Help me overcome my emetophobia

August 4, 2010 11:56 AM

Have you "cured" an extreme phobia that you once had? How did you do it?

Since about 9 years old, I've had an extreme phobia of vomit.
I've talked to some therapists about it in the past - and I'm still not sure where the phobia came from.

It's been extreme in the past - 10 years ago for about 6 months, I only ate bread in fear of anything else giving me a foodborne illness. I had panic attacks constantly. I ended up weighing 100 pounds at 5'8".

I finally saw a doctor about my phobia/panic attacks and to make a long story short - medications did help.

I currently am not insured for the first time since 10 years ago when i first sought help.

My phobia is getting bad again. I've cut out a lot of things from my diet (I can stand to lose weight at this point, though), I'm afraid to go to bars, be around people who are sick, scared to use a public bathroom, scared to be around anyone who is drunk, scared to get on boats/airplanes/cars with other people, I avoid babies, hospitals, watching movies that have "partying" in the plot, I panic if someone coughs, etc.
While on medications, I still had the phobia - but I didn't have panic attacks - and I didn't worry so much about going to bars or getting on airplanes. But if someone got sick - I would still run and freak out.

Another reason why I need to just abolish this phobia - I have an aunt who has cancer and liver disease. She is constantly sick to her stomach and cannot keep anything down. She gets carsick while in the car. When I visit my family (they live out of state), I am a ball of anxiety when I see my aunt. She always wants me to stay over or take her to stores. The last time, I pretty much avoided her because I was terrified.
And I fear that if someone I know was in need of help, that I would run away. Example - My boyfriend had drank way too much one night and I woke up to a flooded kitchen and I could see him in the bathroom slumped over in the bathtub. I started crying and I was in a state of panic - I thought he drowned to death and was dead. I finally opened the door and shook him several times before he awoke. I then ran out of the house in fear that he would throw up. Luckily a friend showed up within minutes. My boyfriend needed my help and I just ran away.

I'm terrified at the idea of exposure therapy - but I'm wondering if this really the only cure.

Does anyone have any advice on how to finally get rid of this phobia? It has made me into a horrible selfish person... and a ball of panic.

posted by KogeLiz to health & fitness (22 answers total)

Have you tried medication for OCD? Something like Luvox? Also a behavioral therapist might help. My understanding is the only way to get over a phobia is to desensitize oneself to it through exposure.
posted by captainscared at 12:03 PM on August 4, 2010

Definitely talk to a professional about this. Therapists who specialize in phobias will understand completely that exposure therapy sounds terrifying and will help you figure out a way to take the initial step. In my experience, exposure therapy starts really gradually and moves as fast as you're comfortable with moving; nobody will chuck you into a horrifying situation and expect you to tough it out.

All the very best to you. This sounds like seriously tough situation. Good for you, recognizing that it needs attention.
posted by corey flood at 12:08 PM on August 4, 2010

I don't really have any advice regarding the phobia (except that captainscared seems to have good advice, but everything I know about psychiatry I learned on Wikipedia).

As far as your aunt -- would you be able to give her a call or write her an email and explain that you have been avoiding her because of a problem you are having? It might make you feel less guilty.
posted by i_am_a_fiesta at 12:12 PM on August 4, 2010

for those suggesting docs or meds - the OP stated "I finally saw a doctor about my phobia/panic attacks and to make a long story short - medications did help. I currently am not insured for the first time since 10 years ago when i first sought help."

therapy and expensive medications are a good treatment suggestion, but i think the OP is asking for other methods.
posted by nadawi at 12:17 PM on August 4, 2010

Exposure and response prevention is REALLY effective. It is one of the most effective psychotherapies. Everyone with a phobia is terrified by it, naturally, but therapists know that and start small.
posted by emilyd22222 at 12:18 PM on August 4, 2010

Thanks for the advice so far.
I currently do not have health insurance (employee status at my job is similiar to a 'contract' or part-time employee) - so I'm on my own with this now. Hopefully I can get insurance in the near future.

