My name is Anna Christie and I have created this little website to provide facts and information for sufferers of emetophobia (fear of vomiting), their doctors, therapists and family members.
I have a B.A. from the University of Waterloo (1979), an M.Div.from Vancouver School of Theology (1989) and a Graduate Diploma from Living Systems: Counselling, Education and Research, Vancouver (2005). I am an ordained clergyperson and psychotherapist in Vancouver, BC, Canada. I provide counselling for individuals and their families in the area of anxiety disorders, in particular emetophobia. I suffered severe debilitating emetophobia for over 30 years, and have been successfully treated. I have led a normal life with career and family for over 20 years, and for the past five years have suffered no symptoms of anxiety whatsoever.
I am also the author of Evoking Change: Make a Difference in your Life and in the World (iUniverse, 2007)
The column to your right lists the articles on this website, which is in blog format for simplicity of setup. You cannot leave a comment on this blog, and I may never add to its contents.
All the best to you in your life journey!
Anna
Monday, July 9, 2007
FAQs
SAGE’S FAQs
Following are a list of questions (and my answers) asked by real emetophobic people on the International Emetophobia Society website/discussion forum:
ON BEING AFRAID TO BE CURED, LEST YOU GET SICK MORE
QUESTION: I was thinking about why it is so hard to cure emetophobia...and I realized there is a huge part of me afraid of being cured, because if I am cured and not so aware of my phobia all the time, then that could mean I could V* because I wouldn't be so careful...does that make sense to anyone?
ANSWER: Yes, this sort of thinking "makes sense" in the phobic way of making sense - lol! Let me put to rest for everyone that I've been cured of the fear of vomiting myself for about 20 years, and have only vomited once in that time, when VERY VERY ILL with chemotherapy, and the experience was a big fat nothing that didn't matter to me in the least. In fact, I wondered why the hell I had given up so many billions of hours of my life to worrying about it! Even in the past 6 years of being totally completely anxiety-free...I don't lead some sort of filthy disease-ridden lifestyle. I'm still clean and I don't eat chili that's been out on the counter all night or anything. I don't get sick any more or less than when I was phobic.
But others have alluded to the real point: your worst problem is NOT the fact that you might vomit one day. Your worst problem is ANXIETY - the fear of it! THIS is what you want to stop...(honestly, you do - you just don't know that you do - lol) You don't really want to stop vomiting. Vomiting is just normal and natural and slightly unpleasant but over in about 5 seconds.
The thing is, to help yourself from having your whole life ruined by this phobia, it's important to keep telling your brain the real truth. That is, that it's NOT logical to think you need to have a debilitating phobia forever in order not to get sick, and that somehow you're better off in this life with a horrible anxiety disorder. That makes no sense. One part of your brain (the fear part) is fighting like hell to tell another part of your brain (the logical part) that you MUST STAY AFRAID in order to protect yourself. In order to be cured of the phobia, the logical part of your brain has to learn to "speak louder" than the fear part. [for those of you interested in the science, the fear part = the amygdala and the logical part = the neocortex]
WHAT TO SAY TO YOUR THERAPIST WHEN THEY ASK WHAT EXACTLY YOU'RE AFRAID OF
Print this out and read it to your therapist, or copy and adjust it for yourself and then print it out and read it:
"I thought about what you asked me in reference to what exactly I'm afraid of if I vomit, and it's like this:
I don't have any thought in my head at all...it's a pure fear response. For some reason vomiting, or even the thought of it, triggers absolute terror and horror for me. It's like a fate worse than death. I panic like I'm dying.
I know that's not logical, but...it's obviously not the logical part of my brain at work, then, is it? Tell my amygdala that it's not logical. All I know is that the thought of vomiting is so terrifying for me that I obsess over it day and night, and it is ruining my life. The number of situations I have to avoid to cope with this fear are mind-bogglingly numerous. Although there may be other aspects to my state of anxiety, what I really want to do is to address this horrible and debilitating phobia first, and deal with whatever else comes up later. Do you think you can help me with it, or should I look for someone else?"
HOW DID WE GET THIS PHOBIA?
QUESTION: I am sorry if this has been asked before but I really would like to know why and how we develop phobias? I know it sounds a silly question but I would just like to know why some people are deeply affected by things and others not. I mean, I really hate spiders but my fear of them is nothing compared to the way I feel about v*!
ANSWER: It is different with everyone, to a degree. What we have in common is that phobias are the result of a "perfect storm" of things coming together. Every psychologist out there who study anxiety disorders agrees that there is no one single cause. Whatever "trauma" we had in childhood with vomiting (such as having food poisoning, or someone getting sick on/near you) does not cause emetophobia in every child. That is because there are other factors at play.
Things like the family's stress level, and how our families handle stress is very influential. Grief and loss, abuse, trauma and anxious parents (particularly mothers) are factors as well. Heredity could play a part, but it's not everything. No gene has ever been found for anxiety/phobia
No matter what led to our phobias, the "cure" is the same...good, solid therapy over a long term which usually involves gradual exposure to the stimulus in a safe environment and avoids re-traumatization (such as saying that the client has to vomit himself to get over it). If it's very very serious then medication might be helpful as well. In any case, there's no need to spend a lot of energy worrying about the cause. Spend your energy on your treatment instead.
DO I NEED TO VOMIT IN ORDER TO BE CURED OF THIS PHOBIA?
ANSWER: This is such a ridiculous notion that I can't believe some therapists actually still suggest it. My advice is to ask THEM the following question in response: "Do you think it's also necessary for victims of sexual abuse to have a goal of experiencing non-consensual sex again in order to get over their anxiety?" In my opinion, it's about the same thing. So is saying that those afraid of heights need to try jumping off a building, or those with flying phobias need to be in a plane crash.
Now let me give your therapist a break for a minute: therapists get this idea because they do not fully understand just HOW AFRAID of vomiting you are. To them, don't forget, vomiting is a big fat nothing...so why not give it a try with ipecac or something and see what happens. But to YOU, it's akin to death, a plane crash, or rape. It really is. You need to get your therapist to LISTEN TO YOU. Keep trying that. If, after a while, they don't listen then FIND ANOTHER ONE WHO DOES. Listening is #1.
NEVER agree to a course of treatment that terrifies you. It will NOT WORK, and it may make your phobia worse. You are in the 'driver's seat' in your therapy. You call all the shots.
WHY IS ANTICIPATORY ANXIETY SO MUCH WORSE THAN ACTUALLY VOMITING? (WHEN I VOMIT, I SEEM TO BE ACTUALLY CALM...BUT THEN THE PHOBIA COMES BACK LATER.)
ANSWER: It's the anticipatory anxiety that is the killer. It's a strange phenomenon, and not "logical" which drives most human beings nuts. We think our logic is the only part of our brain operating, but the brain is just so complicated. The "danger" system in the brain (amygdala) will respond to logic, but 1) not quickly [i.e., over only a long period of time] and 2) not when continually stimulated. So if you're IN a situation where you're terrified, logic just shuts down. You can agree to it and hear it, but it won't stop the fear response. That's why you need to "play with it" /practice gradually...very VERY slowly...i.e., gradual desensitization.
Once you're actually DOING the thing you fear, then all the parts of the brain agree: hey - this isn't dangerous! However a day later, that silly amygdala [fear centre] will start right up again playing tricks on the neo-cortex [logic centre].
Maybe if folks read this post like, a hundred times a day, then it would start to sink in...but maybe not! That's where setting up a treatment program with a therapist really helps.
ARE THESE SCAMS? CUREEMETOPHOBIA.COM AND CHANGETHATSRIGHT.COM AND ANYONE ELSE WHO CLAIMS TO CURE EVERY PHOBIA OVER THE PHONE, OR IN 24 HOURS, OR IN 6 SESSIONS.
At best, they're simply things that don't work. At worst, some of them are absolute scams. Go to their websites and scroll down to the bottom and click on another phobia. The "cure" will be exactly the same thing. Many also claim to treat you until you're better or your money back. But they never give anyone their money back - they just claim you didn't do your homework (which is always something impossible in the end - like drinking ipecac!)
The main thing to remember when assessing treatments is that phobias are not genetic. No gene has ever been found that is a "phobia" gene. This means that although there are multiple factors contributing to an onset of a phobia, they are ALL formed, somehow in relationship. That means they can only be cured, ultimately, in relationship. Milder phobias can be treated quite well with the person working on gradual exposure by himself, but the underlying anxiety doesn't generally go away - it resurfaces somewhere else. But severe phobias cannot be treated with a book or a set of videos or by talking to someone on the phone. And they REALLY can't be treated in 24 hours or even 10 sessions....they took far too long to form to be "fixed" quickly.
