidance of movie or TV programs showing vomiting
• Fear of public restrooms and vomiting there
• Fear of psychotherapeutic intervention that requires exposure to visiting
• Emetophobics also fear jobs and limit career choices, because they are frightened of traveling outside and getting sick
• Fear of others coughing and burping and associated aspects with puking as the final outcome
• Nightmares and night terrors about vomiting
• Refusal or avoidance of vomiting
• Anger and despair at symptoms

When they see someone vomiting or feeling ill, emetophobics will panic immediately and become irrational and dissociate rapidly, causing crying, shouting and self-destructive behaviors. They will also be extra sensitive to feelings of nausea and engaging in vomiting. They may even try to escape from the vomiting situation to the detriment of others. If they are trapped, they may close their ears and eyes for the long duration.

In case emetophobics feel nauseous, they may even refuse to ingest or consume any solids or liquids. Dizziness, headache and body temperature may result. Refusing medication, in the event of side effects like vomiting is also common. An assumption may be made that the panic attack is being caused by vomiting. They may even try to ask for help and panic to the point of harming self or others. They may even try OTC medications to control vomiting.

Vomit phobia may develop in a spontaneous way or following a traumatic vomiting experience. Some of the rituals and avoidance behaviors people develop in response to vomiting actually raise the sensitivity to nausea. In different cases, emetophobia is a sign of underlying conditions.

Different Conditions Co-Morbid with Emetophobia

Agoraphobia

Individuals with agoraphobia are most likely to relate to fear of trapped places and emetophobia in the context of this. Most people talk about agoraphobia in the context of panic attacks. It can be conceptualized as fear of a physical symptom of attack in which escaping or receiving help is tough. If the primary focus is not on vomiting, but the possibility of getting sick when escape is hard, impossible or very public, agoraphobia could be the underlying medical condition. Individuals with agoraphobia may cope with vomiting when at home, but be fearful of it when outside of their house.

OCD/Obsessive Compulsive Disorder

People with OCD can face a vomit phobia as an indication of something dangerous and deadly. This underestimates the ability to cope with the act of vomiting in itself. Those with OCD linked emetophobia exhibit global fears about vomiting associated with social anxiety or agoraphobia. Additionally, vomiting may be seen as distressing or dangerous irrespective of the setting in which it takes place. Other characteristics of OCD co-morbid with vomit phobia may include checking rituals and avoidance behaviors. Individuals with OCD often logically realize rituals are excessive and yet feel unable to reduce them.

Social Phobia

People with social anxiety have symptoms similar to agoraphobia. This is understandable, given that the fear of throwing up has symptoms linked to social anxiety and agoraphobia. The difference between these possibilities is that those with emetophobia pertaining to social anxiety or social phobia would be okay with the idea of getting sick in secluded or remote place. People with agoraphobia finds the possibility distressing because there is difficulty in getting help. Social anxiety linked vomit phobia is only centered around fear of getting sick in public places.

Causes

One single aspect does not cause vomiting. Emetophobics may be reporting trauma in relation to puking since childhood. Suffers details constant trauma related to vomiting. Anxiety in families, trauma, separation anxiety and anxious focus on children are common to sufferers. Hereditary factors are also implicated in the etiology of this disorder. Vomiting presents a danger that is avoided to increase emetophobic’s sense of safety.

Emetophobics report a traumatic vomiting experience, nearly always in childhood. Psychotherapists assume sufferers are victims of childhood abuse either physical or sexual. The details of the patient’s trauma may vary. High levels of anxiety, trauma, separation or anxious feelings focused on vomiting result. Hereditary factors come into play sometimes. But most often than not, fear of vomiting is triggered by a negative experience. While causes of stomach flu, alcohol, and food poisoning happen, it is quite easy to feel alone. Risks of emetophobia are high if you vomited in public view or experienced long nights of uncontrollable puking.

Emetophobia may also be linked to worries about losing control. Most individuals try to control themselves and their environment in different ways, but vomiting is tough and difficult to control. It can happen in places which are inconvenient or distressing. The discomfort in the stomach may be caused by excessive drinking, eating, food intolerance, food poisoning, motion sickness or a stomach bug. It may also be caused by anxiety. Severe discomfort and nausea can result from a full-blown disorder.

If one worries about puking and works in a hypervigilant way to prevent it, the symptoms you don’t want and worrying about getting sick, then it’s clear there’s a disorder at play. When worry and anxiety kick into gear, it intensifies nausea. So, it is actually a vicious cycle. Worries about vomiting can trigger nausea and stomach discomfort, too. Anxiety also triggers nausea, but it cannot cause vomiting. In fact, barfing is the natural reaction of the body to harmful substances or even irritation in the gut or stomach. Some individuals may feel better after they vomit. In most cases, it is essential that patients adjust to uncertainty.

Complications

Across time, additional obsessions or fears may develop. Cibophobia/phobia surrounding food is common among emetophobic. Emetophobia patients may worry that food is not cooked or properly stored and there are chances of food poisoning. Severely restricting the diet or refusing to eat unless one is full is another possible complication. Many sufferers may develop eating disorders like anorexia and binge-purge syndrome.

Many sufferings from emetophobia develop agoraphobia or social anxiety, which is the fear of places or situations that cause individual patients to feel anxious, out of control or panic-stricken. Emetophobics may also be reluctant to interact with others on account of the vomiting phobia. One may also be afraid that others might vomit. It is not unusual to become afraid of other individuals vomiting and not just yourself getting sick when you have emetophobia.

