Emetophobia Differential

Emetophobia is probably one of the top mental health conditions that is misdiagnosed more often than it is diagnosed correctly. Its correct diagnosis is Specific Phobia – Other Type (choking vomiting) F40.298

Misdiagnosing will probably lead to the patient being given the proper emetophobia treatment. Below, I have listed the differential diagnosis for emetophobia. If a patient comes to you with symptoms of any of these, please consider emetophobia.

• Panic disorder
• Separation anxiety
• Agoraphobia
• Social anxiety
• Generalized anxiety
• Depersonalization disorder
• Somatic symptom disorder
• Illness anxiety
• Functional neurologic disorder
• Obsessive compulsive disorder (emetophobia is closely related to OCD, in that everyone with emetophobia displays OCD symptoms, however obsessions and compulsions are limited to those which relate to vomiting/contamination)
• Anorexia nervosa
• Avoidant/restrictive food intake disorder (ARFID)
• Bipolar II
• Disruptive mood dysregulation disorder
• Oppositional defiant disorder
• Intermittent explosive disorder
• Borderline personality disorder
• Malingering

We elaborate on each of these diagnoses in our book “Emetophobia: Understanding and Treating Fear of Vomiting in Children and Adults” (2023) if you have further interest. The key with each of these diagnoses in the list is that the behaviour only relates to vomiting and would not be present otherwise. It’s tricky to pick up on, especially at first, because patients tend to be ashamed of their emetophobia or have been ridiculed for it previously, even by clinicians and other professionals. The final item “malingering” says it all – you’re making it up, it’s all in your head, nobody likes vomiting, you’re just being dramatic. No they’re not; no it isn’t; so what – it’s not the same thing; no they aren’t. They have emetophobia.