Also -
My aunt knows about my phobia. When I talk to her, she will pretend that she isn't that sick (stomach-wise) for me but my sister ends up telling me how sick she really is. My whole family and all my friends know. New friends think it's funny and do the pretend gagging thing at first- which I get pissed about. I do have a sense of humor about it - but... I still get mad when people do crap like that to me on purpose.
posted by KogeLiz at 12:18 PM on August 4, 2010

I have the same phobia. Exactly. Since I was 5. You're not alone. I am also terribly ashamed and afraid of getting in to a situation in which somebody needs help but I am unable to face what needs to be done. I have also been wary of babies, hospitals, any movie with partying (I have a vast and encyclopedic knowledge of any "sick" scene in any movie, any incident that happened 20 years ago in real life, etc), anybody drunk, people having coughing fits, hospitals, etc. As a kid I couldn't even say That Word - or even write it. I would shake like a leaf and my pulse would skyrocket to 200 if anybody around me mentioned feeling sick.

It's hard feeling like a freak. It's hard to have a fear that I can't explain. I don't know where it came from. I am otherwise very happy. I have no idea why I was born with (or developed as a very young child, I don't know) a miswired brain that connected the idea of vomit with MORTAL DEATH AND DANGER such that my entire body flips out in the most terrifying way possible at a mere mention. It's HARD, isn't it?

However. It really, really can get better. I have been working on my issues with pretty much my entire heart and soul for about 6 years now and I've made great strides. I meditate every day and at this point, when I feel panicked by a situation, nobody else will know - I can remain calm and reasonable until I can politely excuse myself. I recover more quickly. I take a low-dose antidepressant as an anxiolytic, and it helps. I have a therapist. I have spent more energy than I would have ever thought possible examining my own past, thoughts, reactions, feelings and habits. I have made a lot of progress in figuring out what, EXACTLY, about vomiting scares me. In excruciating detail. It's making a mess that is embarrassing, requiring help possibly in a public situation, not being able to take care of myself like an adult, choking, the smell, etc. I know this is hard to think about. But it helped me to figure out what exactly I was afraid of - and that makes the fear less real.

I wish I had something really concrete to tell you - a true success story. I'm still in the process. But my life is NOT run by this fear. It has been, at times - but not anymore. That scared voice in my head still worries about food poisoning, public transportation, anybody who might get carsick, norovirus epidemics, and so on - but I just get on with my life. My behavior isn't any different from anybody else, except that if somebody around me has a little stomach bug, I do keep my distance and wash my hands like a demon. But other than that, you wouldn't know.

It takes hard work and the work can be stressful and scary. But you don't have to be dragged around by your fear.

(Also, if it makes you feel any better to know this - I know it would make ME feel better - I haven't been sick in 15 years, and before that, only once. Neither has my father. Or boyfriend.)
posted by Cygnet at 12:23 PM on August 4, 2010 [3 favorites]

That sounds absolutely horrible. If it's any consolation, I used to have a fairly severe (although not as bad as yours) phobia of needles -- especially of getting vaccinations or any other kind of injection. I would close my eyes at places in movies and TV shows where people were getting injections from a doctor (or shooting up), my dentist visits usually required general anesthesia, and it used to take about six orderlies to hold me down for blood draws or immunizations until I was in my twenties. Because I didn't really have great health insurance, I decided to attempt to abolish my needle-phobia on my own. My first step was to watch a bunch of movies and TV shows that involved people getting injected, and to make myself watch the needle-containing scenes over and over again. I just sort of moved along from there at my own pace. Over about the past seven or eight years, I gradually made myself do a bunch of scary stuff (like getting tattoos and letting the doctor's office draw blood for testing). Now I can even go to the dentist and get a root canal without needing to be sedated beforehand. (Although I still can't bring myself to go get a flu shot...)
posted by kataclysm at 12:24 PM on August 4, 2010

I am not a psychologist or psychiatrist. I have never personally struggled with phobias as crippling as the one you describe. This might be terrible advice.

