Reviews
Anna reviews books and online emetophobia resources and “systems” on her website here.
Medical Comorbidities
Following is a very brief description of some of the medical conditions that might be a factor in emetophobia. Our book covers these in more detail (April 2023). Typically, any physical distress (e.g., nausea, GI distress, esophageal discomfort) is the result of anxiety. However, there are occasions when the phobia may be a result of or impacted by a medical condition. For our patients, we often recommend at least a consult with their physician. If there is a condition and it is successfully treated, then behavioral treatment is easier and faster.
Gastroesophageal Reflux Disease (GERD)
This is the result of a weak or malfunctioning esophageal sphincter causing stomach acid to come up the esophagus. The symptoms may be a burning feeling, acid burps, trouble swallowing, sore throat, cough, or chest pain. Medication and diet changes are usually the recommended treatments. More information can be found here.
Eosinophilic Esophagitis (EoE)
Considered rare but increasingly prevalent, EoE is a chronic allergic inflammatory disease. For reasons still unknown, but possibly due to a food allergy, white blood cells build up in the esophagus. Common symptoms include abdominal pain, food impaction, difficulty swallowing, vomiting, chest pain, and failure to thrive. It is diagnosed by endoscopy and if white blood cells are not visible at first, then a biopsy is done to look for them.
Gastric Ulcers
It remains a long-held belief that ulcers are caused by stress or by a combination of stress and spicy or difficult-to-digest food. We now know that ulcers, which are sores in the stomach lining, are almost always caused by the presence of bacteria. Despite this knowledge being fairly prevalent, some people with emetophobia believe that their anxiety is causing ulcers. The symptoms of gastric ulcers are nausea, loss of appetite, and pain in the stomach or even the small intestine. These symptoms are indicative of many other gastric diseases and also of anxiety. Once diagnosed this can be successfully treated with antibiotics. More information can be found here.
Gastroparesis
Gastroparesis is a condition where the muscles of the digestive tract are slow or stop altogether so the stomach does not empty properly. The result is a feeling of fullness (even when the stomach is not at all full), acid reflux, pain, and nausea. The cause of gastroparesis is not wholly known but viral infections, damage to the vagus nerve in surgery or by accident, some medications, and some autoimmune disorders such as scleroderma may lead to it. Gastroparesis can be treated medically. More information can be found here.
Inflammatory Bowel Disease (IBD)
IBD takes two forms: Crohn’s and ulcerative colitis. The latter affects the large intestine, while Crohn’s can affect any part of the GI tract. IBD is not to be confused with IBS (irritable bowel syndrome) as IBD is usually much more serious. The symptoms of IBD are mainly pain and diarrhea, but patients can also experience fever, bleeding, fatigue, and weight loss. These are autoimmune diseases. More information can be found here.
Median Arcuate Ligament Syndrome (MALS)
MALS is a disease caused by the median arcuate ligament sitting lower than usual and therefore pressing on the celiac artery. This slows blood flow to the digestive system and also presses on nerves. The result is a great deal of pain. MALS can be asymptomatic for a time but when symptomatic is quite terrible. It mostly affects thin, young women. As with other GI diseases, MALS can cause nausea, diarrhea, and pain which is worse after eating. MALS is difficult to diagnose since the symptoms can mimic gallbladder, other digestive problems, or liver disease. More information can be found here.
Superior Mesenteric Artery Syndrome (SMAS)
SMAS can also be called Wilkie’s syndrome, mesenteric root syndrome, and a couple of other names. It is a complicated condition wherein the duodenum is compressed by the superior mesenteric artery and the abdominal aorta. It often occurs in children, mainly girls and young women aged 10-30. Since these girls and women are notoriously slim, sometimes even emaciated, it is often misdiagnosed as an eating disorder. The symptoms of SMAS are nausea, vomiting, abdominal pain, acid reflux, and abdominal distention. More information can be found here.
