Fear of throwing up (Emetophobia) and how it’s treated

It’s safe to say most people don’t enjoy vomiting. But unless a stomach bug or illness has taken hold, most people don’t give it much thought. 

That’s not the case for everyone, however. For some, a fear of throwing up is pervasive—even when they are perfectly healthy and no one around them is sick. Sometimes just the idea of someone vomiting, or the word “vomit” itself, sends them into a tailspin. 

There’s a name for this kind of health anxiety: emetophobia. As sufferers try to shield themselves from any possibility of throwing up, their world shrinks. Socializing, eating, even commuting to work becomes a struggle. “The amount of avoidance and restriction that emetophobia can cause can be completely debilitating and miserable,” says Tracie Zinman-Ibrahim, LMFT, CST, a therapist at NOCD, a leading virtual provider of mental health treatment. 

Luckily, effective treatment exists, and many people have conquered the fear of vomiting and reclaimed their lives.

Your fears aren’t just a part of who you are—you can get better. Book a free call to get started.

What is emetophobia?

Emetophobia is a mental health condition that is classified as a specific phobia in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the guidebook used to diagnose mental health conditions. Specific phobias are characterized by an intense, persistent and irrational fear of an object or situation (in this case, throwing up).

There is limited research into how common this fear is. However, some evidence on the prevalence of emetophobia suggests that it’s rare, affecting about .02% of the population. Interestingly, it’s about four times as common in women. While researchers don’t know exactly why this is, some evidence suggests that women may be more prone to the feeling of disgust around puke.

People who struggle with emetophobia may fear the loss of control associated with vomiting, such as being unable to stop throwing up, or needing to vomit while in public but having nowhere to go. “That feeling of being out of control is so overwhelming to some people that it kind of runs their life,” says Dr. Patrick McGrath, Ph.D., Chief Clinical Officer at NOCD.

Behaviors that can be a sign of emetophobia

“People with a fear of vomiting often go out of their way to organize their days, so they can avoid any possibility of getting sick,” says Taylor Newendorp, MA, LCPC, a therapist at NOCD. If you have this phobia, you may find that you’ve developed one or more of the following behaviors.

• Avoiding foods that you perceive will make you feel nauseous, overly full, or cause an upset stomach 
• Avoid eating or drinking things that you’ve associated with vomiting in the past, such as alcohol
• Scoping out where the nearest bathroom is as soon as you get to a new place, or trying to figure this out beforehand 
• Taking antacids even if you don’t have an upset stomach or nausea, just in case
• Avoiding taking any medication that has a side effect of nausea
• Avoiding getting pregnant for the sole purpose of avoiding nausea
• Inspecting every single thing you eat to make sure it doesn’t have mold on it or hasn’t expired
• Throwing away food before it reaches its expiration date
• Avoiding surfaces that could have germs on them, like door handles or toilet seats, for fear that contamination could lead to illness and vomiting
• Avoiding hospitals or the doctor’s office where there’s a potential to see or hear someone vomiting 
• Washing your hands excessively, to get rid of any germs that could potentially lead to illness and vomiting

What are the symptoms of emetophobia?

If you have emetophobia, you may experience some or all of the following emotional symptoms:

• Anxiety 
• Emotional distress
• Panic
• Isolation 

You may also experience physical symptoms such as:

• Increased heart rate 
• Sweating 
• Dizziness
• Muscle tension
• Chest tightness

What causes emetophobia?

While emetophobia can develop spontaneously, researchers suggest it most often occurs after a prior experience with vomiting that was distressing or traumatizing. Ironically, the more effort you give to avoid vomiting, the bigger your fear becomes—as the avoidance trains your brain to continue taking this fear seriously. 

Once you’ve developed emetophobia, it can be triggered by a number of things. For example:

• Going to a hospital or doctor’s office
• Seeing an expiration date that has passed on a food you recently ate
• Feeling full
• Hearing that someone you were recently around is now sick
• Feeling any twinge of stomach discomfort
• Watching a movie in which someone vomits
• Hearing someone talk about vomiting
• Being in an environment where you think a lot of illness-causing germs are lurking

Emetophobia can exist on its own or it may be connected to other fears, such as Cibophobia, the fear of food. It can also be related to an eating disorder or obsessive-compulsive disorder (OCD). “For some, emetophobia may arise as a comorbid condition alongside OCD (occurring simultaneously) or may present as a symptom of OCD,” notes Kimberley Quinlan, LMFT, a therapist who provides treatment for OCD and related disorders.

