Is fear of being sick stressing you? Get over Emetophobia and get your life back!

No one likes the idea of being sick or the smell of vomit. But emetophobia can take the fear of throwing up to another level. This vomit phobia can become a long-term anxiety that you can’t shake off, affecting everyday life. Conventional wisdom would say that the anxiety and phobia can be addressed through therapy alone. However sometimes there are underlying gastric, neurological and immunological “comorbidities” that can compound the emetophobia. In this article I share the story of Tara who was debilitated by anxiety and nausea for over a year despite regular therapy, and it turned out that there was a very out-of-sync gut that was crying out for help!

What is Emetophobia?

Emetophobia is the formal name for an extreme dread of vomiting, seeing or smelling sick, watching other people vomit, or even the worry of feeling sick in the future. If you suffer from emetophobia, you’ll be happy to hear that those potential “trigger” words will not be repeated below this line.

The fear-based behaviours may surround the following worries:

• Not being able to get to the bathroom in time.
• Doing it repeatedly and being unable to stop.
• Choking on it or suffering physically after doing it.
• Embarrassing yourself in front of others.
• Being admitted to hospital due to it.

The phobia can be triggered by an episode of gastroenteritis or a fear of it that builds up more slowly over time. A highly stressed state can also induce the feeling of nausea and needing to do it, so the anxiety behind the emetophobia can drive some of the symptoms that people are trying to avoid. Not only do you feel anxious, but you can feel “green about the gills” and have clammy hands and feel totally drained.

Many people control this fear by actively avoiding situations where it might happen, and they may become very careful with what they eat or touch to prevent infection or food poisoning. However sometimes controlling you environment maybe not enough and the invasive thoughts surrounding emetophobia can ramp up significantly. And in some cases it can become debilitating to every day mental health and may well hold you back from doing the things you love to do.

Comorbidities associated with emetophobia

Our clinical experience is that someone who develops the more debilitating side of emetophobia not only has a fear of it, but also probably feels queasy easily or quite frequently themselves. These factors are not just due to the underlying anxiety. There are also physical, immunological, inflammatory and gastric factors that can go alongside and magnify the symptoms of emetophobia. These are known as medical comorbidities and can be the reason why symptoms are so marked and persistent.

Here are some of the comorbidities that can go alongside and exacerbate the symptoms of emetophobia and should be checked out by a medical professional.

• Gastroesophageal Reflux Disease (GERD) – if stomach acid bubbles up in the throat or food is regurgitated on a regular basis, this may be acid reflux.
• Eosinophilic Esophagitis (EoE) – symptoms of EoE tend to include oesophageal food impaction, difficulty swallowing food, chest pain, severe reflux, abdominal pain and failure to thrive, and can stem from non-IgE (non-classic) food allergies which are typically gluten, dairy, eggs or soya.
• Histamine Intolerance – this is when the gut is unable to break down the histamine naturally occurring in the food we eat, such as in tomatoes, spinach, oranges and avocado and the build-up of histamine in the system can lead to a vast array of symptoms including gastric issues such as nausea, acid reflux, stomach pain, bloating and diarrhoea.
• Gastric ulcers due to a Helicobacter Pylori (H. Pylori) infection can lead to gastric discomfort when you eat or between meals, feeling full up fast and may also experience regular belching and hiccupping.
• Gastroparesis can mean delayed stomach emptying where the muscles of the digestive tract are very slow. Symptoms can include a feeling of fullness (even when the stomach is not at all full of food), acid reflux as well as pain and nausea.
• Postural Orthostatic Tachycardia Syndrome (PoTS) can lead to a wide range of symptoms that can mimic emetophobia such as heart palpitations, dizziness or feeling faint, fatigue, brain fog, nausea, diarrhoea, or constipation and sweating irregularities. See my blogs on PoTS for more information.
• Inflammatory Bowel Disease (IBD) – this is an inflamed bowel such as crohn’s disease or ulcerative colitis and is usually accompanied by blood or mucous in the stool and weight loss or poor growth. This may be triggered by a gastric infection.
• Irritable Bowel Syndrome (IBS) – it is associated with gut pain or cramping with or without bloating and gas. It can present as either constipation or a looser bowel or a changeable bowel habit.
• Paediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infection (PANDAS)/Paediatric Acute-onset Neuropsychiatric Syndrome (PANS). PANDAS and PANS are usually associated with a sudden and dramatic onset of symptoms after a bacterial or viral infection but can occasionally come on more gradually. Symptoms include generalised anxiety, separation anxiety, irritability, OCD and tics as well as signs of major depression or change in personality.

Many of these symptoms and conditions have been found to be more common in the neurodivergent population and those folk who are born with mast cell activation or collagen disorders such as Ehlers Danlos Syndrome or joint hypermobility.

This has been borne out in research where it has been observed that autistic kids who commonly experience highly anxious feelings and emotional dysregulation also are much more likely to have gastrointestinal problems. The prevalence of gut problems in autistic kids varies between 46% and 84% depending on the specific gastric issue. These problems manifest in numerous ways and can include food intolerance and sensitivities, nausea, chronic constipation, chronic diarrhoea, gastroesophageal reflux, flatulence, abdominal discomfort, stomach or duodenal ulcers, inflammatory bowel disease, colitis as well as general failure to thrive. Food allergies and intolerance are also more prevalent in autistic children, with a rate of 20%-25% compared to only 5%-8% in children without autism.