Cricopharyngeus Spasm
A frequent symptom that people with emetophobia describe is an uncomfortable sensation in the throat. There is a muscle that surrounds the top of the esophagus that is always in a contracted state. Normally, it is not the focus of one’s attention. It only relaxes when a person swallows. Sometimes, the muscle will spasm and it feels uncomfortable. Often people with emetophobia interpret this as a signal of impending vomit. Actually, it means the sphincter or ‘gate’ is shut so nothing will come up. More detail and information about treatment can be found here.
Irritable Bowel Syndrome (IBS)
‘Irritable bowel syndrome (IBS) is a common disorder that affects the large intestine. Signs and symptoms include cramping, abdominal pain, bloating, gas, diarrhea or constipation, or both. Only a small number of people with IBS have severe signs and symptoms. Some people can control their symptoms by managing diet, lifestyle, and stress.’ (Mayo Clinic) More severe symptoms can be treated with medication and counseling. While we don’t doubt that IBS is a real disorder unrelated to anxiety, we nevertheless are mindful of the fact that IBS can also be caused by and/or related to anxiety. Many patients (although certainly not all), upon being successfully treated for their emetophobia have expressed that their IBS went away as well.
Retrograde Cricopharyngeus Dysfunction (R-CPD)
R-CPD is the inability to burp due to a type of deformity in the upper esophageal sphincter, which cannot relax to release the air bubbles. We are unaware of any scientific evidence or studies done on R-CPD and emetophobia, but from anecdotal evidence it seems as if many people with emetophobia have this disorder. People with emetophobia also remark that they are in online groups for R-CPD and that there are several members there with emetophobia. The connection could be that trapped gas leads to discomfort and nausea. More information can be found here.
Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infection (PANDAS)
Pediatric Acute-onset Neuropsychiatric Syndrome (PANS)
PANDAS and PANS are the sudden and dramatic onset of symptoms that are exactly like OCD or tic disorders normally associated with Tourette syndrome. Accompanying symptoms may be separation or other anxiety, irritability, major depression as well as a host of others previously atypical for the child. The sudden onset of symptoms always follows an infection of Group A Streptococcus (GAS). This infection can be asymptomatic, which further complicates the likelihood of a correct diagnosis. ‘Sudden onset’ often means that parents can identify the exact day when the child’s behavior changed. Kids who previously had OCD can experience a worsening of symptoms just as suddenly.
Despite these being somewhat rare conditions, we have both experienced more than one patient having been diagnosed with one or the other. As emetophobia is so under-researched, we do not yet know exactly how PANDAS/PANS affects previously diagnosed children, or whether PANDAS/PANS itself can lead to sudden onset of emetophobia or worsen the symptoms. The Pandas Physicians Network diagnostic guidelines list restricted food intake as part of one of the four essential symptom clusters required to make the diagnosis. Specifically, they note that fears of choking or vomiting may drive the food restriction.
RESEARCH
Scientific, peer-reviewed studies (published articles) on emetophobia in chronological order. Type of study done is described only if not evident from the title or publication. Non-English language studies are noted under “type.”
If you are interested in research, it’s best to begin by contacting Dr. David Veale in London, UK.
To help fund much-needed research on emetophobia, visit Emet Action, a charitable organization dedicated to funding research on emetophobia. You can find it at emetaction.org.
