Fear of vomiting often starts in childhood, and it is frequently missed. A child who will not eat certain foods, avoids school when a classmate is unwell, or asks the same anxious question over and over can be assessed for several things before anyone asks whether the real worry is being sick.
Graziano and colleagues published a detailed account of one such boy in 2010. He was 11, and the fear had been present since he was about four, beginning after he saw another child vomit at a family gathering. By the time he reached this clinic he had already been given a diagnosis of generalised anxiety disorder, had a short and unsuccessful course of therapy, and was taking medication with only limited benefit.
Treatment combined three things: graduated exposure, work on the frightening thoughts behind the fear, and training for his parents in how to support him without providing reassurance. Exposures were built from an ordinary tool. Video clips found online let him face sights and sounds that cannot easily be reproduced in a consulting room, and he practised the same exposures at home between sessions.
Over 22 sessions across six months his emetophobia scores dropped by 31% on his own report and 53% on his parents'. He no longer met the criteria for specific phobia, his medication dose was reduced, and the gains were still in place six months later.
If your child's world is shrinking around a fear of being sick, it is treatable, and treatment can be adapted to a child's pace.
The child and the presentation
The case describes an 11-year-old boy, given the name Steve, whose fear of vomiting began at about four years of age after he witnessed another child vomit at a social gathering. At eight he had been diagnosed with generalised anxiety disorder by a psychologist and given a brief course of cognitive therapy, which his mother stopped after a few sessions because he was not improving. His paediatrician had prescribed sertraline at 75 mg, and both parents reported only limited change.
How he was assessed
The authors used several sources rather than one. A semi-structured diagnostic interview, the Anxiety Disorders Interview Schedule, was administered in both child and parent versions and confirmed that he met DSM-IV criteria for specific phobia. Parent report came from the Behavior Assessment System for Children, second edition, and the boy completed the Revised Children's Manifest Anxiety Scale and the Children's Depression Inventory. Emetophobia symptoms specifically were tracked with the Emetophobia Questionnaire, completed by both the boy and his parents. No child version of that questionnaire existed, so an adult measure was adapted, which the authors flag as a limitation.
The treatment
Three components ran together. Graduated exposure used a fear hierarchy the boy helped build, with each item rated on a 0 to 10 distress scale. Cognitive restructuring addressed the catastrophic predictions attached to vomiting. Parent training taught his parents to stop accommodating the fear, particularly by withdrawing reassurance, and to supervise exposure homework without letting him escape an exposure before his anxiety had come down.
From sessions 3 to 21 he completed more than 13 exposures and eventually worked through every item on his hierarchy. Some steps had to be broken into smaller ones. Moving from looking at vomit to touching it, for instance, was split into touching it with gloves, then with one gloved hand, then with a single finger.
The role of everyday technology
In vivo exposure for this phobia is awkward to arrange. The authors used video clips from a public video-sharing site to simulate what could not be staged in the room, and the boy repeated those exposures at home. Their argument is that virtual reality is not the only route to realistic exposure for this fear, and that a household internet connection can carry a good deal of the work between sessions.
What changed
Treatment ran to 22 fifty-minute sessions over six months, longer than the 8 to 12 typical of manualised child anxiety protocols. Scores on the Emetophobia Questionnaire fell by 31% on the boy's own report and 53% on his parents' report, approaching the floor of the scale. He no longer met DSM-IV criteria for specific phobia on the diagnostic interview. Internalising and somatisation scores fell, adaptive skills rose, and his medication dose was reduced. At six-month follow-up his parents reported he had met several vomit-related situations and handled them.
What a single case can and cannot show
A case study cannot establish efficacy. There is no control group, no randomisation, and no way to separate the treatment from time, maturation or the family's own efforts. The authors are explicit that controlled studies are needed for children with emetophobia. What the case does offer is a worked demonstration that a structured, exposure-based approach with genuine parental involvement is feasible in a child, and a reminder that the number of sessions may need to stretch well past a protocol's default.
If a fear of vomiting is narrowing your child's life, an assessment with a psychologist who understands this particular phobia is a reasonable place to start.