Sorry, I'm ranting about this. I hate those guys....!
WHAT ABOUT HYPNOSIS? OR TFT (THOUGHT-FIELD-THERAPY....TAPPING)?
There is nothing about either of these that is a "scam"...what you have to watch out for is people who claim they can "fix you quickly" - like with ONE session of hypnosis or whatever. Hypnosis can be an important part of an overall treatment program - and it is not harmful. Qualified therapists will do it, so you're not being scammed for money or anything. I never underwent hypnosis in my treatment, although my therapist wanted to try it...simply because I was afraid of it. I got successfully treated anyway.
We did do TFT, and it was helpful for many things, but didn't make a dent in the phobia. Others may have a different experience.
The reason I caution about these things is that I don't want folks to become "victims" of insecure therapists (and there are some) who try to blame YOU if one of these quick-fixes doesn't work. Slow and steady wins the race. Keep plugging away in therapy at the underlying relationship issues (i.e., family, childhood) and working on changing cognitions and gradually exposing yourself (VERY gradually) to the stimulus. Talk about emotions, and try to re-experience them in a safe, helpful relationship with the therapist. Work on this over a good long period of time and you'll get results. There are no "quick fixes" in life.
WHAT ARE WE ACTUALLY THINKING (WILL HAPPEN)? WHAT IS REALLY GOING ON IN OUR BRAINS?
For me, I finally figured out that my thought was "if they vomit, then I will too, and then I will die". And when I say thought, I mean that quite loosely. Not even a thought...more of an instantaneous association in my brain. As an educated, intelligent woman with a lot of knowledge about the brain I knew I would not die – of course! I knew I would not go crazy, or have a heart attack. I knew it for a fact. But the “I” in that sentence was my neocortex (thinking brain)… my amygdala (fear centre of the brain) did not “know” it. There’s nothing worse for a phobic than to be treated like a stupid idiot. As though we’re somehow just not “rational”.
One of the problems with CBT people who are big on the "c" (cognitive) is that they believe that if you ONLY think differently that it will change your fear response. And while that is an important part of it, and works very well with milder phobias, it can be pretty useless information to an extreme phobic. I have said this to a psych theorist: "you're telling this information to my neocortex (the "thinking"/logic part of the brain). But can you please figure out a way to tell it to my amygdala? (the fear centre)”
The neocortex and amygdala are quite separate and distinct in the brain. And yes, the neocortex can send a message to the amygdala, but the problem is that the amygdala works faster sending the info the other way. So by the time the "logic" message gets to the amygdala, it has already fired off another "oh my God I'm in terrible danger and I'm going to die" message to the neocortex. ALSO…when the amygdala is rapidly firing DANGER! DANGER! the neocortex can just about completely shut down. This is called “dissociation” – it feels like you’re in a fog, or things aren’t real. I really think this is the problem with emetophobia and other very severe phobias.
For me, I worked away with the 'b' part of cbt - "behavior" - gradual exposure - until I was able to slow down that fear response enough to insert a cognition. The cognition was "I'm not in any danger". Also things like "nothing is happening to me; I'm fine. I'm perfectly safe; I'm afraid, but I'm ok; This is just a body response; It doesn't matter. This is not a big deal." ..........these worked quite well for me over time.
WHAT ABOUT CHILDHOOD "TRUAMA"? ...AND WHAT EFFECT COULD A TRAUMA POSSIBLY HAVE THAT I CAN'T EVEN REMEMBER??
I know there are lots of ideologies out there on phobia, so I'll just give you mine and you can do what you want with it.
I believe that "trauma" is a word that is more encompassing than most people think. We often think of something horribly heinous when we use the word trauma. Yet to child development psychologists and those who study the effects of trauma on the brain, this is not so. Birth itself is a trauma. Most people can overcome this trauma with a secure attachment to their mother. You may not have had this secure attachment at a young age. So you were further "traumatized" as an infant. And while you can't remember it with the logic/language part of your brain your body remembers it. The oldest part of our brains, from an evolutionary perspective, is the amygdala which is responsible for creating "wiring" to respond to danger. An infant with no mother is the biggest danger there is - think about it. If you are an infant and have no mother, you will die very quickly...especially in ancient times, when this part of our brains was "created". Once you reach 3 years of age, you can link together events in "memory", but before this age you cannot. However, the WIRING is still there connecting the fear response to certain triggers. With phobia, some other thing gets associated with that neuro-pathway (like vomiting). Don't ask me why. Nobody knows. For you it's vomiting, for someone else it's another anxiety of some type. In ideal conditions from 3 months on, you might have had no effect whatsoever of the early trauma. But other factors (which you may or may not ever discover) added up to a bouncing baby phobia for you.
Think about it: if a baby were beaten and raped every day from birth to age 3, then "rescued", do you really think that kid would be ok just because they can't remember it? I promise you, even in the most loving home afterward, the child/adult would be permanently damaged beyond belief. In fact, the odds are about 99% that they would become some sort of murderer, completely incapable of forming attachments with anyone or having any kind of conscience. Now granted, this is nothing like what happened to you, but the idea that the body remembers what the "mind" can't is still true.
I don't believe that this is Freudian, by the way. Freud's beliefs are complicated and mainly rest in the unconscious...the idea that you hate your mother, compete for your father, need sexual comfort and avoid death. This has nothing to do with what your therapist is talking about. Although ALL therapy relates, one way or another, to Freud's discoveries about our early experience influencing our lives somehow. Your therapist's beliefs are based on solid research that is pretty standard and universal these days. Rather than Freud, look to the universally accepted work of John Bowlby on attachment, and also Victor Janov. Ask your therapist about these great thinkers of our time. I would also recommend Leslie Greenburg's work. That's if you feel like reading up on trauma, anxiety and emotion.
I always say that the good news is that it doesn't matter WHAT factors contributed to your phobia - adoption, anxious families, sexual abuse, etc...because the cure is the same. And the cure begins with feeling safe with your therapist, and then gradually (either through imagination, talking, or visually) being exposed to that which you fear, and re-writing the outcome [i.e., you're safe]. The idea is to create new synaptic connections in the brain that spell this: VOMIT DOES NOT = DANGER. Right now you've got VOMIT = DANGER going on.
It's true that sometimes therapists go down roads that are out to lunch. Indeed, you have to feel comfortable with the course of treatment - you're in the driver's seat at all times. However, offering a theory related to early trauma is NOT the same thing, in my humble and educated opinion, as suggesting something happened to you that didn't (such as sexual abuse). I, too, have been the "victim" of a silly therapist who tried to suggest I was sexually abused when I was not, and that something else happened to me other than what I was reporting when it did not. This is NOT THE SAME THING as your therapist talking to you about your ACTUAL experience, which YOU reported.
I would suggest asking your THERAPIST the questions you've asked here - esp. about how trauma affects the brain/body when you can't remember it. Take one session to chat about theory so you feel more comfortable with it.
In summary, I think as long as you like and trust your therapist, you're on the right track.
THE 5TH MOST COMMON PHOBIA? REALLY?
THEN WHY HASN'T ANYONE HEARD OF IT?
I did a fair bit of research myself a couple of years ago about emetophobia, although I wasn't all that interested in its statistical incidence. So here goes:
According to the National Institute of Mental Health (USA) approximately 6.3% of Americans suffer from some kind of phobia. "Fearing vomiting" is absolutely NOT a phobia...it's just what a lot of people think, but they never think about vomiting until an hour or less before they do it...when they may be nervous. This has nothing to do with emetophobia.
Phobias in order of "most common" according to the DSM-IV (Diagnostic and Statistical Manual - the "handbook" of diagnosing all psychiatric disorders)
Animals (snakes, dogs, spiders, bugs, etc. etc.)
Nature (heights, tornadoes, thunder, water, germs, etc. etc. etc.)
Blood-injection-injury (blood, needles, surgery, etc. etc.)
Situational (flying, bridges, driving, elevators, shopping, etc. etc. )
Other (choking, vomiting, loud sounds or costumed characters + approximately 3 THOUSAND other misc. things)
The italics are mine. So although emetophobia is listed under the 5th most common, there are actually dozens of phobias MORE COMMON than emetophobia.