| ARTICLE | TYPE | |
| 1974 | Wijesinghe, B. ‘A vomiting phobia overcome by one session of flooding with hypnosis.’ Journal of Behavior Therapy and Experimental Psychiatry. | Case study (flooding) |
| 1979 | Ritow, J. K. ‘Brief Treatment of a Vomiting Phobia.’ American Journal of Clinical Hypnosis. | Case study (hypnosis) |
| 1983 | McFadyen, M., and Wyness, J. ‘You Don’t Have to be Sick to be a Behaviour Therapist but it can Help! Treatment of a “Vomit” Phobia.’ Behavioural Psychotherapy. | Case study (exposure using simulation) |
| 1984 | Klonoff, E. A., Knell, S. M., and Janata, J. W. Fear of nausea and vomiting: The interaction among psychosocial stressors, development transitions, and adventitious reinforcement. Journal of Clinical Child Psychology. | theoretical review |
| 1985 | Philips, H. ‘Return of fear in the treatment of a fear of vomiting.’ Behaviour Research and Therapy 23, 1, 45–52. | (group CBT/ERP) |
| 1990 | Manassis, K., and Kalman, E. ‘Anorexia Resulting from Fear of Vomiting in Four Adolescent Girls.’ The Canadian Journal of Psychiatry 35, 6, 548–550. | |
| 1993 | Herman, D. S., Rozensky, R. H., and Mineka, S. Cognitive behavioral therapy for panic disorder with a primary fear of vomiting: conceptual and treatment issues. Proceedings for Association for Advancement of Behaviour Therapy. | |
| 1994 | de Jongh, A., and ten Broeke, E. ‘Notable Changes After One Session of Eye Movement Desensitization and Reprocessing: A Case of Fear of Nausea and Vomiting.’ Directieve Therapie, 14(2), 46-52. | Case study – Netherlands (EMDR) |
| 1994 | McKenzie, S. Hypnotherapy for vomiting phobia in a 40-year-old woman. Contemporary Hypnosis, 11(1), 37–40. | Case study (hypnosis) |
| 2001 | Lipsitz J.D., Fyer, A.J., Paterniti, A., Klein, D.F. ‘Emetophobia: preliminary results of an internet survey.’ Depress Anxiety. | Internet Survey |
| 2003 | Dattilio, F. M. ‘Emetic Exposure and Desensitization Procedures in the Reduction of Nausea and a Fear of Emesis.’ Clinical Case Studies, 2, 3, 199–210. | Case Study (Exposure/ desensitization using Ipecac) |
| 2005 | Moran, D. J., and O’Brien, R. M. ‘Competence Imagery: A Case study Treating Emetophobia.’ Psychological Reports. | |
| 2006 | Veale, D., and Lambrou, C. ‘The Psychopathology of Vomit Phobia.’ Behavioural and Cognitive Psychotherapy. | |
| 2006 | Baeyens, C., and Philippot, P. ‘L’émétophobie: Un cas particulier de phobie intéroceptive? [Emetophobia: A special case of interoceptive phobia?].’ Revue Francophone de Clinique Comportementale et Cognitive. | Theoretical review – French |
| 2006 | Whitton, Luiselli, J. K., and Donaldson, D. L. (2006). Cognitive-Behavioral Treatment of Generalized Anxiety. Clinical Case Studies. | (emetophobia misdiagnosed as GAD) |
| 2007 | Davidson, A. L., Boyle, C., and Lauchlan, F. Scared to lose control? General and health locus of control in females with a phobia of vomiting. Journal of Clinical Psychology. | |
| 2007 | Boschen, M. J. ‘Reconceptualizing emetophobia: A cognitive–behavioral formulation and research agenda.’ Journal of Anxiety Disorders. | |
| 2008 | Van Overveld, M., De Jong, P. J., Peters, M. L., Van Hout, W. J., and Bouman, T. K. ‘An internet-based study on the relation between disgust sensitivity and emetophobia.’ Journal of Anxiety Disorders. | |
| 2009 | Hunter, P. V., and Antony, M. M. ‘Cognitive-Behavioral Treatment of Emetophobia: The Role of Interoceptive Exposure.’ Cognitive and Behavioral Practice. | Case study |
