Perfectionist thinking, and how it feeds emetophobia

What a perfectionist actually is

‘I’m a bit of a perfectionist’ is something I hear a lot in a first session, usually from people with intense social anxiety they do not yet know they have. There is a good deal of spin in the phrase. It sounds a little like saying ‘yes, I am a bit special’.

Underneath it, a ‘perfectionist’ is really a person running away from feeling like shit. Deep down they usually feel worthless, unlovable and a failure, and they are fighting continually to get away from those unbearable deep-down feelings. So they set themselves very high standards, and they cannot tolerate failure — because failure puts them straight back in touch with those feelings.

The trouble is that if you set yourself impossible standards you will not meet them most of the time. So you see yourself failing constantly — which is the one thing you were trying to avoid. Then you give yourself a hard time for it, sometimes for days. That only increases the need to be perfect, so you set the bar higher still.

Why the successes never land

Perfectionists have low self-esteem and a fairly negative attitude towards themselves, so they focus on the few things they missed rather than the many they hit. Normal accomplishments do not count as noteworthy when you are aiming at faultless, so they go unprocessed — the things most people would be genuinely pleased about.

Even a difficult goal, once achieved, gets explained away: I was lucky, it was not that hard, I should have done more, so-and-so did better. The goalposts move and the success is cancelled.

So as a perfectionist your thinking is likely to be quite distorted, and you see yourself through those ‘shit-tinted spectacles’. A recent client of mine, Liz, was always striving to excel at whatever she did, and really did not see herself as having achieved anything much at all. Instead she was focused on the fact that, some years ago, she had unfairly been sacked from her job. Yet plenty of people would love to be as successful as she is: she is very fit and healthy, studied at Harvard, has won several university rowing races, and now has a high-flying career.

How this shows up in emetophobia

People with emetophobia very often have a perfectionist thinking style, both about the fear and about everything else. Many beat themselves up for having the phobia at all, calling themselves stupid or a failure for being frightened.

It is also why so many keep it secret. In one of our research surveys, 44 out of 58 people — just under 69% — had never told anybody about their fear. They hide it and try to appear perfect, because the social anxiety and the low self-esteem make asking for help feel like weakness.

And it shapes how they approach getting better: wanting to be rid of every last trace of dislike of vomiting, immediately and completely, and counting anything less as failure. You do not want to put that kind of pressure on yourself. Build the knowledge and the skills steadily, and let the changes be permanent ones.

Blips, and what you do with them

Because of the perfectionism, it is very common to overreact to a small wobble while working through the programme: I’ve ruined everything, I’m so stupid, I’m never going to get better. Beating yourself up like that is enough on its own to maintain emetophobia, because it drags in every other thinking style and belief you have. So stop it. Give yourself a break and tolerate the blips.

You are going to have good days and not-so-good days over the coming weeks. You will feel you are getting somewhere, then create a bad day. Put up with it; it is par for the course. Early on you will not catch every unhelpful thought, so there will still be some anxiety about sickness. Calm yourself down, remind yourself that blips are part of it, and move on. Everybody has them — including people who are completely thriving. What matters is how you react.

The drawing shows four days in the life of an emetophobe going through this programme. At (1) they are steadily improving, up to (2) where they have a bit of a blip. There they have two choices: they either manage their thinking and emotions well and get over it, or they tear the arse out of it and create a three-day catastrophe. If they prevent themselves from over-reacting at (2), they are out of the blip within ten to thirty minutes and lose no forward momentum (3).

Overreact, and the emotional reaction can be enormous. They go from being happy, positive, in control and really beginning to change their limiting beliefs, to feeling totally worthless, hopeless and stupid — so low that they can temporarily become worse than they have been in a long time. At (4) they are really beating themselves up: I’ve fucked this up, this isn’t working, I’m never going to get over this bloody thing, I’m so stupid. Sooner or later — the maximum is usually about three days — they run out of energy to keep berating themselves and stop. The moment they stop, the mood lifts, the effort goes back in and they get better; it is completely inevitable. The shaded area (5) is those three days of feeling like an abject failure — three days that could have been three minutes.

What to do about it

Work on the perfectionist thinking itself and the blips get smaller and rarer. That work is set out step by step in the Emetophobia-Free manual, which plenty of people use on their own to overcome the phobia entirely. If you would like somebody alongside you, find a licensed coach here.