People with diagnosed emetophobia don’t necessarily have any comorbid medical conditions, but in our clinical experience we find that many due. Some of these may be as a direct result of the emetophobia or extreme anxiety and panic suffered by some patients and still others may be misdiagnoses by clinicians.
Most often, patients with emetophobia, especially children, undergo a number of medical tests to the GI system. Colonoscopies, endoscopies, abdominal scans and CT scans are common to rule out anything serious that the patient may have that is causing the constant nausea other than anxiety. We agree that this exploration is necessary to ensure that they do not have an underlying GI problem. Usually when tests turn up nothing the patient is diagnosed with IBS (Irritable Bowel Syndrome) which seems to be a catch-all for nausea, diarrhea and/or constipation. At first IBS was described in some of the literature as an anxiety disorder but this was discontinued after patients became upset over it, often saying things like “the doctor thinks it’s all in my head.” The general public is becoming more familiar with things like “the brain-gut connection” and so perhaps this will change in future.
PANDAS. Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infection. PANDAS is something every clinician who works with children with emetophobia should be aware of. Basically, when a child gets a strep infection, sometimes they immediately show symptoms of OCD. It’s a strange phenomenon but parents are to be credited for bringing this to the attention of clinicians as they know their kids and they know they’ve never acted this way before. The thing is, emetophobia appears to be some type of OCD or is very closely related to OCD based on what minimal research we have. Therefore it is indeed possible that a child will begin to have emetophobia after a strep infection even though they’ve never been afraid of vomiting before. There is medical treatment in the form of antibiotics so if caught early enough the PANDAS can disappear altogether.
For the sake of brevity in this blog I will simply list most of the remaining comorbid medical conditions commonly found with emetophobia. In our book for clinicians “Emetophobia: Understanding and Treating Fear of Vomiting in Children and Adults” we go into each of these more in-depth.
- Gastroesophageal Reflux Disease (GERD)
- Eosinophilic Esophagitis (EoE)
- Gastric Ulcers
- Gastroparesis (slow stomach emptying)
- Inflammatory Bowel Disease (IBD)
- Median Arcuate Ligament Syndrome (MALS)
- Superior Mesenteric Artery Syndrome (SMAS)
- Leaky Gut Syndrome (not recognized by the medical/scientific community)
- Food Allergies and Sensitivities including Celiac disease
- Idiopathic Nausea and Digestive problems
- Retrograde Cricopharyngeal Dysfunction (R-CPD) – inability to burp
- Cricopharyngeus Spasm
My final blog in this 3-part series which will be posted next Wednesday will be the differential diagnoses for emetophobia. It is one of the most misdiagnosed mental illnesses.
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