| 2009 | Veale, D. ‘Cognitive behaviour therapy for a specific phobia of vomiting.’ The Cognitive Behaviour Therapist. | |
| 2010 | Graziano, P. A., Callueng, C. M., and Geffken, G. R. Cognitive-Behavioral Treatment of an 11-Year-Old Male Presenting With Emetophobia: A Case study. Clinical Case Studies. | |
| 2010 | Pearson, Megan R. ‘Characteristics, Correlates, and Experiences of Emetophobia: An Exploratory Study.’ Theses and dissertations. Paper 1480. | Doctoral Dissertation |
| 2011 | Leite, C. E. P., Vicentini, H. C., Neves, J. D. S., and Torres, A. R. Emetofobia: revisão crítica sobre um transtorno pouco estudado. [Emetophobia: A Critical Review of an Understudied Disorder.] Jornal Brasileiro de Psiquiatria, | critical review – Brazil |
| 2011 | Vandereycken, W. ‘Media Hype, Diagnostic Fad or Genuine Disorder? Professionals’ Opinions About Night Eating Syndrome, Orthorexia, Muscle Dysmorphia, and Emetophobia.’ Eating Disorders. | |
| 2011 | Williams, K. E., Field, D. G., Riegel, K., and Paul, C. Brief, Intensive Behavioral Treatment of Food Refusal Secondary to Emetophobia. Clinical Case Studies. | |
| 2011 | Kobori, O. Cognitive therapy for vomit phobia: a case report. Asia Pacific Journal of Counselling and Psychotherapy. | Case study – Japanese (cognitive therapy) |
| 2012 | Veale, D., Costa, A., Murphy, P., and Ellison, N. Abnormal Eating Behaviour in People with a Specific Phobia of Vomiting (Emetophobia). European Eating Disorders Review. | |
| 2012 | Price, K., Veale, D., and Brewin, C. R. Intrusive imagery in people with a specific phobia of vomiting. Journal of Behavior Therapy and Experimental Psychiatry. | |
| 2012 | de Jongh A. ‘Treatment of a woman with emetophobia: a trauma focused approach.’ Mental illness | |
| 2011 | van Hout, W. J., and Bouman, T. K. ‘Clinical features, prevalence and psychiatric complaints in subjects with fear of vomiting.’ Clinical psychology and psychotherapy | Survey (Dutch) |
| 2013 | Kerr, C. ‘TA Treatment of Emetophobia: A Hermeneutic Single-Case Efficacy Design Study – ‘Peter’.’ International Journal of Transactional Analysis Research and Practice. | |
| 2013 | Faye, A., Gawande, S., Tadke, R., Kirpekar, V., and Bhave, S. ‘Emetophobia: A fear of vomiting.’ Indian Journal of Psychiatry. | |
| 2013 | Veale, D., Ellison, N., Boschen, M.J., Costa, A., et al. ‘Development of an Inventory to Measure Specific Phobia of Vomiting (Emetophobia).’ Cogn Ther Res. | |
| 2013 | Maack, D. J., Deacon, B. J., and Zhao, M. ‘Exposure therapy for emetophobia: A case study with three-year follow-up.’ Journal of Anxiety Disorders. | |
| 2013 | Boschen, M. J., Veale, D., Ellison, N., and Reddell, T. ‘The emetophobia questionnaire (EmetQ-13): Psychometric validation of a measure of specific phobia of vomiting (emetophobia).’ Journal of Anxiety Disorders. | |
| 2013 | Höller, Y., Overveld, M. V., Jutglar, H., and Trinka, E. ‘Nausea in Specific Phobia of Vomiting.’ Behavioral Science | Internet survey (German) |
| 2014 | Zhao, Mimi. ‘Toward A Conceptualization of Emetophobia: Examining Intolerance Of Uncertainty As A Unique Predictor Of Symptoms.’ Electronic Theses and Dissertations. | Master’s Thesis |
| 2014 | Veale, D., Murphy, P., Ellison, N., Kanakam, N., and Costa, A. ‘Autobiographical memories of vomiting in people with a specific phobia of vomiting (emetophobia).’ Journal of Behavior Therapy and Experimental Psychiatry | |