I can definitely see how exposure therapy might be too frightening to even contemplate. Given the severity of your phobia, it might be helpful to start out with imaginary exposures. Imagine a scenario in which you came into contact with vomit in an extremely incidental way, like walking down a street and there was some on the sidewalk. Run yourself through that scenario, then write about how you feel, and do that every day for a while. Obviously stop if you find your reaction ramping up instead of easing.

To the best of my knowledge, there's no way to handle phobias except for desensitization. Absent good, comprehensive mental health care coverage, I think doing gradual thought experiments is probably your best thin-edge solution.
posted by KathrynT at 12:25 PM on August 4, 2010

I have a friend who went through exposure therapy for emetophobia. They incorporated it with a low-dose SSRI, a PRN anxiety med (some benzo), and general therapy. Their phobia came from an event that happened when they were a child, which required some structured support. I recall, in their recounting, that part of the process was addressing the fear of addressing the fear. I don't want to necessary walk you through what she did for fear of triggering you, but if you're interested in more details, memail me.

KathrynT, what you're describing is a part of exposure therapy.
posted by quadrilaterals at 12:34 PM on August 4, 2010

@Cygnet - I have only been sick one time - last Halloween - but i don't remember any of it because of alcohol - I cried for days about that because it was the only time I blacked out or got sick.
Thanks for your story and advice, I'm glad there's someone else with the same phobia. i've only met one other person.

@kataclysm - actually, I was just wondering if maybe I could attempt to start with watching movie scenes on youtube or something. I can handle cartoons at this point - but that's about it. I'm glad to see that helped you - this may be where I can start
posted by KogeLiz at 12:34 PM on August 4, 2010

Though I certainly think you would benefit from seeing a professional for help with this, there are strategies with a lot of evidence behind them that you can try on your own. Systematic Desensitization is a big one. There's a pretty good rundown of how to do it by yourself (as well as some history and evidence base for the practice) here. Basically what you do is practice relaxation techniques, develop a hierarchy of your phobia, and then practice your relaxation techniques while imagining the scariest version of the phobic stimuli that you can still manage.

So for example, your hierarchy might be a more detailed version of this: seeing old vomit on the sidewalk is less scary than seeing a stranger vomit, which is less scary than seeing a loved one vomit, which is less scary than vomiting yourself. Only you can work out for yourself what situations are more or less anxiety-producing, but if you can come up with a detailed hierarchy it will give you more chances to take "baby steps" in overcoming ever-more-scary situations. You would practice your relaxation techniques while imagining the least scary situation (e.g. seeing old vomit on the sidewalk), until you felt like you could stay in control of your anxiety in that situation. Then you might imagine the next scariest situation on your list, and keep doing the relaxation exercises. You keep this up over time in many sessions (this is not a quick fix!) until you can get to the worst possible fear trigger without letting your anxiety overwhelm you.

Google "systematic desensitization" for loads more info about this technique. Good luck!
posted by vytae at 12:39 PM on August 4, 2010 [2 favorites]

Oh, and based on your last response: you could incorporate videos into your hierarchy, too. If watching a cartoon throw up is the least scary vomit-related idea you can come up with, start there.
posted by vytae at 12:41 PM on August 4, 2010

I have emetophobia as well, though in a more mild, less debilitating form. Still, even reading this thread makes me uncomfortable - I too avoid anything that might reference vomiting, and have actually vomited myself fewer than five times in my adult life. A few things that have helped me:

