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Ever heard of emetophobia? The oddly common phobia often misdiagnosed as anxiety or anorexia
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Emetophobia is a pathological fear of vomiting and can be incredibly debilitating.

Something was wrong with our daughter.

We'd seen the signs brewing for a while, but couldn't pinpoint their exact nature. She'd always been an easy-going kid, but sometimes she'd flat-out refuse to do certain things or go certain places, and she would panic if we tried to coax her. She had frequent dizzy spells and stomachaches with no apparent physical cause. If she heard someone we knew was sick, she'd immediately ask with a worried tone, "What kind of sick?"

Those last two things should have been bigger clues, but we didn't have the clarity of hindsight. And as adolescence approached, she started experiencing more anxiety in general. She would back out of plans with friends more frequently. She spent more and more time in her bedroom. When I took her to orchestra practice—something she enjoyed—she couldn't make herself get out of the car to go in. We could see her trying to do things, but more and more she was paralyzed by a fear she couldn't name.

It was clear she was struggling with anxiety and we tried a couple of different therapists. They each helped a little, at least to keep the spiral from getting worse. But we seemed to be missing something.


It began dawning on me how often she talked about feeling nauseous. I took note of how many times she'd ask us if food was OK to eat and how frequently she'd refuse to eat certain things. She obsessively checked every bite of meat to make sure it looked cooked enough, and if her stomach felt the slightest bit off, she wouldn't eat at all. If a character in a movie or TV show gave any indication that they were about to vomit, she'd hop up and leave the room. If she found out someone had a stomach bug, she'd hole herself up in her bedroom. And so we started piecing it together.

"I've noticed that most of your anxiety seems to be centered around you worrying about throwing up," I said to her one day. "Does that sound accurate?" She flinched when I said, "throwing up," but nodded "yes."

As a shot in the dark, I googled "intense fear of throwing up," and found the clinical term that would change everything: emetophobia.

Emetophobia (also called specific phobia of vomiting, or SPOV) is a pathological fear of throwing up. In scientific literature, it is often referred to as an "understudied" or "underresearched" disorder, but there is a growing consensus that it is surprisingly common. One study found that up to 3% of men and 7% of women are affected by it. No one loves throwing up, of course, but when it becomes an actual phobia it can be incredibly debilitating.

For our daughter and other emetophobes, throwing up is the most terrifying thing that could happen to them. My daughter has said if she were given the choice between throwing up and dying, she's not sure which she'd choose. Totally irrational, but that's what makes it a disorder. Sometimes emetophobia is a PTSD response to a traumatic vomiting episode, but often—as in our daughter's case—there's no clear cause. But the why is less important than the what and the how to treat it.

People with emetophobia are basically afraid of their own bodies. Many phobias are situational—people don't generally freak out about heights or spiders or small spaces unless they're in or around those situations—but a person can't avoid or escape their own body. There are no breaks, no periods of relief from the fear. And the biggest triggers for emetophobia—food and other people—are also unavoidable, which makes it a particularly challenging disorder.

We all know that anything we eat has the possibility of giving us food poisoning—we know it's rare, so we take reasonable precautions and don't worry about it. Emetophobes do worry about it. All the time. They check expiration dates obsessively. They ask for reassurance that food is safe to eat. (I can't count how many times our daughter has asked us to smell or taste something that is not the least bit old.) Obviously, they can't not eat, but they often start limiting their diets to things they deem "safe."

Additionally, in an emetophobe's brain, pretty much every normal stomach sensation—hunger, digestion, gas—gets interpreted as nausea. And if they think they're nauseous, they won't eat. Such disordered eating can easily be misdiagnosed as anorexia nervosa, though it's a totally different illness.

People are another big trigger. Any person we interact with could have a stomach bug and not know it yet, which they could pass along to us. Again, we all know this, but we understand the chance is small, so we don't worry about it. Emetophobes do worry about it, incessantly, to the point of avoiding people and places where people will be, which is basically everywhere except their own personal living space. Hence the spiral into reclusiveness, which can easily be mistaken for agoraphobia.