We all know that most phobias fall under the first four types - as they certainly get the most "press". They probably represent about 95% of all phobias. That only leaves about 1/2M people will all "other" phobias. I suggest that since vomiting is actually listed in the DSM-IV TR along with 3 other subtypes then we can safely say that the incidence is higher than the several thousand phobias that are not listed. My guess would be that about 20,000 people in the USA suffer from emetophobia....(and it's only a guess) This site has seen about 2-3,000 members, which is 10-15% which is consistent with other statistics of people who seek information or help on the internet. (Many more people would have come here, but not joined).
The other thing to consider is just common sense. This phobia is rare! Most doctors, therapists and the average Joe have NEVER HEARD OF IT.
THE GOOD NEWS
1) Although emetophobia is rare, many MANY people have it. Many people also fear clowns, choking, and several other things that folks think are ridiculous or rare. You are not a "freak" if you have emetophobia. It's something that can happen, and in your life it "made sense" somehow.
2) Emetophobia, and ALL phobias are treatable. It doesn't matter if your therapist has never heard of it, because phobic brains are all the same - it's just the stimulus that's different. The thing to remember when you talk to your therapist about it is that it can be a very SEVERE phobia. And they may not realize this when they design a treatment plan. But they can learn about it, and you can help them. Although it can be tricky to treat, it's possible. Think about it - how easy is it to gradually expose oneself to flying? (not!) But people get treated every day for both kinds.
Following are a list of questions (and my answers) asked by real emetophobic people on the International Emetophobia Society website/discussion forum:
ON BEING AFRAID TO BE CURED, LEST YOU GET SICK MORE
QUESTION: I was thinking about why it is so hard to cure emetophobia...and I realized there is a huge part of me afraid of being cured, because if I am cured and not so aware of my phobia all the time, then that could mean I could V* because I wouldn't be so careful...does that make sense to anyone?
ANSWER: Yes, this sort of thinking "makes sense" in the phobic way of making sense - lol! Let me put to rest for everyone that I've been cured of the fear of vomiting myself for about 20 years, and have only vomited once in that time, when VERY VERY ILL with chemotherapy, and the experience was a big fat nothing that didn't matter to me in the least. In fact, I wondered why the hell I had given up so many billions of hours of my life to worrying about it! Even in the past 6 years of being totally completely anxiety-free...I don't lead some sort of filthy disease-ridden lifestyle. I'm still clean and I don't eat chili that's been out on the counter all night or anything. I don't get sick any more or less than when I was phobic.
But others have alluded to the real point: your worst problem is NOT the fact that you might vomit one day. Your worst problem is ANXIETY - the fear of it! THIS is what you want to stop...(honestly, you do - you just don't know that you do - lol) You don't really want to stop vomiting. Vomiting is just normal and natural and slightly unpleasant but over in about 5 seconds.
The thing is, to help yourself from having your whole life ruined by this phobia, it's important to keep telling your brain the real truth. That is, that it's NOT logical to think you need to have a debilitating phobia forever in order not to get sick, and that somehow you're better off in this life with a horrible anxiety disorder. That makes no sense. One part of your brain (the fear part) is fighting like hell to tell another part of your brain (the logical part) that you MUST STAY AFRAID in order to protect yourself. In order to be cured of the phobia, the logical part of your brain has to learn to "speak louder" than the fear part. [for those of you interested in the science, the fear part = the amygdala and the logical part = the neocortex]
WHAT TO SAY TO YOUR THERAPIST WHEN THEY ASK WHAT EXACTLY YOU'RE AFRAID OF
Print this out and read it to your therapist, or copy and adjust it for yourself and then print it out and read it:
"I thought about what you asked me in reference to what exactly I'm afraid of if I vomit, and it's like this:
I don't have any thought in my head at all...it's a pure fear response. For some reason vomiting, or even the thought of it, triggers absolute terror and horror for me. It's like a fate worse than death. I panic like I'm dying.
I know that's not logical, but...it's obviously not the logical part of my brain at work, then, is it? Tell my amygdala that it's not logical. All I know is that the thought of vomiting is so terrifying for me that I obsess over it day and night, and it is ruining my life. The number of situations I have to avoid to cope with this fear are mind-bogglingly numerous. Although there may be other aspects to my state of anxiety, what I really want to do is to address this horrible and debilitating phobia first, and deal with whatever else comes up later. Do you think you can help me with it, or should I look for someone else?"
HOW DID WE GET THIS PHOBIA?
QUESTION: I am sorry if this has been asked before but I really would like to know why and how we develop phobias? I know it sounds a silly question but I would just like to know why some people are deeply affected by things and others not. I mean, I really hate spiders but my fear of them is nothing compared to the way I feel about v*!
ANSWER: It is different with everyone, to a degree. What we have in common is that phobias are the result of a "perfect storm" of things coming together. Every psychologist out there who study anxiety disorders agrees that there is no one single cause. Whatever "trauma" we had in childhood with vomiting (such as having food poisoning, or someone getting sick on/near you) does not cause emetophobia in every child. That is because there are other factors at play.
Things like the family's stress level, and how our families handle stress is very influential. Grief and loss, abuse, trauma and anxious parents (particularly mothers) are factors as well. Heredity could play a part, but it's not everything. No gene has ever been found for anxiety/phobia
No matter what led to our phobias, the "cure" is the same...good, solid therapy over a long term which usually involves gradual exposure to the stimulus in a safe environment and avoids re-traumatization (such as saying that the client has to vomit himself to get over it). If it's very very serious then medication might be helpful as well. In any case, there's no need to spend a lot of energy worrying about the cause. Spend your energy on your treatment instead.
DO I NEED TO VOMIT IN ORDER TO BE CURED OF THIS PHOBIA?
ANSWER: This is such a ridiculous notion that I can't believe some therapists actually still suggest it. My advice is to ask THEM the following question in response: "Do you think it's also necessary for victims of sexual abuse to have a goal of experiencing non-consensual sex again in order to get over their anxiety?" In my opinion, it's about the same thing. So is saying that those afraid of heights need to try jumping off a building, or those with flying phobias need to be in a plane crash.
Now let me give your therapist a break for a minute: therapists get this idea because they do not fully understand just HOW AFRAID of vomiting you are. To them, don't forget, vomiting is a big fat nothing...so why not give it a try with ipecac or something and see what happens. But to YOU, it's akin to death, a plane crash, or rape. It really is. You need to get your therapist to LISTEN TO YOU. Keep trying that. If, after a while, they don't listen then FIND ANOTHER ONE WHO DOES. Listening is #1.
NEVER agree to a course of treatment that terrifies you. It will NOT WORK, and it may make your phobia worse. You are in the 'driver's seat' in your therapy. You call all the shots.
WHY IS ANTICIPATORY ANXIETY SO MUCH WORSE THAN ACTUALLY VOMITING? (WHEN I VOMIT, I SEEM TO BE ACTUALLY CALM...BUT THEN THE PHOBIA COMES BACK LATER.)
ANSWER: It's the anticipatory anxiety that is the killer. It's a strange phenomenon, and not "logical" which drives most human beings nuts. We think our logic is the only part of our brain operating, but the brain is just so complicated. The "danger" system in the brain (amygdala) will respond to logic, but 1) not quickly [i.e., over only a long period of time] and 2) not when continually stimulated. So if you're IN a situation where you're terrified, logic just shuts down. You can agree to it and hear it, but it won't stop the fear response. That's why you need to "play with it" /practice gradually...very VERY slowly...i.e., gradual desensitization.
Once you're actually DOING the thing you fear, then all the parts of the brain agree: hey - this isn't dangerous! However a day later, that silly amygdala [fear centre] will start right up again playing tricks on the neo-cortex [logic centre].
Maybe if folks read this post like, a hundred times a day, then it would start to sink in...but maybe not! That's where setting up a treatment program with a therapist really helps.
ARE THESE SCAMS? CUREEMETOPHOBIA.COM AND CHANGETHATSRIGHT.COM AND ANYONE ELSE WHO CLAIMS TO CURE EVERY PHOBIA OVER THE PHONE, OR IN 24 HOURS, OR IN 6 SESSIONS.
At best, they're simply things that don't work. At worst, some of them are absolute scams. Go to their websites and scroll down to the bottom and click on another phobia. The "cure" will be exactly the same thing. Many also claim to treat you until you're better or your money back. But they never give anyone their money back - they just claim you didn't do your homework (which is always something impossible in the end - like drinking ipecac!)
