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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.


This article originally appeared two years ago.

Last weekend, I went to a speed-dating event. Just walking up to the door made the hairs on the back of my neck stand up.

I like to think of myself as a social, outgoing person. But when it comes to anything related to dating, I can be painfully shy.


A speed dating event in the U.K. Photo by Jack Taylor/AFP/Getty Images.

As I got closer to the building, I started to feel like there was some horrible, inaudible, invisible static in the air that only I could sense. To anyone else, I'm sure everything looked perfectly normal — the bar was nice, all the people I met were very lovely ... but I couldn't help but feel that static playing across the back of my neck.

I was, in other words, anxious.

Everyone gets anxious sometimes, and that's OK.

Image via iStock.

In fact, anxiety is a normal and evolutionary biological response to stressful situations. Our brains are really good at linking bad experiences (like awkward dates) and stimuli together, mostly because it keeps us safe.

If something bad happens and then you're in a similar situation in the future (like, say, having to talk to nearly 20 strangers in five-minute increments), your brain holds up big signs to help you remember to stay safe — signs like that prickling feeling on the back of my neck.

Other signs can be mental symptoms, like hypervigilance or intrusive thoughts, or physical ones, like a racing heartbeat or feeling nauseous or dizzy. And these can sometimes be really, really hard to ignore.

"[Anxiety is] a whole-body, a whole-mind, a whole-person experience," Dr. Michael Irvine told Upworthy.

Irvine is a clinical psychologist who knows a lot about anxiety. He's worked extensively with combat veterans experiencing post-traumatic stress disorder, a diagnosis that, at its heart, is about anxiety.

“It’s not just battling your thoughts. The work isn’t just trying to convince yourself not to be scared. Anxiety is a reflex."

Irvine explained that fighting off anxiety isn't as simple as just ignoring those anxious feelings.

“It’s not just battling your thoughts," said Irvine. "The work isn’t just trying to convince yourself not to be scared. Anxiety is a reflex."

And anxiety doesn't just affect our bodies and minds; it can actually affect how we see the world every day.

An anxious job applicant, circa 1940. Photo by Rondal Patridge/National Archives/Wikimedia Commons.

An experiment from the Weizmann Institute of Science in Israel showed clearly that having anxiety can affect our ability to process sights and sounds.

Researchers from the lab set up the experiment by training volunteers with specific sounds. They taught them that some sounds had good outcomes (gaining money), and some had bad outcomes (losing money).

Then they played the good and bad sounds, plus some benign and neutral ones, back to the volunteers. And what they found was fascinating: The volunteers with anxiety were more likely to identify benign sounds as bad sounds, too, even though those sounds were neutral.

Why? It wasn't a conscious decision. Instead, the anxious volunteers' brains had automatically overcompensated. In trying to keep them safe, their brains had changed the way they perceived all the sounds, not just the bad ones.

This might sound like an odd scenario, but it helps to explain why the speed-dating event was so weird for me. To outsiders, the event looked like a couple dozen young people enjoying themselves. But to my brain, through the filter of anxiety, the event was suddenly attached to bad dates of years past and uncomfortable social interactions. What might seem benign to everyone else actually looked much worse to me.

Sometimes, though, our brains take it too far.

Anxiety is normal — especially after a bad event — but, similar to how an overactive immune system can give us allergies, our brain's natural protective response can sometimes overcompensate. And when anxiety progresses to the point where it disrupts your everyday life, that's when it becomes what psychologists would call an anxiety disorder.

The U.S. Army now requires soldiers take suicide awareness classes. PTSD, an anxiety disorder, may be associated with higher suicide rates in soldiers. Photo from Chris Hondros/Getty Images.

About 1 out of every 5 adults in the U.S. is affected by an anxiety disorder. Anxiety disorders come in a lot of different forms, too, ranging from social anxiety disorder to PTSD.

I don’t have a diagnosed anxiety disorder, but for folks who do, the symptoms can be really paralyzing. Those intrusive thoughts and physical symptoms can keep people with anxiety disorders from leaving the house. The symptoms can make them struggle at work and seriously affect their quality of life.

The stigma of having an anxiety disorder can be just as tough as the symptoms, too.

Image from iStock.

Even though 1 in 5 people struggles with it, people who are living with anxiety disorders often feel like they should be able to fix themselves alone — to pull themselves up by their bootstraps. In a 2007 survey, only 25% of people with mental health symptoms said they believed people would be sympathetic to their stories.

But in reality, anxiety is nothing to be ashamed of; it's just your brain working extra hard. Plus, talking about your struggles and looking for treatment early are some of the best strategies for managing it.

"The earlier we intervene on the timeline, the more likely an individual is to get a better outcome," said Irvine.

So biologically, it's not too weird to have a prickly-neck feeling or an upset stomach while meeting a bunch of strangers.

But when your brain is dealing with anxiety, especially an anxiety disorder, it actually functions differently. Things that might be benign suddenly seem scary. Meeting potential dates might make you really sweat. An overwhelming feeling of being unsettled might come over you just as you enter a new place that reminds you of an old place.

That is OK. Because even though we can't always control how our brains see the world, or what warnings signs they throw in our faces (needed or not), we've got nothing to be ashamed of when we start to feel anxious.

And if you ever run into me at another speed-dating event, I hope you'll cut me some extra slack.