Originally posted at Field of Science on April 18, 2011.

I have a specific phobia of vomiting. I don't like to talk about it in my online life because it is a major source of stress in my offline life (it is the root of my agoraphobia), but I bring it up today because I have some unanswered questions that I'd like to put out into the blogosphere.

For those of you who are not familiar, I will try to outline the nature of emetophobia, at least the way I experience it. It stems ultimately from a fear of losing control of one's body. Vomiting is unavoidable, violent, and sometimes unpredictable. It isn't fun for anyone (well, almost anyone), but for an emetophobe it becomes a life or death situation. That loss of control is not just unpleasant, it is entirely unbearable and intolerable, and the mere thought of losing control in such a manner is enough to arouse panic and hysteria. As a result, an emetophobe becomes hyperalert to internal and external cues that vomiting is about to happen. Internal cues like nausea, or external cues like someone else actually vomiting, saying they don't feel well, saying they had vomited recently, etc. It differs from person to person, and some people are only afraid of themselves vomiting whereas others are afraid of themselves and others vomiting. To speak for myself, the only reason why I'm afraid of someone else vomiting is because I'm afraid I'll catch whatever they have and, as a result, vomit myself.

As a result of this state of being hyperalert, there are undoubtedly a lot of false positives. Emetophobes are notorious for not being able to decipher their own gastrointestinal cues. Non-pathological sensations like having gas or feeling full are misinterpreted as nausea. Nausea (real or perceived) causes anxiety, and one of the symptoms of anxiety is, yeah, more nausea. It becomes a terrible positive feedback loop that can be really hard to escape once the ball is rolling.

I have several coping mechanisms that I use when I feel the anxiety beast starting to swell inside me. They fall into several categories: preparative, preventative, and distractive. Preparative behaviors are things that will ease the process if I actually do throw up, such as taking off loose clothing, tying back my hair, and making sure I have access to a toilet. Preventative measures are things like taking antiemetics, benzodiazepines, sipping water, sucking on peppermints, etc. The distractions, however, seem to be the most effective.

My distraction techniques usually have two horns: giving my body a menial task to accomplish and giving the rest of my brain something to focus on. Generally this involves walking around my apartment and either having a conversation with my boyfriend (if he's around and willing to oblige) or putting something light and fluffy on the TV. I'm fond of sitcoms and baking shows (like Cupcake Wars) for this situation. The TV/conversation part is easy to understand: I'm providing an easy distraction for my brain to focus on instead of thinking about the nausea and anxiety. If I don't focus on it, most of the time it will go away on its own. The walking part is less easy for me to understand.

I know that having a menial activity to focus on is part of the distraction process. If I'm focused on walking around and balancing, even if only a tiny part of my brain is involved, that's one less bit of my brain that can be thinking about my stomach. But, that's not the only thing. The walking actually jostles my body, and adds "noise" to the internal cues that I'm misinterpreting as nausea. The walking seems to literally settle my stomach by covering up the stimulus with other sensations. But finally, I can't fully rule out a physiological connection. Could there be a chemical reason why walking settles the stomach or reduces anxiety? I've heard of "walking through the pain", but can you walk through the fear as well? I don't know enough psychology or neuroscience (I imagine the brain-gut axis is very important in this response, but I don't know how) to know the answer to that, so I'm hoping that someone out there will. Can physical movements calm the sympathetic response?

As a side note, I have often wondered if there was a physiological reason why emetophobes claim to vomit less often than normal people. I know that the sympathetic response causes gastrointestinal motility to slow down. If fear slows down peristalsis, could it also slow down reverse peristalsis?

BOSCHEN, M. (2007). Reconceptualizing emetophobia: A cognitive–behavioral formulation and research agenda Journal of Anxiety Disorders, 21 (3), 407-419 DOI: 10.1016/j.janxdis.2006.06.007

Davidson, A., Boyle, C., & Lauchlan, F. (2008). Scared to lose control? General and health locus of control in females with a phobia of vomiting Journal of Clinical Psychology, 64 (1), 30-39 DOI: 10.1002/jclp.20431

Lipsitz, J., Fyer, A., Paterniti, A., & Klein, D. (2001). Emetophobia: Preliminary results of an internet survey Depression and Anxiety, 14 (2), 149-152 DOI: 10.1002/da.1058

Veale, D., & Lambrou, C. (2006). The Psychopathology of Vomit Phobia Behavioural and Cognitive Psychotherapy, 34 (02) DOI: 10.1017/S1352465805002754