The compulsive food checking, the frequent hand washing and the avoidance of certain things that go along with emetophobia also look a lot like OCD. (And indeed, as my daughter's therapist explained, emetophobia is a form of obsession.) All of these things make diagnosis tricky, especially since emetophobes won't usually walk into a therapist's office and say, "Hey, I'm deathly afraid of throwing up." They often avoid all words related to vomit and won't talk about it, so they speak in vague terms about their fear, which can lead to an initial diagnosis of generalized anxiety.

Getting the correct diagnosis is vital, however, to getting the right kind of treatment.

Before we found a therapist who knew how to treat emetophobia, we utilized a website called emetophobiahelp.org. It's run by therapist Anna Christie, who suffered from emetophobia herself, and it's an excellent starting place for self-help.

One of the first things the website suggested was to have my daughter look at this:

V * * * *

Not the word "vomit," just the first letter with the rest of the letters as stars. That's how avoidant many emetophobes are about anything involving the idea of throwing up. We added one letter at a time—just looking at them, not even saying the word—until she worked up to reading the whole word, then saying it out loud until she could do it with minimal discomfort, then saying synonyms—puke, barf, upchuck, and so on. The day my daughter could say "vomit" and "puke" without hesitation was a huge milestone.

Incremental exposure like that, eventually leading up to watching videos of people vomiting and pretending to throw up yourself, is one part of treatment. (Successful treatment doesn't require actually throwing up, by the way. Nor is vomiting a cure for the phobia. It's common for people to think, "Oh, if they just throw up and see it's not that bad, then they'll get over it," but that's not how it works. Generally speaking, an emetophobe vomiting without undergoing the mental changes needed to process it will not resolve the phobia.)

The other part of treatment is cognitive behavioral therapy (CBT). This is the retraining of the brain to manage the fearful thoughts. There are various elements of this part of treatment, including learning how the amygdala—the fear center in your brain—works and how to purposefully interact with it. Through various thought-feeling-behavior exercises, you learn how to diffuse the fear and stop inadvertently reinforcing it. (There's some evidence that EMDR can also be helpful for people with emetophobia.)

As her parents, we had to learn how the behaviors we thought were helping our daughter actually weren't. Telling her over and over again that food was fine seemed like the logical counter to her repeated requests for reassurance, but really, we were reinforcing her need for reassurance, which then reinforced the anxiety. We had to learn to tell her once, and only once, that something smelled or tasted fine and then stop responding. We had become avoidant of talking about vomit in front of her because it seemed so traumatizing—that wasn't helpful either.

So much of what we've learned in treating emetophobia is counterintuitive. That's true of treating most anxiety disorders, but with emetophobia, the behaviors are so specific it's important to find a therapist who understands how to treat it. It also can be hard to find a therapist who is familiar with it. Most we have called have never heard of it or never treated it.

Anna Christie's website is a good place to start your search. It has a list of therapists who specialize in treating emetophobia. She also has recommendations for finding a therapist if there aren't any on her list near you. We're in a rough time for finding therapists right now, though, as so many are booked out for months and aren't accepting new patients.

For self-help, an incredibly helpful book also came out last year. It has been a lifeline for my daughter, as her therapist moved out of state and we have struggled to find another to complete her treatment. "The Emetophobia Manual" by Ken Goodman, L.C.S.W. is basically a whole course of therapy in book form, complete with exercises and exposures. It's so good, I can't recommend it highly enough.

The good news is, emetophobia is treatable and there are more and more resources available for people who suffer from it. But it starts with getting the correct diagnosis, which is often the hardest part of the process.

Pop Culture

Artist uses AI to create ultra realistic portraits of celebrities who left us too soon

What would certain icons look like if nothing had happened to them?

Mercury would be 76 today.

Some icons have truly left this world too early. It’s a tragedy when anyone doesn’t make it to see old age, but when it happens to a well-known public figure, it’s like a bit of their art and legacy dies with them. What might Freddie Mercury have created if he were granted the gift of long life? Bruce Lee? Princess Diana?

Their futures might be mere musings of our imagination, but thanks to a lot of creativity (and a little tech) we can now get a glimpse into what these celebrities might have looked like when they were older.

