Hi, I'm Dr. Tracy Marks, a psychiatrist
and I make mental health education videos.
Today's video is based on a viewer question from HH.
Would you possibly do a video about emetophobia
and how it correlates with agoraphobia?
I've had this issue for years and I've tried several meds
and therapies, but I still struggle
to leave my house due to fear of vomiting.
I am also afraid of the general act
of vomiting even at home.
It affects my daily life, how I eat,
what I eat, where I go, etc.
Thanks HH for your question.
Emetophobia is a fear of vomiting
or seeing someone else vomit.
It falls under the category of specific phobias
in the diagnostic manual.
Specific phobias are the most common
anxiety disorder people have.
18% of people will develop a phobia
at some point in their life.
Having a fear is not the same as having a phobia.
Many people fear heights, snakes, and even vomit.
No one wants to feel sick or look at vomit,
but what takes an ordinary fear and converts it
from an aversion to a phobia is the severity
of the anxiety reaction that you have
and the avoidance behaviors that you engage in
to reinforce the fear.
Some people will have full on panic attacks
when they encounter the object or situation
or they can have an intense panic attack
from just thinking about it.
People experience panic attacks differently,
but a typical panic attack could be trouble breathing,
racing heart, feeling faint, intense nausea,
or feeling out of body, just to name a few symptoms.
Most phobias like heights and enclosed spaces
are driven by fear, but another very strong emotion
behind the phobias is disgust.
Disgust is a complex emotion because it's not as easy
to see and measure like fear or/and anger.
Also, what people find disgusting varies by culture.
And lastly, discuss is a multidimensional concept.
You can be disgusted by things on a sensory level,
like things that are a visual turnoff, smell bad,
taste bad, but there's also a moral component to it.
Like being disgusted by certain attitudes or behaviors.
Self-disgust has been studied as a basis
for suicidal thinking.
Disgust really deserves its own video
because it's a really big topic, but for today's purpose,
disgust proneness or how easily you are to be disgusted
by things is seen as a root cause of certain phobias
like emetophobia and some types
of obsessive compulsive disorder.
I say some types because not everyone with OCD
has obsessions about contamination.
With emetophobia, you start with the fear
or disgust over the experience or sight of vomiting.
Then, you have avoidance in safety behaviors
that keep the phobia active.
I talk about safety behaviors in this video.
Safety behaviors are things that you do
to keep yourself from encountering
the feared object or situation.
Emetophobics, you safety behaviors
to avoid any situation that they think may cause
them to vomit or see vomit.
And some examples are avoiding parties
where people are drinking.
Usually you have to party pretty hard
to vomit from drinking and that kind of outing
with free flowing hard alcohol is different
from a cocktail hour where everyone's in business suits
and limited to one or two drinks,
but an emetophobic person will avoid any outing
that has any kind of alcohol on the remote possibility
that someone may throw up.
They may avoid traveling abroad
or women may not want to get pregnant
because they don't want to have morning sickness
or deal with a sick child.
And by the way, it's fairly common for people
with contamination fears or emetophobia to be able to
tolerate these exposures when you're caring for your child,
it's like your brain grants you an exception
and allows you to do what you need to do.
Why?
I don't know.
This isn't well-studied but if I had to guess,
I would say it has something to do with oxytocin.
Oxytocin is called the love hormone or bonding hormone.
Mothers get a triple dose of it and it gives you
an intense desire to nurture and protect your offspring.
And it's because of oxytocin
that you see animals nursing the young of other species,
there's a popular video on YouTube
showing a cat nursing ducklings.
Cats normally kill birds but this cat had just given birth
and had a surge of oxytocin.
I think that's fascinating, but I digress.
The point is there's hope for the emetophobic person
to be able to take care of a vomiting baby.
Sometimes the avoidance behaviors
can become compulsive similar to OCD.
It's so happens that many people
with emetophobia also have OCD.
An example of how this looks is you may develop
a ritual of checking expiration dates
or smelling food to check, to make sure
that it's safe to eat.
Without OCD, you may only check once, but with OCD,
you need to check multiple times to relieve your anxiety.
Some people will throw away food
that may have stood next to an item that was expired.
