Catastrophic Thinking and Vomiting Anxiety (Emetophobia)

Catastrophic Thinking and Vomiting Anxiety (Emetophobia)

‘I’d rather die than vomit’ – how does catastrophic thinking play a role in anxiety around vomiting?

“Most people with a fear of vomit/SPOV [specific phobia of vomiting] evaluate vomiting as being 100% awful and if given the choice would prefer to die rather than to vomit.” (Veale, 2009)

If you don’t have a phobia of vomiting (emetophobia), you will probably find it hard to imagine how someone could think about being sick in such a catastrophic manner! For those with an anxiety of being sick, however, this kind of thinking is part of every day life and contributes to maintaining their symptoms.

What is Vomiting Anxiety?

Vomiting anxiety is a significant fear of being sick, feeling sick, or seeing others be sick. Although no one particularly likes throwing up, people with vomit anxiety will often go to extreme or seemingly over-the-top lengths to avoid it. This can include excessive hand-washing, limiting and controlling what they eat and drink, avoiding bars, clubs and social gatherings, or even limiting contact with children when they’re unwell – sometimes avoiding having children completely. Find out more about a fear of vomiting.

Can Anxiety Cause Vomiting?

Although nausea is a common side effect of anxiety, it rarely causes you to actually throw up. Many people with anxiety experience IBS-related symptoms, for example a churning stomach and queasiness, which is all the more distressing for people suffering from emetophobia. As they experience more anxiety, feelings of nausea can increase, which can cause a vicious cycle where the more anxious you become, the more you convince yourself you’ll be sick. It’s important to challenge yourself in these moments and remind yourself it’s just the anxiety causing this, you’re not really going to be sick.

What is Catastrophising?

“Catastrophising is the process where a person emotionally magnifies, exaggerates or blows out of proportion a perceived threat or worry. The ‘catastrophiser’ is the person who uses very strong (exaggerated) language and who thinks and feels in a dramatic fashion.

If you are a catastrophiser, instead of saying, ‘I’ve got a headache’, you might say, ‘My head is killing me.’ Instead of saying, ‘I feel I’m stuck at home all the time,’ you might say, ‘I’m stuck in this prison cell and I don’t know where the key is to get out.’ When you have a sore leg, you might think, ‘Oh my god, I’ve got a deep vein thrombosis.’ When you have a spot on your arm, you worry it is a cancer. When you have hiccups, it’s a heart attack. When the phone rings, it’s your mum to say someone has died.

You are likely to have strong catastrophic thinking, especially surrounding your fear of vomit. Research into emetophobia has supported the notion that people with a vomit phobia tend to be catastrophisers! Boschen (2007), for example, suggested that those with emetophobia have ‘a tendency to catastrophically misappraise nausea and other gastrointestinal symptoms’. They assume that any such symptoms are signs of impending vomiting, rather than being down to anxiety, which is far more likely given the stress that they are creating through their unhelpful thinking.

Does Catastrophising Increase Anxiety?

The main problem with catastrophising is that it leads people to lose perspective and create a great deal of anxiety and panic. Catastrophising about a feared situation often results in the person then experiencing the feared consequences! For example, someone who catastrophises: ‘Oh my god, I’m going to be so terrified at the dentist this afternoon, it’s going to be so awful,’ is very likely to indeed feel a lot of panic and anxiety. Catastrophising builds up small things into big ones! Minor problems become ‘unbelievable disasters’ very quickly! This can lead to your limiting belief systems being reinforced by many seemingly ‘hugely significant’ experiences that were in fact fairly minor before you built them up by catastrophising. (Read more about why language matters in your mental health)

You should bear in mind that your catastrophising about vomiting will likely mean that whenever you are sick, your experience is worse than it otherwise would have been. If you believe that being sick is terrible, frightening and so bad you would rather die than experience it, then, due to the amount of anxiety and stress arousal you will create, you are likely to experience vomiting as far more traumatic than someone who just thinks of vomiting as being a little bit unpleasant. (Read an ex-emetophobe’s account of coping with being sick after she cured herself and reduced her catastrophic thinking)

Why Do I Catastrophise?

Catastrophising is more common in people whose parents tended to catastrophise. If, as a child, your parents usually responded to you in an ‘over the top’ catastrophic manner, you are likely to pick up on this and learn to catastrophise yourself. Obviously all parents shout unnecessarily at, or worry overly about their kids from time to time. It is when the child is consistently presented with extreme emotional reactions to perceived mistakes or threats that he or she is likely to learn to respond in the same way.

“Specifically, it is possible that parents who tend to catastrophise are visibly anxious and demonstrate anxious behaviors in the presence of their child. It is also possible that child learning of anxiety develops, at least in part, from parents modeling anxious interpretation of situations. Thus, children may also come to interpret situations in an overly anxious or catastrophising manner, further contributing to their experience of anxiety symptoms.” (Fisak and Grills-Taquechel, 2007)

Emetophobes are highly likely to have had a parent who catastrophised and they have picked up this thinking style from them. Some people with a fear of vomit will have had a mother (or potentially a father) with the same fear. They will have witnessed a parent responding to vomiting in a highly anxious and over the top manner and learnt to do this themselves. Indeed most people with emetophobia will have some reinforcement from a significant other, who has responded to either vomiting or the phobia in a catastrophic, overly emotional manner.”

Do Emetophobes Feel More Nauseous than Other People?

As mentioned, if people with vomit anxiety ever do ever feel nauseous, it’s likely they’ll ‘zoom in’ on these feelings of nausea and actually make themselves feel more nauseous! We have a helpful podcast discussing whether emetophobes do feel more nauseous than other people and why this happens.

How can I reduce my Catastrophic Thinking?

A helpful place to start is to reduce your unhelpful thinking styles. Life is not black-and-white. Start to notice if you’re thinking in a catastrophic way and challenge those thoughts. Your mum’s calling you – instead of jumping straight to the worst case scenario that someone must have died ask yourself, ‘what else could she be calling about?’ By using some imagination you can start to live in the ‘grey’ area where things aren’t always the most extreme case. It’s also helpful to start trying to manage your anxiety – why not read our simple tips to reduce your anxiety? We’ve created a helpful workbook which has helped thousands of people overcome their emetophobia and anxiety. Find out more below.

References

Boschen, M. J. (2007). ‘Reconceptualizing emetophobia: A cognitive–behavioral formulation and research agenda.’ Journal of anxiety disorders, 21(3), 407–419

Fisak, B and Grills-Taquechel, A.E (2007). ‘Parental Modeling, Reinforcement, and Information Transfer: Risk Factors in the Development of Child Anxiety?’ Clinical Child and Family Psychology, 10 (3) 213-231

Veale, D. (2009). ‘Cognitive behaviour therapy for a specific phobia of vomiting.’ The Cognitive Behaviour Therapist, 2(04), 272–288.