- Understanding that it really is your body's way of protecting your system from toxins, and that it's natural and safe and in fact often a way to avoid prolonging whatever misery (food poisoning, alcohol poisoning, etc) your body is currently suffering.
- Getting a dog. He vomits sometimes. It sucks. I clean it up, and it isn't the end of the world. This has been a good way for me to deal with the exposure therapy sort of thing. (Obviously, this is not a reason to get a dog, but caring for someone/something you love can help overcome the aversion enough to make it tolerable). KathrynT, above, suggests imagining vomit on the street - Ack! Horrible! Ew! I can't handle that, but I can totally handle my dog vomiting.
- The last time I threw up was three years ago. It was incredibly sudden, public, and embarrassing. So embarrassing I can't even tell the story here. But I got through it, and it's now sort of funny to me, and having been through really what I imagine is the absolute worst possible vomiting scenario, I feel like if I ever have to throw up again, it will likely be significantly less awful than that. Which is weirdly reassuring.

Anyway, best of luck. Phobias are strange beasts. Though I've not used his books/recordings, people I know speak very highly of the work of Dr Howard Leibgold, a psychiatrist who suffered phobias himself and developed methodologies for treatment. Perhaps you might find something useful there.
posted by judith at 12:50 PM on August 4, 2010

For you or anyone else in need of therapy who is not insured: please CALL and talk about the fact that you are not insured with a therapist's office. Some therapists will work on a sliding scale, others manage to adjust their practice so that there is a floating subsidy available for them to work with patients in need. Just because you don't have insurance doesn't mean that you can't get therapy.

You might have to make a few phone calls and I realize how terrifying that can be, but write out what you want to ask in advance and read off the script.

"I am looking to work with someone on my phobias of x, y and z. At this point in my life, the phobias have gotten worse, are debilitating and severely impact my quality of life. I have had luck with therapy in the past, however, at this time I do not have insurance and am on a limited income. Do you offer a sliding scale or could you recommend someone who does?"

They may ask you some more questions after that, but at least you have something to work with.

Some therapists are even on email now, which will still require an effort but at least you don't have to talk to anyone.
posted by micawber at 12:54 PM on August 4, 2010 [4 favorites]

I have had a phobia of insects from a very early age. It was never as severe as what you describe but it included hyperventilating, panic attacks, etc. What has worked for me over the years was being in situations where there was something more important to me than the fear. Specifically, whenever there are kids around, I can somehow steel myself to behave "normally" with regard to bugs. For a little kid, I can capture an indoor cricket or spider in a jar and put it outside, let a caterpillar walk on the back of my hand, chase fireflies, etc. I know that if I freak out over a bug, that kid is going to be freaked out by bugs, and I don't want any kid to have to experience that phobia. This has gone on for 20+ years, since my oldest nephew was small, and at this point I am pretty calm about bugs overall. The anxiety is still there, but my behavior is calm, and I don't avoid many situations where there may be bugs (camping, hiking).

Is it possible for you to think of the consequences of avoiding situations with the potential for vomit, such as the added stress your aunt experiences trying to hide her symptoms from you, or the idea that a severely restricted diet will actually make you more susceptible to illness rather than less? Without feeling guilty about them, let your imagination explore the (very real) kinds of consequences of your phobia-driven actions/inactions, and see if that helps you get some perspective.

And don't feel guilty about your boyfriend --- you did go in and make sure he was awake before you retreated.

(If/when you are ready to look at videos of vomiting, Family Guy has several scenes with it that are so over-the-top ridiculous that they might be a good first step.)
posted by headnsouth at 1:19 PM on August 4, 2010

From the age of about 10 to 18, I was arachnophobia. The sight of a spider paralyzed me and sent me into shock. Cobwebbed attics and basements were 100% off limits, and if I was outside and felt like I'd been brushed by any sort of silk-spinning arthropod's web, I'd have a minor panic attack. I had no idea why this was the case, as before 10, I'd been one of those fearless bug-collecting little kids.

One afternoon, on my way to a therapy session, a huge -- or so it seemed to me at the time --spider dropped into the car through the sun roof, right in front of my face. I completely freaked out, and started thrashing around, but was held in place by my seatbelt, and was on the verge of total panic when my sister, who was driving me, got rid of the spider. When she dropped me off at my therapists, I was still pale, shaking, and in shock.

