Why does social anxiety play such a big part in emetophobia?

Social anxiety plays a big role in the development and maintenance of emetophobia, but it isn’t a concept that’s likely crossed many emetophobes’ minds. Social anxiety is often misinterpreted as being shy or introverted — ‘I go to parties, I chat to everyone, I manage a successful team at work, how can I be socially anxious?’

What is social anxiety?

Fundamentally, social anxiety is a fear of embarrassment and being judged. As well as social anxiety, emetophobes also have (to a greater or lesser extent) perfectionism and low self-esteem. The three feed off each other. If you have low self-esteem, you’re likely to also have social anxiety. If you’re a perfectionist, you’re likely to have very high standards and berate yourself for not reaching them, which leads to low self-esteem.

Taking this into account, social anxiety is a massive projection of how you feel about yourself right now. If you have low self-esteem and berate yourself all the time, criticising every flaw on your face or cringing every time you say something ‘stupid’, you’re likely going to think everyone is thinking the same and judging you! But it’s important to recognise that it is not based on actually being judged.

Think about a part of your body that you like. Maybe you like your legs, or your hair, or your hands. How often do you worry what other people think about that part? Likely never, right? But if you feel particularly insecure about one bit of your body, you’re likely to feel self-conscious about it and think everyone is judging you and thinking the same.

Social anxiety in emetophobes

A key part of emetophobia is social anxiety about throwing up in public. Research has shown that people with a fear of being sick feel more anxious about vomiting in public than in the privacy of their own home. A lot of sufferers we treat say how ‘embarrassing’ it would be to vomit in public, fearing that people would judge them and find them ‘disgusting’.

How can I build social confidence?

You may be the most sociable person in the room and still experience social anxiety. It’s all a belief about you right now. So you need to identify areas where you feel socially anxious and build up your coping skills in them. Rob gives the example of a woman he took through the programme who challenged her social anxiety by wearing odd socks to work every day for a week. She felt uncomfortable and awkward at first, but tolerated that discomfort — and by the end of it, she didn’t care!

It’s important not to run before you walk. Don’t push yourself too far or you’ll overwhelm yourself. As perfectionists, you’re going to want to jump straight into doing a presentation in front of a thousand people to ‘challenge’ your social anxiety. This is entirely unrealistic and unhelpful. To change a belief, you need to take small steps. Why not start off by doing a presentation in front of one person, then 5, 6, 10, 100?

The key antidote for low self-esteem, social anxiety and perfectionism is being kind and loving to yourself. What would you say to your best friend who stepped out of their comfort zone? However small it may seem, I bet you’d be pretty proud of them!

This episode featured discussion between Joe Manuel and Rob Kelly.