Tara’s story

Tara (not her real name) had always hated the idea of doing “it” or anyone doing it around her. This probably stemmed from her brother doing being unwell quite regularly on long-haul flights. Other than during airplane flights, this fear did not affect her day-to-day life and she was a bright, fun and confident teenager.

Just before she started studying for GCSEs her whole family picked up a week-long tummy bug which involved both ends. Because of her fear, this was a very traumatic event for her. Instead of recovering within a week or so like the rest of her family, she continued to feel off colour every day for months afterwards, with some reflux and stomach cramps.

Her gastric symptoms escalated her anxiety, and it hugely affected her appetite. She couldn’t even eat pizza (her favourite food) without feeling nauseous and unwell. She had always been academically able but with the heightened anxiety and nausea bombarding her every day, she found it hard to learn and to study and this meant her grades plummeted. School assumed this was all due to mental health challenges and stress around her upcoming exams and they put in therapy and other strategies to help with the anxiety which did not make a huge difference.

This had all been going on for four terms by the time I first saw Tara. It was the start of the Christmas holidays with upcoming mock GCSEs in the January and grave concerns that she would not be able to achieve the right grades for the A levels she wanted to do. I had to work fast!

Because of the now well-established link between gut health and mental health, I decided to run a stool test to investigate if there were any imbalances in her gut microbiome or gut function which could be behind this. These results found that poor Tara’s gut was overrun with chronic bacterial infections including Campylobacter and Helicobacter pylori; as well as Blastocystis hominis and Dientamoeba fragilis, which are microscopic parasites that have been associated with IBS-type symptoms. Symptoms of these gastric infections can vary from person to person and can include nausea, reflux, cramps and generalised gastric discomfort.

Research has also found that a Campylobacter infection can increase anxiety-like behaviour and that H. Pylori may induce depression. The presence of chronic H. Pylori can also affect how well you absorb key nutrients from the stomach. These include important nutrients for the neurological system, mood and learning such as iron, vitamin B12, zinc and magnesium.

I put her on a daily regime of herbal remedies with antimicrobial properties that are known to reduce both bacterial overgrowth and parasitic infections. Even by Christmas Day she was feeling much better and was able to eat Christmas lunch. Since she wasn’t feeling rough any more and she was getting better nourished, the anxiety went right down, and she found her ability to focus and learn returned. We have kept in touch and even though her GSCE results were not ideal, because she had fallen behind, she caught up during the A level years and ended up with a handful of A*s! She no longer feels rough, her tummy is much happier, and her anxiety has melted away.

What can you do to help your or your child’s Emetophobia?

Here are some simple things you can do to help to reduce the anxiety as well as any associated feelings of nausea.

• Learn relaxing breathing techniques and meditation, as well as other strategies to reduce anxiety.
• Step out into fresh air to help calm the mind and ease feelings of nausea. Many people with emetophobia feel instantly better when they are walking outside in fresh air.
• Drink plenty of water as well as herbal teas such as chamomile, ginger or liquorice. They feel comforting and can ameliorate symptoms quite quickly.
• Consider therapies such as hypnotherapy or cognitive behavioural therapy, as they can help to displace negative thoughts with more positive ones.
• See a gastroenterologist to carry out baseline tests to check for significant gastric infections as well as inflammation markers or motility problems. See a cardiologist if you suspect PoTS and an immunologist if you suspect PANS/PANDAS.
• Organise a comprehensive stool test to check the health of the gut microbiome via one of our NatureDoc Clinical team to look for other gastric infections as well as functional markers. Then work with them to support gut health balance and overall nutrition.

Round up

Emetophobia can be debilitating and hard for the person who is suffering, as well as their friends and family around them. It can be complex in nature and sometimes it is hard to unravel what is driving the heightened anxiety. Our NatureDoc team is highly skilled using functional tests to gain an understanding of what may be magnifying a whole host of mental health symptoms and often there is a gut-brain link, neuroinflammation or nutritional imbalance involved. To book with one of our expert clinical team, get in touch here.

References

• The stomach-brain axis
• Emetophobia Resources
• The Emetophobia questionnaire (EmetQ-13): Psychometric validation of a measure of specific phobia of vomiting (Emetophobia)
• Gastrointestinal symptoms and nutritional issues in patients with hypermobility disorders: assessment, diagnosis and management
• Gastrointestinal involvement in the Ehlers-Danlos syndromes
• Role of gastrointestinal health in managing children with autism spectrum disorder  
• Anxiety is associated with uninvestigated and functional dyspepsia (Rome III criteria) in a Swedish population-based study
• Campylobacter jejuni infection increases anxiety-like behavior in the holeboard: possible anatomical substrates for viscerosensory modulation of exploratory behavior
• Psychometric scores and persistence of irritable bowel after Campylobacter concisus infection
• Postinfectious irritable bowel syndrome: follow-up of a patient cohort of confirmed cases of bacterial infection with Salmonella or Campylobacter  
• The Psychotic Impact of Helicobacter pylori Gastritis and Functional Dyspepsia on Depression: A Systematic Review
• Prevalence of Helicobacter Pylori Infection and Stress, Anxiety or Depression in Functional Dyspepsia and Outcome after Appropriate Intervention
• Depression among people with dyspepsia and H. pylori infection: A community based cross-sectional study in Ethiopia  
• Effect of Helicobacter pylori Infection on Autonomic Nervous Function and Calcitonin Gene-related Peptide in Patients with Functional Dyspepsia