I'd talked to this therapist and a prior one about my spider phobia before, but it never really did much. Talking to him while in the throws of my phobia, however, was completely different -- all sorts of previously inaccessible associations started pouring out of my mouth, and the next thing I new, I was talking about an sleepaway camp trip to see the movie arachnophobia -- during a year in which me and my bunkmates were being physically beaten and tortured by two older kids who were in our bunk because they'd been held back in school a few times. It had never occurred to me that that experience had correlated with my newfound fear of spiders.

The difference was almost immediate. All of a sudden, I became really curious about pushing the limits of my spider tolerance. Over time, it's gotten to the point where I still don't like spiders more than a lot of people -- if I see one in my apartment, I have to get rid of it, but at least I can kill them myself now. I can also store stuff in attics, basements and crawlspaces again, which is nice.

Anyway, I tell this story to illustrate that talk therapy can be really, really helpful for phobias, even if they hadn't been before, especially when combined with some sort of exposure therapy -- in my case, accidentally -- and that it doesn't always take prolonged and agonizing repeat exposure to get help from it.

I guess I really don't have anything to tell you that you probably don't already know, but I figured a "this worked for me" pep talk never hurts.
posted by patnasty at 1:20 PM on August 4, 2010

It has made me into a horrible selfish person...
posted by KogeLiz to health & fitness

No. You aren't. You have a condition that you cannot help despite your best intentions and efforts. That it very occasionally leaves you in a position where you cannot assist someone in need of help is not something you need to feel guilty about. You are not being selfish. You can remove this from your concerns surrounding your phobia. Good luck to you.
posted by nickjadlowe at 1:21 PM on August 4, 2010 [3 favorites]

I've never had any phobias (that I'm aware of), but I've been fascinated by them for years and have picked the brains of everyone I know about the irrationality of the fears they experience. The people that have "gotten over" their phobias in most cases did so through some sort of forced exposure (e.g. They didn't have a choice, they were going to have to deal with what they were afraid of whether they liked it or not.).

I would imagine that if you have the choice, a scaled system of exposure, where you start small and get progressively more involved with what you are afraid of, would probably be the least uncomfortable.

("gotten over" in quotes, because in most cases, people still had their phobias, they just had trained themselves to get over it and push down the fear/ loathing to a quiet noise in the background so that they could do what needed to be done.)
posted by quin at 1:32 PM on August 4, 2010

Don't give up on the medication while you pursue more thorough options; it sounds like it at least took the edge off. Walmart, Walgreens and various grocery chains now have $4/month generics ($10 for a 3 month supply), and since you were taking meds 10 years ago it's likely that whatever you were taking qualifies. I understand that you can't afford ongoing psychiatric treatment but you may able to get even a primary care provider to write you a prescription if you provide your health records.
posted by Wordwoman at 2:49 PM on August 4, 2010 [1 favorite]

I had terrible arachnophobia in my late teens - used to go into panic attacks whenever I saw one, couldn't even say the word 'spider', had nightmares and had elaborate rituals before bedtime when I'd check my bedroom, sheets etc. My situation was a case of transference - difficult home life coupled with the need for 'forced jollity' at all times meant I'd put all the negative feelings that I was not allowed to express onto something other than my family.

I had a relatively short course of one-on-one CBT and talk therapy and I am still amazed how quickly I moved beyond those feelings. No exposure therapy though. I still don't like them, but it is not ruling my life.
posted by poissonrouge at 7:19 PM on August 4, 2010

Please don't give up on treatment because you don't have insurance. As mentioned above, some therapists offer sliding scales. As for medication, both my GP and a psychiatrist provided me with generous amounts of free samples when I could not afford the prescriptions. Good luck.
posted by Majorita at 11:03 PM on August 4, 2010