The main thing to remember when assessing treatments is that phobias are not genetic. No gene has ever been found that is a "phobia" gene. This means that although there are multiple factors contributing to an onset of a phobia, they are ALL formed, somehow in relationship. That means they can only be cured, ultimately, in relationship. Milder phobias can be treated quite well with the person working on gradual exposure by himself, but the underlying anxiety doesn't generally go away - it resurfaces somewhere else. But severe phobias cannot be treated with a book or a set of videos or by talking to someone on the phone. And they REALLY can't be treated in 24 hours or even 10 sessions....they took far too long to form to be "fixed" quickly.
Sorry, I'm ranting about this. I hate those guys....!
WHAT ABOUT HYPNOSIS? OR TFT (THOUGHT-FIELD-THERAPY....TAPPING)?
There is nothing about either of these that is a "scam"...what you have to watch out for is people who claim they can "fix you quickly" - like with ONE session of hypnosis or whatever. Hypnosis can be an important part of an overall treatment program - and it is not harmful. Qualified therapists will do it, so you're not being scammed for money or anything. I never underwent hypnosis in my treatment, although my therapist wanted to try it...simply because I was afraid of it. I got successfully treated anyway.
We did do TFT, and it was helpful for many things, but didn't make a dent in the phobia. Others may have a different experience.
The reason I caution about these things is that I don't want folks to become "victims" of insecure therapists (and there are some) who try to blame YOU if one of these quick-fixes doesn't work. Slow and steady wins the race. Keep plugging away in therapy at the underlying relationship issues (i.e., family, childhood) and working on changing cognitions and gradually exposing yourself (VERY gradually) to the stimulus. Talk about emotions, and try to re-experience them in a safe, helpful relationship with the therapist. Work on this over a good long period of time and you'll get results. There are no "quick fixes" in life.
WHAT ARE WE ACTUALLY THINKING (WILL HAPPEN)? WHAT IS REALLY GOING ON IN OUR BRAINS?
For me, I finally figured out that my thought was "if they vomit, then I will too, and then I will die". And when I say thought, I mean that quite loosely. Not even a thought...more of an instantaneous association in my brain. As an educated, intelligent woman with a lot of knowledge about the brain I knew I would not die – of course! I knew I would not go crazy, or have a heart attack. I knew it for a fact. But the “I” in that sentence was my neocortex (thinking brain)… my amygdala (fear centre of the brain) did not “know” it. There’s nothing worse for a phobic than to be treated like a stupid idiot. As though we’re somehow just not “rational”.
One of the problems with CBT people who are big on the "c" (cognitive) is that they believe that if you ONLY think differently that it will change your fear response. And while that is an important part of it, and works very well with milder phobias, it can be pretty useless information to an extreme phobic. I have said this to a psych theorist: "you're telling this information to my neocortex (the "thinking"/logic part of the brain). But can you please figure out a way to tell it to my amygdala? (the fear centre)”
The neocortex and amygdala are quite separate and distinct in the brain. And yes, the neocortex can send a message to the amygdala, but the problem is that the amygdala works faster sending the info the other way. So by the time the "logic" message gets to the amygdala, it has already fired off another "oh my God I'm in terrible danger and I'm going to die" message to the neocortex. ALSO…when the amygdala is rapidly firing DANGER! DANGER! the neocortex can just about completely shut down. This is called “dissociation” – it feels like you’re in a fog, or things aren’t real. I really think this is the problem with emetophobia and other very severe phobias.
For me, I worked away with the 'b' part of cbt - "behavior" - gradual exposure - until I was able to slow down that fear response enough to insert a cognition. The cognition was "I'm not in any danger". Also things like "nothing is happening to me; I'm fine. I'm perfectly safe; I'm afraid, but I'm ok; This is just a body response; It doesn't matter. This is not a big deal." ..........these worked quite well for me over time.
WHAT ABOUT CHILDHOOD "TRUAMA"? ...AND WHAT EFFECT COULD A TRAUMA POSSIBLY HAVE THAT I CAN'T EVEN REMEMBER??
I know there are lots of ideologies out there on phobia, so I'll just give you mine and you can do what you want with it.
I believe that "trauma" is a word that is more encompassing than most people think. We often think of something horribly heinous when we use the word trauma. Yet to child development psychologists and those who study the effects of trauma on the brain, this is not so. Birth itself is a trauma. Most people can overcome this trauma with a secure attachment to their mother. You may not have had this secure attachment at a young age. So you were further "traumatized" as an infant. And while you can't remember it with the logic/language part of your brain your body remembers it. The oldest part of our brains, from an evolutionary perspective, is the amygdala which is responsible for creating "wiring" to respond to danger. An infant with no mother is the biggest danger there is - think about it. If you are an infant and have no mother, you will die very quickly...especially in ancient times, when this part of our brains was "created". Once you reach 3 years of age, you can link together events in "memory", but before this age you cannot. However, the WIRING is still there connecting the fear response to certain triggers. With phobia, some other thing gets associated with that neuro-pathway (like vomiting). Don't ask me why. Nobody knows. For you it's vomiting, for someone else it's another anxiety of some type. In ideal conditions from 3 months on, you might have had no effect whatsoever of the early trauma. But other factors (which you may or may not ever discover) added up to a bouncing baby phobia for you.
Think about it: if a baby were beaten and raped every day from birth to age 3, then "rescued", do you really think that kid would be ok just because they can't remember it? I promise you, even in the most loving home afterward, the child/adult would be permanently damaged beyond belief. In fact, the odds are about 99% that they would become some sort of murderer, completely incapable of forming attachments with anyone or having any kind of conscience. Now granted, this is nothing like what happened to you, but the idea that the body remembers what the "mind" can't is still true.
I don't believe that this is Freudian, by the way. Freud's beliefs are complicated and mainly rest in the unconscious...the idea that you hate your mother, compete for your father, need sexual comfort and avoid death. This has nothing to do with what your therapist is talking about. Although ALL therapy relates, one way or another, to Freud's discoveries about our early experience influencing our lives somehow. Your therapist's beliefs are based on solid research that is pretty standard and universal these days. Rather than Freud, look to the universally accepted work of John Bowlby on attachment, and also Victor Janov. Ask your therapist about these great thinkers of our time. I would also recommend Leslie Greenburg's work. That's if you feel like reading up on trauma, anxiety and emotion.
I always say that the good news is that it doesn't matter WHAT factors contributed to your phobia - adoption, anxious families, sexual abuse, etc...because the cure is the same. And the cure begins with feeling safe with your therapist, and then gradually (either through imagination, talking, or visually) being exposed to that which you fear, and re-writing the outcome [i.e., you're safe]. The idea is to create new synaptic connections in the brain that spell this: VOMIT DOES NOT = DANGER. Right now you've got VOMIT = DANGER going on.
It's true that sometimes therapists go down roads that are out to lunch. Indeed, you have to feel comfortable with the course of treatment - you're in the driver's seat at all times. However, offering a theory related to early trauma is NOT the same thing, in my humble and educated opinion, as suggesting something happened to you that didn't (such as sexual abuse). I, too, have been the "victim" of a silly therapist who tried to suggest I was sexually abused when I was not, and that something else happened to me other than what I was reporting when it did not. This is NOT THE SAME THING as your therapist talking to you about your ACTUAL experience, which YOU reported.
I would suggest asking your THERAPIST the questions you've asked here - esp. about how trauma affects the brain/body when you can't remember it. Take one session to chat about theory so you feel more comfortable with it.
In summary, I think as long as you like and trust your therapist, you're on the right track.
THE 5TH MOST COMMON PHOBIA? REALLY?
THEN WHY HASN'T ANYONE HEARD OF IT?
I did a fair bit of research myself a couple of years ago about emetophobia, although I wasn't all that interested in its statistical incidence. So here goes:
According to the National Institute of Mental Health (USA) approximately 6.3% of Americans suffer from some kind of phobia. "Fearing vomiting" is absolutely NOT a phobia...it's just what a lot of people think, but they never think about vomiting until an hour or less before they do it...when they may be nervous. This has nothing to do with emetophobia.
Phobias in order of "most common" according to the DSM-IV (Diagnostic and Statistical Manual - the "handbook" of diagnosing all psychiatric disorders)
Animals (snakes, dogs, spiders, bugs, etc. etc.)
Nature (heights, tornadoes, thunder, water, germs, etc. etc. etc.)
Blood-injection-injury (blood, needles, surgery, etc. etc.)
Situational (flying, bridges, driving, elevators, shopping, etc. etc. )
Other (choking, vomiting, loud sounds or costumed characters + approximately 3 THOUSAND other misc. things)
The italics are mine. So although emetophobia is listed under the 5th most common, there are actually dozens of phobias MORE COMMON than emetophobia.
