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Emetophobia is a fear or anxiety pertaining to vomiting. This specific phobia can also include subcategories of what causes the anxiety, including a fear of vomiting in public, a fear of seeing vomit, a fear of seeing the act of vomiting, or the fear of being nauseated. Emetophobia is clinically considered an “elusive predicament” because limited research has been done pertaining to it.

Definition
The root word for emetophobia is “emesis,” from the Greek word emein which means “an act or instance of vomiting” with “-phobia” meaning “an exaggerated usually inexplicable and illogical fear of a particular object, class of objects, or situation.” Emetophobia is not limited by age or maturity level. There are cases of emetophobia present in children, adolescents, as well as adults.

Causes
There are many contributing factors that define a legitimate case of emetophobia. In a clinical case study by Dr. Frank M. Datillio of Harvard Medical School and the University of Pennsylvania School of Medicine, he refers to cases from the 1980s that reference how a great number of children who are affected by emetophobia are mentally retarded. He quotes Barmann’s findings and says “[many of these children have] a history of self-stimulatory hand-mouthing and ruminative vomiting.” Dr. Datillio also illustrates how many adults are affected through the results of gastrointestinal surgery.

In an internet survey conducted by Dr. Joshua D. Lipsitz et al. given to emetophobic people, respondents gave many different reasons as to why they became emetophobic. Among some of the causes listed were severe bouts of vomiting as children and being firsthand witnesses to severe vomiting in others due to illness, pregnancy, or alcoholism.

Locus of Control
A locus of control is an individual’s perception of where control comes from. Having an internal locus of control means that an individual perceives that they have their own control over a situation whereas an external locus of control means that an individual perceives that some things are out of their control. To try to understand emetophobia more clearly, Dr. Angela L. Davidson et al. conducted an experiment where it was concluded through various surveysthat people suffering from emetophobia are more likely to have an internal locus of control pertaining to their everyday life as well as health related matters. She explains how this phobia is created through the locus of control by stating, “Thus far, it seems reasonable to stipulate that individuals with a vomiting phobia deem events as being within their control and may therefore find it difficult to relinquish this control during the act of vomiting, thus inducing a phobia.”

Treatments
Because there have been a limited number of studies in regards to emetophobia, no specific treatment can be explicitly called the cure to this fear. Therapies and treatments available for individuals with other phobias have been used in trying to treat people with emetophobia.

Hypnosis
There are some cases where emetophobics sought help through hypnosis. In Lipsitz et al.’s internet survey about emetophobia, some of the respondents replied “yes” in answer to the question of whether they had received hypnotic treatment for their fear of vomiting. Those who had said yes said that this had no effect on their phobia.

Hypnosis in general has been known to help with nausea and vomiting, especially in regards to cancer patients undergoing chemotherapy. Dr. Marchioro et al. conducted a study where 16 cancer patients underwent hypnotherapy before some of their chemotherapy sessions. They concluded that hypnotic treatments could greatly help patients with anticipatory nausea and vomiting, which comes from anticipating chemotherapy treatments. This could relate to and help people who are suffering with emetophobia.

Medications
Also noted in the emetophobia internet survey was information about medications. People were asked whether they would consider taking anxiety medication to potentially help their fear, and many in the study answered they wouldn’t for fear that the drugs would make them nauseous. Others, however, stated that some psychotropic medications (such as benzodiazepines and antidepressants) did help with their phobia, and some said gastrointestinal medications were also beneficial.

Exposure Treatments
Exposure methods, where patients are exposed to film of people vomiting, are also used in the psychological treatment. They can have a positive effect on the phobia of the patient involved, and can often aid in helping them overcome the fear, although people with emetophobia who were asked whether they would try an exposure treatment were reluctant and perhaps skeptical as to whether it would work.

Effects on Life
Dr. Lipsitz et al.’s findings also showed that those afflicted with emetophobia often have difficulties comfortably leading a normal life. Many find that they have problems being alone with young children, and they may also avoid social gatherings where alcohol is present. Retaining an occupation becomes difficult for emetophobics. Professions and personal goals can be put on hold due to the high-anxiety associated with the phobia, and travelling becomes almost impossible for some.

In Lipsitz et al.’s survey, women afflicted with emetophobia said that they either delayed pregnancy or avoided pregnancy all together because of the morning sickness associated with the first trimester, and if they did become pregnant, it made pregnancy difficult.

Other inhibitions on daily life can be seen in meal preparation. Many emetophobic people also have specific “rituals” for the food they eat and how they prepare it. They frequently check the freshness of the food along with washing it several times in order to prevent any potential sicknesses that they could contract from foods not handled properly. Eating out is also avoided, if possible, and when asked Lipsitz et al.’s survey, many felt they were underweight because of the strict diets that they put upon themselves.

Emetophobia and Anorexia
There are some cases where anorexia is the result of a fear of vomiting instead of the typical psychological problems that trigger it. In Frank M. Datillio’s clinical case study, a situation where anorexia results from emetophobia is mentioned. Datillio says, “…in one particular case report, atypical anorexia in several adolescent females occurred as a result of a fear of vomiting that followed a viral illness as opposed to the specific desire to lose weight or because of an anxiety reaction.”

Loni: The Study of an Emetophobic Woman
Because very little research had been done regarding vomiting and nausea, Dr. Frank M. Datillio took it upon himself to research a case of a grown woman who had severe emetophobia. In his article, he refers to the woman as “Loni,” who was an accomplished concert pianist.

Loni had no history of getting anxiety before performing in front of large crowds, and no previous history of any gastric problems, which was a contributing factor in her becoming emetophobic. Prior to a performance, she had eaten a spicy meal from an Indian restaurant that included a fair amount of curry. When she went on stage and sat down at the piano, due to the spicy meal and unknowingly being in the first trimester of a pregnancy, she got a severe case of nausea and vomited in front of the entire crowd.

In the following year, her anxiety had increased due to the stress of the event and also the stress of losing her pregnancy. The stress of the event increased the fear that she began having of replicating the incident, which also increased the levels of nausea she felt more frequently as time passed. As she realized that her career could potentially be in jeopardy due to the growing fear of vomiting in front of a crowd again, which increased her growing anxiety in general.

The Anxiety Disorder Interview Schedule-IV (ADIS-IV), The Anxiety Sensitivity index Schedule (ASI), and the Body Sensations Questionnaire (BSQ) were given to her in order to measure her general level of anxiety and fear. These tests were administered in order to find any potential mood disorders she may have had which contributed to her emetophobia, and they also would show if she had some sort of panic disorder associated with her fear.

An exposure treatment was then suggested and given to her. Doctors would give her small doses of the vomit inducing Ipecac in the hopes that she would undergo a bout of nausea. If a state of nausea was reached, she was instructed to use visualization and relaxing techniques in order to overcome the nausea without throwing up. The idea was to make her gain confidence in her body’s ability to control its functions and to relax it while the nausea was making her anxious.

Once she began controlling her relaxation techniques, she was then placed in front of people to play the piano again, and was gradually worked up to community events. After treatments were over, they followed-up with her and her anxiety levels had gone down dramatically. She found out in later interviews with people who were either backstage or in the audience during her initial vomiting incident that they felt sympathetic towards her and not disgusted, as she had originally thought.