What is emetophobia?

The many names for it

Emetophobia, Specific Phobia of Vomiting, SPOV, vomit phobia, sickness phobia, a fear of being sick — all the same thing. Some people fear being sick themselves, some fear seeing anyone else be sick, and plenty fear both.

It rarely arrives on its own. It sits alongside a fear of gagging, swallowing or choking, a fear of pregnancy, social anxiety, and obsessive thinking. Quite often somebody is treated for OCD or an eating disorder for years before anyone notices that a fear of vomiting is underneath it.

A dislike of being sick is not a phobia

Almost nobody enjoys vomiting. The difference is what happens in the mind around it.

For someone with emetophobia, the possibility of being sick — or of being near someone who is — produces real anxiety and a constant, exhausting effort to make sure it cannot happen. That effort is the phobia: the scanning, the checking, the avoiding, the planning.

It is widely misunderstood, and most sufferers say nothing, because they expect to be told they are making a fuss. That is why it is often called the secret phobia.

What it looks like day to day

It shows up as avoidance and as rituals. Public transport is avoided. Alcohol is limited or cut out entirely, and pubs and clubs with it, in case somebody else is sick. Hygiene becomes a project: hand washing, sanitising, cleaning surfaces.

Food narrows down to what feels safe — often bland, beige, nothing prepared by anyone else, nothing eaten out, use-by dates checked and double-checked, everything cooked through.

Work and school get missed, either from fear of catching something or because the anxiety has simply taken over. Medication with any chance of nausea gets refused.

A fear of pregnancy is common, because of the morning sickness, and some people avoid pregnancy altogether because of it. Those who do have children often live in dread of them being ill, and can feel completely unable to care for them when they are.

Left to run, that avoidance tends to pull in other problems alongside it — restrictive eating, ARFID, anorexia, OCD.

How common it is

Nobody can say precisely, because there has never been a large-scale survey of it. The studies that exist put it anywhere between 0.1% and 8.8% of the population, and the gap is mostly a question of whether the researchers counted any fear of vomiting or only a severe phobia. On the wider figure that is up to 30 million people in the United States alone.

What is certain is that the number is far higher than the number of people talking about it. We ran the first Emetophobia Awareness Day in 2014 for exactly that reason.

Most people have been told it is hard to treat

Veale and Lambrou (2006) found that 29% of the vomit phobics in their sample had had some form of therapy for the fear, and rated it as largely ineffective. They noted that clinicians generally regard it as difficult to treat, with high drop-out and poor response.

It is not hard to treat. It is hard to treat if you go after the vomiting, because the vomiting is not what the fear is about. Underneath it is a powerful need to feel in control, propped up by particular thinking styles and beliefs — and those can be changed. Here is what effective treatment looks like.

If this sounds like you

You are not unusual, and you are not stuck with it. Thousands of people have worked through this programme and come out the other side — some with a coach, plenty on their own with the manual. The recovery stories are worth half an hour of anyone’s time.