We all know that most phobias fall under the first four types - as they certainly get the most "press". They probably represent about 95% of all phobias. That only leaves about 1/2M people will all "other" phobias. I suggest that since vomiting is actually listed in the DSM-IV TR along with 3 other subtypes then we can safely say that the incidence is higher than the several thousand phobias that are not listed. My guess would be that about 20,000 people in the USA suffer from emetophobia....(and it's only a guess) This site has seen about 2-3,000 members, which is 10-15% which is consistent with other statistics of people who seek information or help on the internet. (Many more people would have come here, but not joined).
The other thing to consider is just common sense. This phobia is rare! Most doctors, therapists and the average Joe have NEVER HEARD OF IT.
THE GOOD NEWS
1) Although emetophobia is rare, many MANY people have it. Many people also fear clowns, choking, and several other things that folks think are ridiculous or rare. You are not a "freak" if you have emetophobia. It's something that can happen, and in your life it "made sense" somehow.
2) Emetophobia, and ALL phobias are treatable. It doesn't matter if your therapist has never heard of it, because phobic brains are all the same - it's just the stimulus that's different. The thing to remember when you talk to your therapist about it is that it can be a very SEVERE phobia. And they may not realize this when they design a treatment plan. But they can learn about it, and you can help them. Although it can be tricky to treat, it's possible. Think about it - how easy is it to gradually expose oneself to flying? (not!) But people get treated every day for both kinds.
Saturday, July 7, 2007
Tools for Treatment/ Desensitization/ Info
This little informational website will probably provide you with all the info you need. However, for quick reference I have made a list of resources here:
Desensitization Websites
http://www.emetophobia.bravehost.com/ [I created this website myself. It is complely safe to click on this link, if you're an emetophobic. ALL pictures and even the word you fear are behind safe, well-labelled links. The first step is as simple as looking at this word + asterisks: v****]
http://www.ratemyvomit.com/ [WARNING: This is very graphic! Emetophobes should NOT click on this link, or visit this website without first having gone through extensive therapy and consulting a professional]
Video Resource
http://www.ambassadorvideo.com/ "Exposure to Vomit" video
Information Websites
http://www.gutreaction.freeuk.com/survey-results.htm [A very interesting survey, that was well done. I don't care much for the rest of the information on this website, however.]
http://www.emetophobia.org/
Books and Articles:
Bourne, EJ. The Anxiety and Phobia Workbook, Harbinger, Oakland, 2000.
Bowen, Murray. Family Therapy in Clinical Practice, Aronson, Northvale (NJ), 1978.
Campion, J. 2003. I was so scared of being sick, I starved myself. Zest. July/03: 42-43.
Klonoff EA, Knell SM, Janata JW. 1984. Fear of nausea and vomiting: the interaction among psychosocial stressors, development transitions and adventitious reinforcement. J Clin Child Psychol 13: 263-267
Lipsitz, JD, Fyer, AJ, Paterniti, A, Klein, D. 2001. Emetophobia: Preliminary Results of an Internet Survey. Depression and Anxiety 14: 149-152.
Lydiard RB, Laraia MT, Howell EF, Ballenger JC. 1986. Can panic disorder present as irritable bowel syndrome? J Clin Psychiatry 47: 470-473.
McFayden M, Wyness J. 1983.You don’t have to be sick to be a behavior therapist but it can help: treatment of a vomit phobic. Behav Psychother 11: 173-176.
Morrison, J. DSM-IV Made Easy: The Clinician’s Guide to Diagnosis, Guildford, New York, 2001.
Phillips HC. 1985. Return of fear in the treatment of a fear of vomiting. Behav Res Ther 23: 45-52.
Desensitization Websites
http://www.emetophobia.bravehost.com/ [I created this website myself. It is complely safe to click on this link, if you're an emetophobic. ALL pictures and even the word you fear are behind safe, well-labelled links. The first step is as simple as looking at this word + asterisks: v****]
http://www.ratemyvomit.com/ [WARNING: This is very graphic! Emetophobes should NOT click on this link, or visit this website without first having gone through extensive therapy and consulting a professional]
Video Resource
http://www.ambassadorvideo.com/ "Exposure to Vomit" video
Information Websites
http://www.gutreaction.freeuk.com/survey-results.htm [A very interesting survey, that was well done. I don't care much for the rest of the information on this website, however.]
http://www.emetophobia.org/
Books and Articles:
Bourne, EJ. The Anxiety and Phobia Workbook, Harbinger, Oakland, 2000.
Bowen, Murray. Family Therapy in Clinical Practice, Aronson, Northvale (NJ), 1978.
Campion, J. 2003. I was so scared of being sick, I starved myself. Zest. July/03: 42-43.
Klonoff EA, Knell SM, Janata JW. 1984. Fear of nausea and vomiting: the interaction among psychosocial stressors, development transitions and adventitious reinforcement. J Clin Child Psychol 13: 263-267
Lipsitz, JD, Fyer, AJ, Paterniti, A, Klein, D. 2001. Emetophobia: Preliminary Results of an Internet Survey. Depression and Anxiety 14: 149-152.
Lydiard RB, Laraia MT, Howell EF, Ballenger JC. 1986. Can panic disorder present as irritable bowel syndrome? J Clin Psychiatry 47: 470-473.
McFayden M, Wyness J. 1983.You don’t have to be sick to be a behavior therapist but it can help: treatment of a vomit phobic. Behav Psychother 11: 173-176.
Morrison, J. DSM-IV Made Easy: The Clinician’s Guide to Diagnosis, Guildford, New York, 2001.
Phillips HC. 1985. Return of fear in the treatment of a fear of vomiting. Behav Res Ther 23: 45-52.
Cured of Emetophobia
© 2003 A. S. Christie
(please do not reproduce without permission)
I have been successfully treated for emetophobia, which I suffered from to an extremely serious degree for 40 years. For twenty of those years, I searched for help and was willing to do anything to be rid of this gripping terror in my life. Finally, I succeeded. Here is my story.
I'm 45 years old. My childhood was quite traumatic with my brother dying in an accident when I was 3, and my dad dying of cancer (literally throwing up to death, it seemed) when I was 9. My mother was psychotic, and always sick and expected me to look after her. Once she went into the hospital "for a rest" when I was only 10 and left me home alone for 3 days, even though I was sick myself. Most of the rest of my childhood was spent in horror and terror every moment. Obviously I associated vomiting with dying - even if I only saw (or thought I would see) someone else do it.
As time went on I avoided things more and more. In my teens I went to university, and stopped eating almost everything but bananas and digestive cookies (you all know this routine). My fear of others vomiting was so intense that I started avoiding people altogether at one point. I remember sitting on the bed in my room, curled up in fetal position, crying and feeling so terrified that I wanted to die. I thought it would be better to die than to ever be anywhere near someone who vomited, or to ever be sick myself. I thought if I got some sickness that involved vomiting, I would rather kill myself quickly. As soon as that thought entered my head, I knew I needed professional help. I was only 18.
I got a referral to a psychiatrist from my doctor, and the shame of just telling him my disorder (the first person on the face of this earth that I ever told) sent me into a deep depression. I wallowed in grief for weeks. I had some limited success with this psychiatrist and a 10-week group therapy for emetophobes. At least I stopped obsessing about being sick, and learned some relaxation techniques that I’ve carried with me for years. I learned that I would not be sick just because I thought I felt nauseous. I learned the difference between nausea and anxiety. This kind of therapy is a basic “cognitive-behavioral” approach, and does not involve actually having to vomit in order to get over the fear. (That should be a relief to most of you!) That was over 20 years ago. The test came 9 years ago when I got cancer and went through chemotherapy. I was pretty scared then (of dying, not just of vomiting), but when I did vomit, for the first time since I was treated back in that group (some 15 years earlier), I couldn't believe what a simply "nothing" thing it really was. Since then I've never given being sick myself a second thought.
Miraculously, I graduated from university and went on to do a Masters degree. I met my husband (we've been married 22 years now). I adopted a son, and gave birth to two girls. They're 29, 21 and 19 now and they are normal, well-adjusted, successful young people. Praise God.
I still had a huge problem. Although I feared myself vomiting less (so long as I wasn’t “trapped” “in public” I was ok), I was still terrified of others. The whole phobia seemed to get “channeled” into this fear, and it got to ridiculous proportions. I thought I was completely crazy. I didn't have much success with therapists. Most misdiagnosed me, didn't believe me, tried to tell me I must have been sexually abused, etc. I thought I was the only person in the world now who feared seeing someone else vomit. The fear was so gripping and intense that it paralyzed me, and stopped me from enjoying a normal life.