| 2014 | Snæbjarnardóttir, K., and Sigurðsson, E. ‘Emetophobia: sjúklegur ótti við uppköst og ógleði.’ Læknablaðið. | Case study – Iceland |
| 2015 | Benoit, Jean-Pierre. ‘Quand la phobie s’empare du corps: à propos de l’émétophobie [When Phobia Takes Hold of the Body: About Emetophobia].’ Enfances & Psy. | Overview – French |
| 2015 | Wu, M. S., Rudy, B. M., Arnold, E. B., and Storch, E. A. ‘Phenomenology, Clinical Correlates, and Impairment in Emetophobia.’ Journal of Cognitive Psychotherapy. | |
| 2015 | Ahlen, J., Edberg, E., Di Schiena, M., and Bergström, J. Cognitive behavioural group therapy for emetophobia: An open study in a psychiatric setting. Clinical Psychologist. | |
| 2015 | Veale, D., Hennig, C., and Gledhill, L. ‘Is a specific phobia of vomiting part of the obsessive compulsive and related disorders?’ Journal of Obsessive-Compulsive and Related Disorders. | |
| 2015 | Brunner, J. ‘Emetophobie bei einem jungen Mann. [Emetophobia in a young man].’ Psychotherapeut. | Case study – German |
| 2016 | Riddle-Walker, L., Veale, D., Chapman, C., Ogle, F., Rosko, D., Najmi, S., Walker, L. M., Maceachern, P., and Hicks, T. Cognitive behaviour therapy for specific phobia of vomiting (Emetophobia): A pilot randomized controlled trial. Journal of Anxiety Disorders. | Randomized Controlled Trial |
| 2016 | Fix, R. L., Proctor, K. B., and Gray, W. N. Treating Emetophobia and Panic Symptoms in an Adolescent Female. Clinical Case Studies. | Case study (Adolescent: Rx + CBT) |
| 2016 | Sykes, M., Boschen, M. J., and Conlon, E. G. ‘Comorbidity in Emetophobia (Specific Phobia of Vomiting).’ Clinical Psychology and Psychotherapy. | |
| 2016 | Verwoerd, J., van Hout, W. J., and De Jong, P. J. ‘Disgust- and anxiety-based emotional reasoning in non-clinical fear of vomiting.’ Journal of Behavior Therapy and Experimental Psychiatry. | |
| 2016 | Wu, M. S., Selles, R. R., Novoa, J. C., Zepeda, et al. ‘Examination of the Phenomenology and Clinical Correlates of Emetophobia in a Sample of Salvadorian Youths.’ Child Psychiatry and Human Development. | |
| 2016 | Paulus, D. J., and Norton, P. J. ‘Purging Anxiety: A Case study of Transdiagnostic CBT for a Complex Fear of Vomiting (Emetophobia).’ Cognitive and Behavioral Practice. | Case study |
| 2016 | van Hout, W., and Bouman, T. ‘Imagery and core beliefs in fear of vomiting.’ 8th World Congress of Behavioural and Cognitive Therapies, Melbourne, Australia. | Convention Presentation (Australia) |
| 2017 | Dosanjh, Sarabpreet et al. ‘I think I’m Going to be Sick: An Eight-Year-Old Boy with Emetophobia and Secondary Food Restriction.’ Journal of the Canadian Academy of Child and Adolescent Psychiatry = Journal de l’Academie canadienne de psychiatrie de l’enfant et de l’adolescent. | case study |
| 2017 | Gormez, V., Meral, Y., and Orengul, A. Emetophobia (specific phobia of vomiting): Its Relationship with Anxiety-related Disorders and Cognitive Behavioral Therapeutic Approach. Journal of Cognitive-Behavioral Psychotherapy and Research. | Theoretical Review – Istanbul, Turkey |
| 2017 | Roy, D. ‘Emetophobia (a specific phobia of vomiting): A case study.’ European Psychiatry. | |
| 2017 | Maertens, C., Couturier, J., Grant, C., and Johnson, N. ‘Fear of Vomiting and Low Body Weight in Two Pediatric Patients: Diagnostic Challenges.’ Journal of the Canadian Academy of Child and Adolescent Psychiatry = Journal de l’Academie canadienne de psychiatrie de l’enfant et de l’adolescent. | |