They know that the container of orange juice
can't be contaminated from the milk carton
that's one day pass due, they know that logically,
but their anxiety and OCD
makes them need to get rid of everything in the vicinity
of an expired item, because that makes them feel reassured
that they've eliminated all possibilities
of eating something that could make them vomit.
And this measure of getting rid of everything
is a safety behavior.
This food avoidance can get really serious
and lead to malnutrition.
Some people have been hospitalized with dehydration
because of emetophobia.
A lesser extreme as a person
who avoids eating fresh or raw foods
and limits their diet to package goods,
all of that process food is unhealthy
because processed food is low
in essential nutrients like magnesium.
I talk about magnesium and its role
in anxiety in this video.
If you have co-occurring OCD, not only do you have rituals,
but you can be consumed with thoughts all day
about what will and won't make you feel sick.
It's like every thought and behavior is guided by your fear
and those thoughts control how you go about your day.
You can have intrusive thoughts that pop into your head.
Like what if the UPS delivery person had been sick
and they touch the package that my partner brought
into the house?
I didn't go near it but my partner did
and they can get sick.
So, I need my partner to quarantine for a couple of days
to make sure that they don't get sick.
HH asked about how emetophobia relates to agoraphobia.
Agoraphobia is a separate anxiety disorder
where you fear being in a place
where you can't escape if you become anxious.
It's commonly seen with people who have panic attacks,
but this can happen also with people who have emetophobia.
Some will get to the point
where they can't leave their home at all,
because of fear that they'll vomit in public
or have the need to vomit and not be able
to get to a safe place.
Unfortunately, nausea is a symptom of anxiety.
So your mind can fool you into thinking
that because you're nauseous, vomiting is imminent.
So you must stay put.
What can you do about this?
The most robust treatment is cognitive behavior therapy.
Your therapist can use cognitive therapy
to help you recognize and change your distorted thinking
and use exposure therapy for the behaviors.
And there's different kinds of exposure therapy.
And your therapist could design the best program for you.
The cognitive part of the therapy will focus
on your sensitivity to body sensations.
It's about breaking the thought loops
that you have about what these sensations mean
and imagining catastrophic consequences.
Part of the exposure therapy will involve letting go
of your safety behaviors.
If you don't have a therapist, sit down and write out
all of the things that you do to keep yourself
from throwing up or becoming nauseous.
Are there any rituals that you perform,
like throwing things out before they expire
that you use to reassure yourself that you'll be okay.
If you live with someone, that person may help you recognize
some things that you do that are safety behaviors
that you may not think of as safety behaviors.
Another thing you can do is to make sure
you're taking adequate magnesium.
I talk in my magnesium video about how anxiety
can make you urinate extra magnesium and become depleted.
So, making sure that your body is getting enough,
you want to increase your consumption
of high magnesium containing foods
and take magnesium supplements.
The National Institute of Health website
has a reference list of the magnesium content
in certain foods and I have a link
to that and the description.
Magnesium supplements are generally safe,
but if you have other medical problems,
it's always a good idea to check with your doctor
about any supplement that you want to add
to make sure it doesn't conflict
with another medication you're taking.
Keep in mind what should be reasonable goals
for your therapy or your self help efforts.
You won't get to the point where you welcome vomiting.
You will probably always feel at least a twinge of disgust,
an angst at the thought or sight of it
but reasonable improvement is getting to where your fear
or disgust doesn't cause intense distress.
You're not having panic attacks because of it.
You've dropped your safety behaviors
and you allow yourself to take risks.
If something does make you throw up,
it doesn't set you back to ground zero.
You accept that sometimes your anxiety
will peak to the point of making you nauseous,
but instead of running from it or freaking out over it,
you turn to your calming tools to reduce your anxiety
and let the distress pass through you.
That means you have to develop calming tools
that work for you so you can grab them
like grabbing a tool from a toolbox
and using it when you need it.
Knowing what tools works for you takes time.
Another end point goal is that your vomiting fear
doesn't interfere with your normal functioning.
You're leaving your house.
You're going to places where someone can be sick.
You're having children if that applies to you.
These are just some reasonable endpoint goals
to strive toward.
Here's the video on Safety Behaviors
and here's the one on Magnesium.
Have a great day, see you next time.