The differential for emetophobia is, sadly, a very long list. However, there are some conditions which tend to be comorbid with emetophobia more often than not.
The first is depression, which should come as no surprise. Many people have depression comorbid with a variety of anxiety disorders. If the depression is moderate or worse, and the patient is unmedicated, then it is necessary to treat the depression first before tackling the emetophobia.
OCD. Obsessive-Compulsive Disorder is probably not comorbid with emetophobia in that it is somehow much more closely linked. I (Anna) give all of my patients and members of my classes the Y-BOCS questionnaire for OCD and I have not found anyone yet who did not score in the “moderate,” or “severe” range. There was one study done by Veale, Hennig and Gledhill (2015) asking if emetophobia were a part of OCD and related disorders and concluding that it was probably a subset of OCD. Emetophobia is greatly under-researched, so it will take more studies looking at the two to see what their relationship may be.
PTSD. Some people with emetophobia have trauma in their past which may or may not appear to be related to the emetophobia. As ERP (exposure and response prevention) is indicated for both disorders, the clinician will want to treat them together as well. Many clinicians try to treat the PTSD and ignore the emetophobia which, based on reporting, proves fairly futile. Similarly, EMDR can be greatly helpful for PTSD but it doesn’t seem to help the emetophobia. There is only one study to date (DeJongh, 2012) of a single case study of someone being successfully treated for their emetophobia with EMDR.
Many patients diagnosed with emetophobia have also received a diagnosis of GAD, social anxiety and/or agoraphobia, although these are part of the differential and probably not comorbid. Once the clinician becomes familiar with all the symptoms of emetophobia, they may soon discover that each of the GAD symptoms such as panic attacks happen as a result of the fear of vomiting. With agoraphobia, the person is often only afraid to leave the house also because of the fear of vomiting, and many people with emetophobia who have been diagnosed with social anxiety are only afraid of vomiting in public.
My next two blogs will be 1) Medical Conditions Comorbid with Emetophobia, and 2) Differential Diagnosis for Emetophobia
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