| 2017 | Veale, D., and Keyes, A. ‘Atypical Eating Disorders and Specific Phobia of Vomiting: Clinical Presentation and Treatment Approaches. In L.K. Anderson, S.B. Murray, and W.H. Kaye (Eds.), Clinical Handbook of Complex and Atypical Eating Disorders. Oxford University Press. | |
| 2018 | Dargis, M., and Burk, L. ‘A Transdiagnostic Approach to the Treatment of Emetophobia: A Single Case study.’ Clinical Case Studies. | |
| 2018 | Liebenberg, A., and Dos Santos, M. ‘Health-related subjective well-being with emetophobia.’ Journal of Psychology in Africa. | Assessment – African |
| 2018 | Simons, M., and Vloet, T. D. ‘Emetophobia – A Metacognitive Therapeutic Approach for an Overlooked Disorder.’ Zeitschrift für Kinder- und Jugendpsychiatrie und Psychotherapie. | Case study – Germany |
| 2018 | Nakamura, M., and Kitanishi, K. ‘Morita therapy for the treatment of emetophobia: A case report.’ Asia-Pacific Psychiatry. | Case study – Japan |
| 2018 | Bogusch, L. M., Moeller, M. T., and O’Brien, W. H. ‘Case study of Acceptance and Commitment Therapy and Functional Analysis for Emetophobia.’ Clinical Case Studies. | |
| 2018 | Keyes, A., Gilpin, H. R., and Veale, D. ‘Phenomenology, epidemiology, co-morbidity and treatment of a specific phobia of vomiting: A systematic review of an understudied disorder.’ Clinical Psychology Review | Systematic review |
| 2018 | Maack, D.J., Ebesutani, C., and Smitherman, T.A. ‘Psychometric investigation of the Specific Phobia of Vomiting Inventory: A new factor model.’ International Journal of Methods in Psychiatric Research. | |
| 2019 | Petell, Jennifer Arden. ‘Behavioral Similarities And Differences Among Symptoms Of Emetophobia, Disordered Eating, And Disgust.’ Electronic Theses and Dissertations. 1937. | Master’s thesis |
| 2019 | Salgado, M.E. ‘Someone Could Be Sick. Cognitive Behaviour Therapy for a Specific Phobia of Vomiting (Emetophobia): A Study Case. REVISTA ARGENTINA DE CLINICA PSICOLOGICA. | Argentina |
| 2019 | Mitamura, T. ‘Case study of Clinical Behavior Analysis for a 20-Year-Old Patient with Emetophobia.’ Clinical Case Studies. | |
| 2020 | Kannappan, A., and Middleman, A. B. ‘Emetophobia: A case of nausea leading to dehydration in an adolescent female.’ SAGE Open Medical Case Reports. | |
| 2020 | Mircea, M. M. ‘Employing Long Short-Term Memory Networks in Trigger Detection for Emetophobia.’ Studia Universitatis Babeș-Bolyai Informatica. | Romania – studied and created an API and Chrome extension to censor emetophobia-triggering words. |
| 2020 | Keyes, A., Veale, A., Foster, C., and Veale, D. ‘Time intensive cognitive behavioural therapy for a specific phobia of vomiting: A single case experimental design. ‘Journal of Behavior Therapy and Experimental Psychiatry. | |
| 2022 | Zickgraf, H. F., Loftus, P., Gibbons, B., Cohen, L. C., and Hunt, M. G. ‘If I could survive without eating, it would be a huge relief: Development and initial validation of the Fear of Food Questionnaire.’ Appetite. | Assessment Instrument |
| 2022 | Orme, K., Challacombe, F., and Roxborough, A. ‘Specific fear of vomiting (SPOV) in early parenthood: Assessment and treatment considerations with two illustrative cases.’ The Cognitive Behaviour Therapist 15, E12. |
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