When my children were sick my husband looked after them, as I would either run out of the house in terror, or lock myself in the basement and curl up in a ball crying. We never traveled anywhere ever. I refused to get in anyone's car, or take people in my car. Once I had to fly on business and I made it through on "tranquilizers and terror". It was horrible. I avoided children and all sick people -- this was exceptionally difficult to do since I'm the minister of a church. If someone in my congregation were in hospital, I would race in (in some dissociative state), say hello, pray a short prayer, and race out - paralyzed with fear the whole time. When I would leave the hospital I would have no memory of the visit.
The fear steadily got worse over the years. Once I celebrated 5 years cancer-free, I decided to conquer this phobia once and for all. MY GOAL WAS TO STAND NEXT TO SOMEONE IN THE HOSPITAL AND HOLD ONE OF THOSE VOMIT DISHES FOR THEM. (It was laughable! I couldn't even IMAGINE the dish itself without a full-blown panic attack and about an hour of crying!!!) I knew that it would take a gradual exposure approach, and I needed a professional to journey through it with me. I set out once again to look for a therapist. I tried several who specialized in phobia, and found one after another to be most unhelpful -- again - not really believing my childhood story, UNDERESTIMATING the intensity of the fear or else being arrogant, or rude. One told me he could cure me in one 90-minute session. I was outraged that he could diminish this horrible disorder that ruled my life down to a "simple thing with a simple cure".
SEVERAL therapists concluded that I was “unmotivated” “non-compliant” or “resistant to treatment”. I was furious! I had read enough about the treatment for this MYSELF that I thought – geez, I could just do this myself…but I also had read enough to know that you can run off track a long way when you try to treat yourself and waste time and energy…you need someone detached and outside-observing to help you see clearly. Sick of all these rude, arrogant and useless professionals I finally I went to my doctor in tears and said, "can you PLEASE just refer me to someone nice?"
I just wanted someone who was kind, gentle and compassionate to walk with me through a journey of gradual exposure that I would design myself if necessary. She gave me the business card of a Registered Social Worker who specialized in geriatrics, and also did couples and individual therapy, mostly with addiction, depression, self-esteem. In other words, no expertise in this area at all. But she had heard that “he was really a nice guy”. He sure was. In short, he saved my life.
We learned together about emetophobia (thanks to this website’s information), and designed the exposure therapy together. He was kind and gentle indeed, full of compassion and understanding -- for the first time in my life -- someone just simply cared. I worked with him for a year - once a week. He used an integrative therapy based mainly in the standard “cognitive behavioral” approach (“CBT”). He also did EMDR which we used off and on with good success (for information about Eye-Movement-Desensitization-Reprocessing see emdria.org).
About 8 months into the therapy he finally figured out that I did not have just a "specific phobia" (formerly called a "simple phobia"). That this disorder was so severe it was actually PTSD (post-traumatic stress disorder). When I experienced the trigger (someone vomiting, or about to vomit, or even just nauseous) in a split-second, in the time it takes to cross a synapse, I dissociated completely from reality and flashed back to my entire childhood (the phobia didn't start with one incident, but many things over several years, so the flashback was a "somatic" or body flashback). We discovered that my negative cognition was "I am dying". Although I knew INTELLECTUALLY that I was in no danger or dying or going crazy or having a heart attack, at some primal level I actually believed at that moment that my own death was imminent. And it all happened so fast, I could not possibly use any rational thoughts to help myself. No wonder I was so suffering so badly!
Since EMDR was originally developed for PTSD, we scheduled a series of 6 intensive sessions (90 minutes long). It was quite difficult, and took a lot of courage on my part, but by the end of this treatment, (it actually took 10 weeks) we had "opened up some space" - so that between the trigger and my terror response (flashback) there was a few seconds of time when I could insert some tools (positive cognitions – for example, “I am perfectly safe”. “I am in no danger”.) Meanwhile, I worked away on the gradual exposure (very VERY slowly). I have this website and Margaret to thank for that. I began with pictures on Margaret's site and worked through each one (go to the “treatments” thread to find this site). Then I went to the videos - each week working on a more difficult one. Next I ordered a video from the gut-reaction website link from England. It's called "Exposure to Vomit" and shows people actually vomiting. Once I conquered that I was ready for in vivo exposure and I arranged to work as a volunteer chaplain in a hospital medical ward every day for 2 weeks.
I saw my therapist each of those days at 5 pm. After the first day there I went to my therapist's office crying and shook and shook and shook. I have no idea how I managed to go back to the hospital the next day. Each day got a little better. I agreed one day in the second week to do another EMDR session targeting the time my mother left me alone at home at 10 years old. I have no idea why I agreed to do this, or how I thought I would make it through it. During the EMDR I was more seized by utter terror than I have ever been in my life, yet for some reason I kept going - and kept going. I guess you reach a point where you just “go for it”. My therapist told me it took incredible courage to do this. I attribute it more to being at the end of my rope "fed up". "Just get rid of it for God's sake!!" was all I could think of.
The next day at the hospital I finally sat by the bedside of an old woman who was going to vomit at any time. I sat there 20 minutes before she actually did it. I did not feel very anxious. When she finally vomited, my anxiety level shot up, but I stayed by her side and handed her tissues. Then I went and got a nurse. Then I kind of fell apart! But I don't know if it was joy or horror!! A mixture I guess. I went to my therapist and proclaimed "it worked!" "What worked?" he asked. "All of it," I said. We rejoiced in ourselves that day, and also in the grace of God who we both agreed was at work in our midst. (My therapist and I are of two different religions, yet we both sensed God at work many times during this therapy. Often we reflected on it.)
The next couple of days in the hospital were like I was a normal person - like a nurse or something. I went bed to bed, greeting and talking to patients with zero anxiety. Pretty good for someone who freaked out and cried just hearing the word “vomit” a year earlier. I now have another therapist whom I see regularly to ensure that I can continue to enjoy this anxiety-free life, and also to work on other issues of personal growth. We also reflect on things that come up in my work and family environment, and how I respond to them.
My new therapist and I discovered together that this fear of seeing someone else vomit was really a fear that the sight of it would trigger me to vomit. So what I feared was actually myself all along (in public – as I got older). I guess somewhere down deep I believed that if I were to vomit and other people saw me, that I would be a horrible, awful person – a completely worthless human being that no one could ever love. As I work more and more through therapy, these core beliefs are slowly changing, so that I have more confidence all the time, and feel less anxious in every situation. I plan to stay in therapy for many years, realizing that I have a history of a serious disorder that should never go “unchecked”. I am confident that no matter what happens in my life to raise the general level of stress, I will never go back to responding with inappropriate fear.
I have received incredible benefit from therapy and after being so angry any cynical about it for so many years, I am now its greatest advocate. I have had immense far-reaching benefits from psychotherapy which go far beyond treating the phobia. I’m a different person. It is “new life” indeed.
Therapy with a competent professional can and should be a gift and a blessing in your life. I can now travel (I’ve been on a boat cruise – amazing -- and a trip to Europe that involved every form of transportation and crowded spaces). I look forward to sitting with my grandchildren (if I ever have any!) one day when they are sick - maybe reading them a story or consoling them while they wait to be sick. Sure beats being in fetal position crying in the basement. I enjoy my volunteer work in the hospital, and plan to continue, in order to "give something back" to the sick I have neglected all these years.
My story is unique, as is each of yours. You all have your own sources for this disorder, your own unique experience of it. But I write this to give each and every one of you hope. Whoever you are out there, there is no possible way you could have this any WORSE than I did. There IS a cure for emetophobia/PTSD. But the cure is not instant like an antibiotic shot, nor is it a "quick fix". You can't keep looking for an easy cure in some method or technique. Hypnosis, TFT, EMDR - they all have their place in a treatment program, but don't let anyone tell you they can cure something as complex and difficult to treat as this in a few sessions. It takes time. It takes dedication, and commitment and courage.
I was not cured because I am a special person, different than you. I was cured because I made my mind up to do it, no matter what it took. It took years. It took failure. It took thousands of dollars (but I probably spent a grand total of $5000 over the past 10 years - a hell of a lot less than people pay for a car, so don't make that excuse!). What it really took in the end was courage - the courage to open up the wounds of the past that had scabbed over. Just rip them open and let them hurt and let them bleed and keep washing that infection out so they heal up properly. It takes a willingness to be terrified, but knowing that you are terrified in a safe place. So that's the simple cure: dedication, courage, commitment, the willingness to endure hurt and pain and anguish. The reward, however, is something more precious than gold -- a life filled with peace and comfort and unbelievable joy. It is like the sun shining out from the clouds with all its splendor and warmth. It is incredible. I cannot thank God enough. I write this story to give you all hope. If one person can be cured of emetophobia, no matter what the story, then you can too. God bless you all.