Vomiting in Children/Teens

Fear of throwing up can be extreme in kids or teens. In children, school attendance may suffer as kids may panic and avoid or refuse to go to school. Academic performance suffers as well, on account of this. Children miss out on developmentally important milestones. Kids or teens who develop emetophobia may avoid every social gathering from birthday parties to dates, sleepovers, eating out, sports games etc. Missing out on these activities can impact social development and effect relationships. This leads to chronic social impairments. Even when longstanding social problems are not common, children or teens with this phobia may still suffer anxiety, fear, and distress.

Vomiting in Adults

Adults with a vomiting fear may also be significantly impaired as a result of their symptoms. There may be absences from work and work-related traveling may also deter them. This impacts opportunities for advancement. Emetophobics also dread meetings, and feel trapped and uncomfortable and may avoid responsibilities like public speeches or presentations. This can leave bright, capable individuals stagnating in jobs beneath their capacity or capabilities. Vomit phobia impacts travel for leisure as well. It can destroy social and personal relationships. For example, women with emetophobia may experience distress at the thought of pregnancy and morning sickness. Women with this phobia may delay starting families and choose to never have children at all due to fear of recurrent vomiting at the time of pregnancy. This can have a long-lasting impact on life.

Treatment

Therapy serves to generate compassion and create a stronger support system for the emetophobic. Cognitive behavioral methods should be applied in the event of strong symptoms. Client-centered or Rogerian/humanistic therapy is also beneficial for the treatment of this disorder. Treatment involves graded exposure to stimuli that are feared or vomit and vomit associated material. Misdiagnosis is important to avoid. Emetophobics become associated with anorexia nervosa, OCD, social phobia and other disorders belonging to the spectrum of the DMS-IV-r.

But this is wrong. Emetophobia is a disease in its own right. OCD however, is a disorder which is frequently co-morbid (i.e it occurs) along with emetophobia. The key sign is that the person only has a fear of vomiting in public, though he or she is not afraid of social interaction. Agoraphobia or fear of crowded places can also occur along with emetophobia. IBS, schizophrenia, bipolar disorder and other forms of psychoses may also occur along with this disorder. PTSD or post-traumatic stress disorder type symptoms may also result.

While CBT involving gradual exposure is a common therapy for this disorder, humanistic counseling can also work wonders. CBT is oriented towards creating the right thought patterns to correct flaws in thinking associating vomiting with danger and death.

Emetophobia is a hard-to-treat condition. A study found repeated exposure to film footage of vomiting was viewed by participants with emetophobia and a particular subgroup of individuals needed a greater number of sessions, as fear was created between sessions of exposure. This observation is in line with the result of internet surveys which found that those suffering from this phobia is likely to have undergone previous treatments with fair success. EMDR or Eye Movement Desensitization and Reprocessing is a recommended treatment for PTSD. Emetophobics report an onset in childhood, followed by exposure to distressing events such as the emergence of phobic conditions. Emetophobia is responsive to EMDR and among types of phobia reported for treatment including phobias of snakes, mice, choking or traffic and even fear of vomiting.

The standard for emetophobia is CBT and ERP or exposure response prevention. If one is seeking therapists and counselors who can help, finding an anxiety specialist is critical. Generalists may not have the expertise required to address the phobia. Helping patients to change their point of view of the problem and changing the behavior, desensitizing them is what makes them afraid or anxious. CBT involves imparting coping skills like understanding and addressing automatic negative thoughts.

ERP involves exposing oneself to what makes one anxious without having an anxious response or reaction. This may involve looking at a cartoon of a vomiting person and then a photo of the person puking. It also may involve saying words like puke, barf, and vomit. Eating foods avoided, taking a trip by bus or a ride at amusement parks or cutting down on washing hands are some other steps taken. CBT coping skills helps to limit anxious responses.

Exposure therapy can also be conducted using virtual reality. This is a treatment option that allows graded progression of the patient through a life-changing treatment exposes them to real-world phobic situations so they can respond in a more anxiety-free manner. Other techniques used for treating anxiety disorders such as emetophobia like yoga, meditation, mindfulness and breathing exercises also abound.

The standard treatment for emetophobia is cognitive behavioral therapy involving graded exposure. The therapist comes up with a hierarchy of fears for exposure that clients need to feel confident and comfortable tracking. Taking medication, and avoiding exposure do not yield any results. As the patient works on the exposure, the therapist explores issues, relationships and feelings using techniques he or she is comfortable with. To discuss the treatment approach honestly, it is important to work through the hierarchy.

Medication

In extreme cases, other disorders being co-morbid, anti-anxiety medication may be required. Emetophobics respond well to anti-anxiety medication and topical treatments such as a relaxing massage also work well. In extreme patients, where the disorder is co-morbid with OCD, depression, and agoraphobia, anti-anxiety medication may be required. Many emetophobics, however, draw back from medication fearing side effects like vomiting. Therefore, it is beneficial if therapists also prescribe a powerful anti-emetic for the first couple of weeks and reassure patients it works. Being open, gentle and caring is important. In extreme cases, anti-anxiety medication can be compounded into cream absorbed via the skin.

Treatment Duration

Emetophobia can be treated in 8-10 standard sessions, though some experts also suggest more sessions. The aim is to get the client to become anxiety-free. The goal of therapy is to rid the person of anxiety. Gradual methods of desensitization work well.

Conclusion

Those with emetophobia exhibit distinctive symptoms and need a gentle therapeutic relationship to combat the fear of vomiting. A winning perspective and a fresh mindset are taken to combat the condition. It can make all the difference to your reactions to salmonella scares and other such factors.