Most treatment for a fear of vomiting works forwards, through gradual exposure to the situations a person has been avoiding. A 2012 case report from the Netherlands took a different route and worked backwards, towards the memories the fear appeared to have grown from.
Ad de Jongh described a 46-year-old woman whose fear had been present for most of her life and had narrowed what she could do. He used Eye Movement Desensitisation and Reprocessing, better known as EMDR, a therapy developed for post-traumatic stress. Instead of eye movements, the alternating stimulation was delivered as tones through headphones.
Four sessions were spent identifying and processing specific memories. One was a classmate vomiting over a table when she was small. Another was a school bus trip where a child felt sick and she could not get off. What emerged during the sessions was that the frightening part often had less to do with the vomiting itself than with feeling trapped, unseen or unable to tell anyone how afraid she was.
Her score on a general symptom questionnaire fell from 275, in the very high range, to 121, an average score. Treatment was stopped by agreement. Three years later she reported that she was still not entirely comfortable seeing someone be sick, but the violent panic had gone.
One case does not establish a treatment. It does suggest that where a fear of vomiting is anchored to particular distressing memories, addressing those memories directly is worth considering.
Why a trauma-focused approach was tried
Emetophobia is generally regarded as harder to treat than most specific phobias, and published cases are few. Many people with it describe a childhood onset following a distressing experience of vomiting or of seeing someone else vomit. EMDR is an established treatment for post-traumatic stress disorder and has been used for disturbing memories underlying other phobic conditions. That reasoning is the basis for this case: if the fear is anchored to specific aversive memories, processing those memories may reduce the fear.
The patient
The report describes a 46-year-old office worker, given the name Debbie, with a long-standing and disproportionate fear of vomiting and wide-ranging avoidance, including situations such as hospital visits. Before treatment she completed the SCL-90, a general symptom checklist whose total score can range from 90 to 450. Her total was 275, which fell in the very high range against the norm group, with elevations on the anxiety, agoraphobia and interpersonal sensitivity dimensions.
What EMDR involves
EMDR is a protocolised eight-phase therapy. A distressing memory is held in mind while the patient carries out a second task, and distress is tracked on a subjective units of disturbance scale from 10 down to 0 while an accompanying positive belief is rated on a validity of cognition scale from 1 to 7. The working-memory account of why this helps is that recalling an aversive memory uses limited capacity, and performing a demanding secondary task at the same time leaves less capacity for the recall, so the memory is experienced as less vivid and less emotional. Eye movements are the usual secondary task, but other modalities can tax working memory in the same way. Here the therapist used alternating tones played through headphones from a CD player. For phobias the protocol adds preparation for future encounters with the feared stimulus.
Because she could not initially recall when her fear had started, the therapist used a structured method to help her access memories thought to be relevant to the origin and maintenance of the problem.
The four sessions
The first session targeted an early memory from around kindergarten age of a classmate vomiting over a table. As the memory was processed she reported the image shifting, becoming broader and more proportionate, and then losing its disgusting quality. Further memories surfaced during and between sessions, which she recorded in a journal.
The second and third sessions worked on those. One was a school bus trip on which another child became nauseated and she felt unable to get off, an experience she connected to helplessness rather than to vomiting itself. Another concerned lying awake, frightened and listening for sounds, with the painful part being that her father did not recognise how afraid she was. A recurring theme was the fear of not being understood and of having no one to tell. The emotional charge on these memories was brought down to zero on the disturbance scale before moving on.
The fourth session used a future template, rehearsing an anticipated confrontation with the feared situation.
Outcome and follow-up
After treatment she repeated the SCL-90. No subscale was elevated and the total score was 121, in the average range. Treatment was discontinued by agreement, with the understanding that she could contact the therapist again if needed. Three years later the therapist emailed to ask how she was. She replied that she was still not entirely happy when she saw someone vomit, but the violent panic reaction was gone.
What this does and does not establish
This is a single uncontrolled case with a self-report outcome measure that was not specific to emetophobia. No comparison condition existed, and the passage of time, the therapeutic relationship and expectancy cannot be separated from the technique. What it contributes is a documented example of a fear of vomiting responding to memory-focused work in a small number of sessions, with gains apparently intact three years later.
If your fear of being sick seems to trace back to particular experiences you can still picture clearly, that is worth raising with a psychologist when you discuss treatment options.