(“SAGE”)
(please do not reproduce without permission)
I have been successfully treated for emetophobia, which I suffered from to an extremely serious degree for 40 years. For twenty of those years, I searched for help and was willing to do anything to be rid of this gripping terror in my life. Finally, I succeeded. Here is my story.
I'm 45 years old. My childhood was quite traumatic with my brother dying in an accident when I was 3, and my dad dying of cancer (literally throwing up to death, it seemed) when I was 9. My mother was psychotic, and always sick and expected me to look after her. Once she went into the hospital "for a rest" when I was only 10 and left me home alone for 3 days, even though I was sick myself. Most of the rest of my childhood was spent in horror and terror every moment. Obviously I associated vomiting with dying - even if I only saw (or thought I would see) someone else do it.
As time went on I avoided things more and more. In my teens I went to university, and stopped eating almost everything but bananas and digestive cookies (you all know this routine). My fear of others vomiting was so intense that I started avoiding people altogether at one point. I remember sitting on the bed in my room, curled up in fetal position, crying and feeling so terrified that I wanted to die. I thought it would be better to die than to ever be anywhere near someone who vomited, or to ever be sick myself. I thought if I got some sickness that involved vomiting, I would rather kill myself quickly. As soon as that thought entered my head, I knew I needed professional help. I was only 18.
I got a referral to a psychiatrist from my doctor, and the shame of just telling him my disorder (the first person on the face of this earth that I ever told) sent me into a deep depression. I wallowed in grief for weeks. I had some limited success with this psychiatrist and a 10-week group therapy for emetophobes. At least I stopped obsessing about being sick, and learned some relaxation techniques that I’ve carried with me for years. I learned that I would not be sick just because I thought I felt nauseous. I learned the difference between nausea and anxiety. This kind of therapy is a basic “cognitive-behavioral” approach, and does not involve actually having to vomit in order to get over the fear. (That should be a relief to most of you!) That was over 20 years ago. The test came 9 years ago when I got cancer and went through chemotherapy. I was pretty scared then (of dying, not just of vomiting), but when I did vomit, for the first time since I was treated back in that group (some 15 years earlier), I couldn't believe what a simply "nothing" thing it really was. Since then I've never given being sick myself a second thought.
Miraculously, I graduated from university and went on to do a Masters degree. I met my husband (we've been married 22 years now). I adopted a son, and gave birth to two girls. They're 29, 21 and 19 now and they are normal, well-adjusted, successful young people. Praise God.
I still had a huge problem. Although I feared myself vomiting less (so long as I wasn’t “trapped” “in public” I was ok), I was still terrified of others. The whole phobia seemed to get “channeled” into this fear, and it got to ridiculous proportions. I thought I was completely crazy. I didn't have much success with therapists. Most misdiagnosed me, didn't believe me, tried to tell me I must have been sexually abused, etc. I thought I was the only person in the world now who feared seeing someone else vomit. The fear was so gripping and intense that it paralyzed me, and stopped me from enjoying a normal life.
When my children were sick my husband looked after them, as I would either run out of the house in terror, or lock myself in the basement and curl up in a ball crying. We never traveled anywhere ever. I refused to get in anyone's car, or take people in my car. Once I had to fly on business and I made it through on "tranquilizers and terror". It was horrible. I avoided children and all sick people -- this was exceptionally difficult to do since I'm the minister of a church. If someone in my congregation were in hospital, I would race in (in some dissociative state), say hello, pray a short prayer, and race out - paralyzed with fear the whole time. When I would leave the hospital I would have no memory of the visit.
The fear steadily got worse over the years. Once I celebrated 5 years cancer-free, I decided to conquer this phobia once and for all. MY GOAL WAS TO STAND NEXT TO SOMEONE IN THE HOSPITAL AND HOLD ONE OF THOSE VOMIT DISHES FOR THEM. (It was laughable! I couldn't even IMAGINE the dish itself without a full-blown panic attack and about an hour of crying!!!) I knew that it would take a gradual exposure approach, and I needed a professional to journey through it with me. I set out once again to look for a therapist. I tried several who specialized in phobia, and found one after another to be most unhelpful -- again - not really believing my childhood story, UNDERESTIMATING the intensity of the fear or else being arrogant, or rude. One told me he could cure me in one 90-minute session. I was outraged that he could diminish this horrible disorder that ruled my life down to a "simple thing with a simple cure".
SEVERAL therapists concluded that I was “unmotivated” “non-compliant” or “resistant to treatment”. I was furious! I had read enough about the treatment for this MYSELF that I thought – geez, I could just do this myself…but I also had read enough to know that you can run off track a long way when you try to treat yourself and waste time and energy…you need someone detached and outside-observing to help you see clearly. Sick of all these rude, arrogant and useless professionals I finally I went to my doctor in tears and said, "can you PLEASE just refer me to someone nice?"
I just wanted someone who was kind, gentle and compassionate to walk with me through a journey of gradual exposure that I would design myself if necessary. She gave me the business card of a Registered Social Worker who specialized in geriatrics, and also did couples and individual therapy, mostly with addiction, depression, self-esteem. In other words, no expertise in this area at all. But she had heard that “he was really a nice guy”. He sure was. In short, he saved my life.
We learned together about emetophobia (thanks to this website’s information), and designed the exposure therapy together. He was kind and gentle indeed, full of compassion and understanding -- for the first time in my life -- someone just simply cared. I worked with him for a year - once a week. He used an integrative therapy based mainly in the standard “cognitive behavioral” approach (“CBT”). He also did EMDR which we used off and on with good success (for information about Eye-Movement-Desensitization-Reprocessing see emdria.org).
About 8 months into the therapy he finally figured out that I did not have just a "specific phobia" (formerly called a "simple phobia"). That this disorder was so severe it was actually PTSD (post-traumatic stress disorder). When I experienced the trigger (someone vomiting, or about to vomit, or even just nauseous) in a split-second, in the time it takes to cross a synapse, I dissociated completely from reality and flashed back to my entire childhood (the phobia didn't start with one incident, but many things over several years, so the flashback was a "somatic" or body flashback). We discovered that my negative cognition was "I am dying". Although I knew INTELLECTUALLY that I was in no danger or dying or going crazy or having a heart attack, at some primal level I actually believed at that moment that my own death was imminent. And it all happened so fast, I could not possibly use any rational thoughts to help myself. No wonder I was so suffering so badly!
Since EMDR was originally developed for PTSD, we scheduled a series of 6 intensive sessions (90 minutes long). It was quite difficult, and took a lot of courage on my part, but by the end of this treatment, (it actually took 10 weeks) we had "opened up some space" - so that between the trigger and my terror response (flashback) there was a few seconds of time when I could insert some tools (positive cognitions – for example, “I am perfectly safe”. “I am in no danger”.) Meanwhile, I worked away on the gradual exposure (very VERY slowly). I have this website and Margaret to thank for that. I began with pictures on Margaret's site and worked through each one (go to the “treatments” thread to find this site). Then I went to the videos - each week working on a more difficult one. Next I ordered a video from the gut-reaction website link from England. It's called "Exposure to Vomit" and shows people actually vomiting. Once I conquered that I was ready for in vivo exposure and I arranged to work as a volunteer chaplain in a hospital medical ward every day for 2 weeks.
I saw my therapist each of those days at 5 pm. After the first day there I went to my therapist's office crying and shook and shook and shook. I have no idea how I managed to go back to the hospital the next day. Each day got a little better. I agreed one day in the second week to do another EMDR session targeting the time my mother left me alone at home at 10 years old. I have no idea why I agreed to do this, or how I thought I would make it through it. During the EMDR I was more seized by utter terror than I have ever been in my life, yet for some reason I kept going - and kept going. I guess you reach a point where you just “go for it”. My therapist told me it took incredible courage to do this. I attribute it more to being at the end of my rope "fed up". "Just get rid of it for God's sake!!" was all I could think of.