Emetophobia and OCD: What’s the link?

OCD is a mental health condition characterized by intrusive thoughts, images, or urges known as obsessions, which create intense anxiety and distress. People with OCD often engage in compulsions — or repetitive behaviors or rituals done with the intent to mitigate obsessions and the distress they bring.  For people with a fear of vomiting, these compulsions might look like washing your hands excessively or obsessively throwing away food before it expires.

Fear of throwing up can be a manifestation of a couple of different subtypes of OCD.  Contamination OCD, for example, is rooted in a fear of becoming contaminated or seriously ill by coming into contact with certain substances or foods. Health Concern OCD is characterized by intrusive thoughts and health anxieties about developing a serious medical condition. With both of these forms of OCD, your mind is hijacked on a daily basis by intrusive thoughts about getting ill, and you may be focused on vomiting as evidence that something is truly wrong.

Common obsessions related to the OCD fear of vomiting

• Once when I was kid, I threw up the day after eating a hot dog—I can’t eat hot dogs anymore.
• If I wear the shirt I wore last time I vomited, I might vomit again.
• Vomiting probably means I have a serious underlying condition.
• What if I vomit because I’m so contaminated that the germs need to get out of me somehow?
• What if eating the food that someone else has prepared for me makes me sick and causes me to vomit?
• What if we hit traffic while driving somewhere and I get car sick and vomit?
• What if I use a public restroom and accidentally encounter the smell of vomit?

Common compulsions related to the OCD fear of vomiting

• Googling any twinge of physical discomfort you have to see if it has the potential to lead to vomiting.
• Seeking reassurance from loved ones that you’re not going to vomit or won’t see vomit. (“Do I look pale or queasy to you?” “Are you sure people at the party won’t be drinking too much and potentially start vomiting?”)
• Mentally reviewing past situations where you vomited to look for anything that could have led to the vomiting, even if it’s irrational. (i.e. what color shirt you were wearing)
• Constantly monitoring and “checking” your body to make sure you don’t feel too full or uncomfortable in any way.
• Creating certain rituals around eating, such as only eating at certain times, only eating certain foods, or only eating small amounts.

Should I see a healthcare professional for my fear of vomiting?

“When you are doing something that could affect your health negatively, like restricting your food intake, or if you’re avoiding doing things that you enjoy, like going out to places where other people might vomit, that’s a good sign that it’s time to seek help,” says Zinman-Ibrahim. 

Treatment for emetophobia or OCD fear of vomiting

As mentioned above, the gold-standard treatment for both emetophobia and OCD is ERP. The important thing to know about ERP is that it’s a specialized treatment and differs from traditional talk therapy or general cognitive behavioral therapy (CBT). Without practicing ERP specifically, it’s very likely that your fear of throwing up will get worse, not better.

ERP works by gradually (and with the guidance of a trained therapist) exposing you to the things that trigger your fears. The idea is to take steps toward overcoming your fear without being forced into anything too intense before you’re ready. What’s an example of an exposure you might do at the beginning of your therapy? It differs for everyone, but you might watch cartoon characters vomiting, or simply look at a picture of a food that you associate with puking, says Zinman-Ibrahim.

ERP teaches you response prevention techniques—in other words, how to not engage in compulsions or avoidance behaviors. Over time, your brain learns you don’t need to engage in compulsions to stay safe—because your fears were never the serious threat you thought they were.

Zinman-Ibrahim tells a story of a patient who wanted to live in a dorm during their first year of college, but was terrified by the thought of seeing fellow students vomit. After working with an ERP therapist, this person was able to overcome their fear and do something that was valuable to them: living out the experience of dorm life. This is the kind of freedom people find every day when they get the right kind of help for their fear—and it’s possible for you, too.