Many people misunderstand emetophobia as a dislike of vomit itself, but this would encompass most people. Those who suffer from emetophobia can find that it is not the physical act of vomiting that is the hardship, but the social perception of being in such a vulnerable state.
The Different Forms of Emetophobia
Emetophobia can be broadly categorised as a fear of vomit. Although not many people are diagnosed with this, it is an anxiety disorder that is more common than you may think. People with this disorder usually experience fears surrounding:
- Vomiting (at home or in public).
- Nausea.
- Not being able to stop vomiting.
- Seeing others vomit.
- Being around sick people.
- Embarrassment and shame around vomiting.
When triggered, these fears can manifest through physical and emotional symptoms, such as:
- Anxiety.
- Nervousness.
- Panic.
- Distress.
- Increased heart rate.
- Shaking or sweating.
- Dizziness or fainting.
- Tight feeling in your chest.
- Nausea.
Whilst these symptoms prevail across emetophobia, understanding your specific form of this disorder will help you to manage your triggers and symptoms.
What Is Social Emetophobia?
Whilst all definitions of emetophobia pertain to a fear of vomit, social emetophobia is encompassed by the fear of vomiting in a public setting. The phobia is centred around others’ viewing, judging and being disgusted by you, not necessarily the act of vomiting itself.
Emetophobia is a spectrum between self-focused, other-focused and social-focused. Some will exclusively suffer from a fear of others being sick around them or the physical act of themselves being sick. For those with social emetophobia, the focus is on the public situation.
Triggers For People With Social Emetophobia
The main difference between the different types of emetophobia is the triggers. Triggers for social types of this disorder can include:
- Situations where you feel trapped.
Environments that you cannot leave quickly or discreetly if you were to feel sick. This includes being next to strangers on public transport, appointments that restrict you somewhere for a certain period of time, or somewhere like a cinema, where your leaving would be obvious and disruptive to others. - Workplaces.
Professional environments often bring with them a high level of stress and pressure, which can lead to feelings of nausea. They consist of situations where you have to be the centre of attention, such as a presentation or a meeting, where you will feel watched and unable to leave. Workplaces also often feature important events where making a good impression counts, and being sick would not be forgotten. - Social situations.
Being around new people can feel like a high-pressure situation where perfectionism thrives. The pressure of seeming perfect and making a good impression can bring a lot of fears. Being intoxicated at social events can also bring fears of being perceived as a “messy” drunk and intrinsically brings a heightened probability of vomiting. - Sensory environments.
You can become hyper-aware of your surroundings, especially if you are somewhere quiet or bright, where you would be clearly perceived. Different strong smells can seem very overwhelming in public, when they may not be an issue at home. These can lead to you feeling exposed and your feelings amplified. - Intrusive thoughts.
You may be in a comfortable situation, but all of a sudden, you are hit with “what if” thoughts. These imaginings can make usual situations feel triggering, creating a loop of anxiety and nausea that feeds each other.
Are There Complications of Emetophobia?
People who have emetophobia often experience it through triggers, not a constant daily thought, but this doesn’t mean that there are no complications to this phobia. People often experience avoidance, which can completely alter their quality of life. These complications include:
- Malnutrition.
- Dehydration.
- Eating disorders (anorexia nervosa or avoidant/restrictive food intake disorder).
- Social isolation and agoraphobia.
- Social anxiety.
- Depression.
Is It Linked To Social Anxiety?
Unlike general emetophobia, this type is usually a subset of social anxiety. That doesn’t mean you have to experience both an equal amount, but this fear of judgement spans across different aspects of life.
For many sufferers of social anxiety, these feelings can also trigger nausea. Therefore, in high anxiety-inducing situations, emetophobia often follows.
Do I Have Social Emetophobia?
There are a few easy questions to ask yourself to determine what type of emetophobia you are suffering from:
- Social-focused: Is the thought of being sick at home manageable, but being sick at work brings with it a panic attack?
- Self-focused: Does the thought of being sick make me think that I will die or never stop?
- Other-focused: Does the mention of others being ill instantly make you feel sick?
Can It Be Treated?
Treating your social emetophobia means shifting your perception of yourself and your surroundings, which can be effectively addressed through therapy or CBT.
You need to challenge the idea that the spotlight is always on you. By refocusing your attention away from an obsessive idea that everyone is watching you, you will realise that most people are preoccupied with themselves as well. Even if they did notice you falling ill, they are much more likely to be sympathetic towards you, not disgusted.
In therapy, it is helpful to evaluate how many times you have noticed somebody in public who looked ill and whether you judged them. Most of the time, you wouldn’t have noticed or have passed judgement on them. Rebuilding the way you see yourself through the way you perceive others is an effective way to offset your anxieties.
Behaviour experiments are a scary but effective way to rationalise your fears. Testing your fears in small, safe ways allows you to realise your feared situation never occurs.
Once you have become more comfortable with your behavioural experiments, it can be a good idea to dive full force into your fears, also known as “shame-attacking”. This involves purposefully doing something that you fear in public to prove that social discomfort is survivable. This could entail eliminating your safety factors in public situations, such as purposefully sitting in the middle seat at the cinema. By doing so, you face the worst possible situation, and you are in control of it happening.
Safety behaviours make you feel comfortable in the moment, but they unfortunately keep your fears alive by reinstating that you have to do certain things in order to stay safe. To treat your anxieties, you need to break away from these safety behaviours slowly and reinstate healthier routines to teach yourself that you don’t need these ways to “stay safe”.
Treating your phobia doesn’t mean just getting over it or trying harder to stay calm. For many people, these things are unattainable and will lead them to believe that their emetophobia will never be tolerable. But by retraining your brain into healthier habits and perceptions, you will slowly understand that the worst possible situation is not so bad.
