Emetophobia is the pathological fear of vomiting oneself, of seeing another person vomit, the fear of feeling nauseous, or the irrational fear of seeing vomit (Stossel, 2014).
Many people with emetophobia also have other disorders, such as social anxiety, agoraphobia, and fear of flying, because their greatest terror is being exposed to situations where they might vomit, in private or in public. For this reason, these individuals tend to avoid going to restaurants, consuming alcohol, attending social events, and riding a bus, especially if there are children who might vomit (Stossel, 2014).
R.T suffers from emetophobia and has counted the days since the last time he vomited. In fact, “thirty-five years, two months, four days, twenty-two hours, and forty-five minutes” have passed since he last did so in June 1979. This means he has spent approximately 60% of his life worrying about something he hasn’t done in over three decades, which is totally irrational.
R.T has come to believe that being in constant vigilance is what has “magically” protected him, whether through neurotic reinforcement of his immune system or pure obsessive avoidance of germs, intoxications, and stomach viruses. When he commented on this to the psychotherapist, she replied, “Let’s say you’re right about that causal relationship; your behavior is still irrational because you waste a large part of your time and minimize your quality of life by worrying about something that, although unpleasant, is very infrequent and almost always medically harmless.” Therefore, the cost for R.T to reduce his hypervigilance would be contracting a stomach virus, very occasionally, in exchange for regaining his own life.
Consequently, R.T also exhibits traits of germophobia: he avoids hospitals, public restrooms, stays away from sick people, obsessively washes his hands, pays excessive attention to the origin of everything he eats, etc. He even has hidden motion sickness bags (taken from airplanes) throughout his house, car, and office, in case he suddenly feels the need to vomit. He always carries an antiemetic with him.
Given these behaviors, several imagined exposure sessions were conducted to overcome the patient’s emetophobia. However, by the sixth session, the patient stated that “honestly, he was less anxious than ashamed and disgusted when trying to cure his public speaking phobia for fear of vomiting through a fake conference, with a fake audience amidst images of vomit, since he was aware that he could always escape that unreal situation.”
Vomiting was at the core of R.T.’s fears, so he was suggested to confront the phobia face-to-face, that is, to vomit. For this, a real exposure session was prepared with long-term emetophobics. The patient took ipecac, a syrup used to induce vomiting. He began to feel slight retches and turned towards the toilet, but did not experience anything coming up from his stomach. After a while, he retched again and felt the diaphragm convulse. Nausea came and went in waves, as R.T described, retching loudly again without anything coming out. The patient began to perspire, sweat, and felt faint, thinking he could aspirate the vomit and die.
After about 40 minutes of the session, the patient did not vomit, so he was suggested to take more ipecac. However, nothing happened. The nurse in charge of administering the medication told him: “You are the most controlled person I have ever seen. This has never happened before with any patient exposed to this medication.”
It was decided to conclude the test. The patient felt nauseous, but less so than at the beginning of the process. The overall experience was traumatic, and R.T’s anxiety levels increased; however, judging by his resistance to the effects of ipecac, he concluded that he had a great ability to avoid vomiting.
Nevertheless, subsequent sessions took on a disheartened and uncomfortable tone. The therapist and R.T knew that their process together had ended.
As psychotherapists with clinical psychology training, we must be prepared for some cases to be difficult or for us not to find the ideal connection with the patient for the intervention to be effective. With proper specialization, through programs like ISEP’s Master’s in Clinical and Health Psychology, we must be prepared to reorient treatment if we see that the current process is not working.