Alper Yesiltas, an Istanbul-based lawyer and photographer, created a photography series titled “As If Nothing Happened,” which features eerily realistic portraits of long gone celebrities in their golden years. To make the images as real looking as possible, Yesiltas incorporated various photo editing programs such as Adobe Lightroom and VSCO, as well as the AI photo-enhancing software Remini.

“The hardest part of the creative process for me is making the image feel ‘real’ to me,” Yesiltas wrote about his passion project. “The moment I like the most is when I think the image in front of me looks as if it was taken by a photographer.”

Yesiltas’ meticulousness paid off, because the results are uncanny.

Along with each photo, Yesiltas writes a bittersweet message “wishing” how things might have gone differently … as if nothing happened.
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All images provided by Adewole Adamson

It begins with more inclusive conversations at a patient level

True

Adewole Adamson, MD, of the University of Texas, Austin, aims to create more equity in health care by gathering data from more diverse populations by using artificial intelligence (AI), a type of machine learning. Dr. Adamson’s work is funded by the American Cancer Society (ACS), an organization committed to advancing health equity through research priorities, programs and services for groups who have been marginalized.

Melanoma became a particular focus for Dr. Adamson after meeting Avery Smith, who lost his wife—a Black woman—to the deadly disease.

melanoma,  melanoma for dark skin Avery Smith (left) and Adamson (sidenote)

This personal encounter, coupled with multiple conversations with Black dermatology patients, drove Dr. Adamson to a concerning discovery: as advanced as AI is at detecting possible skin cancers, it is heavily biased.

To understand this bias, it helps to first know how AI works in the early detection of skin cancer, which Dr. Adamson explains in his paper for the New England Journal of Medicine (paywall). The process uses computers that rely on sets of accumulated data to learn what healthy or unhealthy skin looks like and then create an algorithm to predict diagnoses based on those data sets.

This process, known as supervised learning, could lead to huge benefits in preventive care.

After all, early detection is key to better outcomes. The problem is that the data sets don’t include enough information about darker skin tones. As Adamson put it, “everything is viewed through a ‘white lens.’”

“If you don’t teach the algorithm with a diverse set of images, then that algorithm won’t work out in the public that is diverse,” writes Adamson in a study he co-wrote with Smith (according to a story in The Atlantic). “So there’s risk, then, for people with skin of color to fall through the cracks.”

Tragically, Smith’s wife was diagnosed with melanoma too late and paid the ultimate price for it. And she was not an anomaly—though the disease is more common for White patients, Black cancer patients are far more likely to be diagnosed at later stages, causing a notable disparity in survival rates between non-Hispanics whites (90%) and non-Hispanic blacks (66%).

As a computer scientist, Smith suspected this racial bias and reached out to Adamson, hoping a Black dermatologist would have more diverse data sets. Though Adamson didn’t have what Smith was initially looking for, this realization ignited a personal mission to investigate and reduce disparities.

Now, Adamson uses the knowledge gained through his years of research to help advance the fight for health equity. To him, that means not only gaining a wider array of data sets, but also having more conversations with patients to understand how socioeconomic status impacts the level and efficiency of care.

“At the end of the day, what matters most is how we help patients at the patient level,” Adamson told Upworthy. “And how can you do that without knowing exactly what barriers they face?”

american cancer society, skin cacner treatment"What matters most is how we help patients at the patient level."https://www.kellydavidsonstudio.com/

The American Cancer Society believes everyone deserves a fair and just opportunity to prevent, find, treat, and survive cancer—regardless of how much money they make, the color of their skin, their sexual orientation, gender identity, their disability status, or where they live. Inclusive tools and resources on the Health Equity section of their website can be found here. For more information about skin cancer, visit cancer.org/skincancer.

via Dion Merrick / Facebook

This article originally appeared on 02.09.21


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Nurse turns inappropriate things men say in the delivery room into ‘inspirational’ art

"Can you move to the birthing ball so I can sleep in the bed?"

Holly the delivery nurse.

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Some of the comments are so wrong that she did something creative with them by turning them into “inspirational” quotes and setting them to “A Thousand Miles” by Vanessa Carlton on TikTok.

“Some partners are hard to live up to!” she jokingly captioned the video.

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