The next day at the hospital I finally sat by the bedside of an old woman who was going to vomit at any time. I sat there 20 minutes before she actually did it. I did not feel very anxious. When she finally vomited, my anxiety level shot up, but I stayed by her side and handed her tissues. Then I went and got a nurse. Then I kind of fell apart! But I don't know if it was joy or horror!! A mixture I guess. I went to my therapist and proclaimed "it worked!" "What worked?" he asked. "All of it," I said. We rejoiced in ourselves that day, and also in the grace of God who we both agreed was at work in our midst. (My therapist and I are of two different religions, yet we both sensed God at work many times during this therapy. Often we reflected on it.)
The next couple of days in the hospital were like I was a normal person - like a nurse or something. I went bed to bed, greeting and talking to patients with zero anxiety. Pretty good for someone who freaked out and cried just hearing the word “vomit” a year earlier. I now have another therapist whom I see regularly to ensure that I can continue to enjoy this anxiety-free life, and also to work on other issues of personal growth. We also reflect on things that come up in my work and family environment, and how I respond to them.
My new therapist and I discovered together that this fear of seeing someone else vomit was really a fear that the sight of it would trigger me to vomit. So what I feared was actually myself all along (in public – as I got older). I guess somewhere down deep I believed that if I were to vomit and other people saw me, that I would be a horrible, awful person – a completely worthless human being that no one could ever love. As I work more and more through therapy, these core beliefs are slowly changing, so that I have more confidence all the time, and feel less anxious in every situation. I plan to stay in therapy for many years, realizing that I have a history of a serious disorder that should never go “unchecked”. I am confident that no matter what happens in my life to raise the general level of stress, I will never go back to responding with inappropriate fear.
I have received incredible benefit from therapy and after being so angry any cynical about it for so many years, I am now its greatest advocate. I have had immense far-reaching benefits from psychotherapy which go far beyond treating the phobia. I’m a different person. It is “new life” indeed.
Therapy with a competent professional can and should be a gift and a blessing in your life. I can now travel (I’ve been on a boat cruise – amazing -- and a trip to Europe that involved every form of transportation and crowded spaces). I look forward to sitting with my grandchildren (if I ever have any!) one day when they are sick - maybe reading them a story or consoling them while they wait to be sick. Sure beats being in fetal position crying in the basement. I enjoy my volunteer work in the hospital, and plan to continue, in order to "give something back" to the sick I have neglected all these years.
My story is unique, as is each of yours. You all have your own sources for this disorder, your own unique experience of it. But I write this to give each and every one of you hope. Whoever you are out there, there is no possible way you could have this any WORSE than I did. There IS a cure for emetophobia/PTSD. But the cure is not instant like an antibiotic shot, nor is it a "quick fix". You can't keep looking for an easy cure in some method or technique. Hypnosis, TFT, EMDR - they all have their place in a treatment program, but don't let anyone tell you they can cure something as complex and difficult to treat as this in a few sessions. It takes time. It takes dedication, and commitment and courage.
I was not cured because I am a special person, different than you. I was cured because I made my mind up to do it, no matter what it took. It took years. It took failure. It took thousands of dollars (but I probably spent a grand total of $5000 over the past 10 years - a hell of a lot less than people pay for a car, so don't make that excuse!). What it really took in the end was courage - the courage to open up the wounds of the past that had scabbed over. Just rip them open and let them hurt and let them bleed and keep washing that infection out so they heal up properly. It takes a willingness to be terrified, but knowing that you are terrified in a safe place. So that's the simple cure: dedication, courage, commitment, the willingness to endure hurt and pain and anguish. The reward, however, is something more precious than gold -- a life filled with peace and comfort and unbelievable joy. It is like the sun shining out from the clouds with all its splendor and warmth. It is incredible. I cannot thank God enough. I write this story to give you all hope. If one person can be cured of emetophobia, no matter what the story, then you can too. God bless you all.
(“SAGE”)
Information about Emetophobia
A Professional Article - for doctors, therapists, family members of emetophobics
© 2004 A. S. Christie, B.A., M.Div.
Permission is granted to sufferers of emetophobia to photocopy this article to give to their doctor or therapist.
Unauthorized reproduction or publication is strictly prohibited.
About the Author:
I am a professional psychotherapist who has specialized in grief and crisis counseling for the past 20 years, and more recently in marriage and family counseling. My initial training was Rogerian, and I have done further self-directed study in Cognitive-Behavioral and Emotion-Focused methods. I am also a recent graduate of the North Shore Counseling Centre (Bowen Family Systems Theory) in Vancouver, BC, Canada, and have written (published) and taught extensively on the topic of Leadership using Bowen theory. I suffered from emetophobia from childhood, began treatment in my late 20s, and now believe I have been completely successfully treated. My treatment involved group therapy (CBT) about 20 years ago (after which I was free from the fear of vomiting myself) and finally – since I still had a morbid fear of seeing someone else vomit – about 100 hours of individual psychotherapy (CBT-gradual exposure/EMDR). My symptoms were so severe I was at one time diagnosed with PTSD. Yet I now enjoy a life completely free from any diagnosable symptoms of anxiety. Nevertheless, I continue to be dedicated to my own emotional work with a psychologist who uses an integrated approach, but the main direction of our work together is Emotion-Focused.
The two psychotherapists who treated me are to be commended, as I had previously been to see 10 others in 10 years, none of whom were able to help me. Although I have always been a highly motivated client, most of these therapists misunderstood the disorder, or assumed I was “resistant to treatment” or “non-compliant”. I write this article so that you as a professional physician or psychotherapist may be enlightened as to your client’s disorder and will be able to help. In conjunction with one of my previous psychotherapists, I am currently researching and writing a longer work on emetophobia and the story of my successful treatment. One goal of the book is to help the psychotherapeutic community understand the mind of a phobic with severe symptoms.
This article is also intended to be a source of valuable information for sufferers of the disorder and their families, and thus is written as simply and explicably as possible.
Emetophobia?
The DSM-IV[1] diagnosis of emetophobia is 300.29 - Specific Phobia: Other Type. “Other Type” refers to “situations that might lead to illness, choking, vomiting.”[2] I would submit that it is more closely related to the Blood-Injection-Injury Type because sufferers tend to identify strongly with others they see vomiting – the phobic enters into their reality and assumes she, too, is sick or soon will be.
Since the phobic fears her own body, this disorder tends to be particularly debilitating. Avoidance of the stimulus is impossible, and thus without treatment the emetophobe is continually re-traumatized, ritualistic behavior intensifies and the condition worsens. Treatment is difficult, as structuring gradual exposure is tricky. (How can you set up someone continually vomiting for the client to be gradually exposed to? How does exposure work when the client fears himself?)
Most sufferers of emetophobia fear vomiting themselves, while a few only fear seeing someone else vomit. Despite the fact that many professionals have never heard of this anxiety disorder, it is a fairly common phobia, manifesting mainly in women and more acutely in adolescents than adults. The English-speaking International Emetophobia Society’s website (www.emetophobia.org) has nearly 2,000 contributing members world-wide. (Your client will have found this article posted there – I am a moderator of the site, and participate daily in a discussion forum with hundreds of emetophobic people.) There are several other support websites specifically for emetophobia. One in the U.K. has done an internet study that is quite interesting (see www.gut-reaction.freeserve.co.uk/survey-results.htm). This website claims to have been contacted by over 100,000 people since its inception. An informative article for professionals is available online at this address: www.emetonline.co.uk/news/archive/emetofobie.pdf . Conducted by Joshua D. Lipsitz, Ph.D. and others (New York, 2001), the bibliography cites many other relevant works.
Symptoms:
Emetophobes are terrified of vomiting – most of them anywhere, anytime. Others only fear vomiting in front of someone else, or seeing someone vomit. Symptoms range from mild disturbance to acute panic attacks (rapid heartbeat, rush of adrenalyn, difficulty breathing, choking sensations, derealization, dizziness, fear of dying, numbness, sweating, trembling). The derealization can be akin to a PTSD-flashback with the client completely dissociating.
Most emetophobes report quite sincerely that they would rather die than vomit. For many, vomiting and death anxiety are inextricably linked. In severe cases, emetophobes will show symptoms of OCD and agoraphobia. (They will wash their hands until raw for fear of germs from an illness that will make them vomit – they may fear seeing someone vomit or catching germs so much that they will not leave the house.) Many emetophobes have other symptoms of OCD, such as a variety of rituals to keep from vomiting or to reassure oneself that one is not sick (i.e., obsessive temperature-taking), or superstitions about numbers and dates (especially the date they last vomited). The following are characteristics of most emetophobes:
r excessive cleanliness
r fear of eating outside of one’s home, or eating food one has not prepared (in case it may lead to food poisoning which would cause vomiting)
r nausea, stomach cramps, diarrhea a great deal of the time. (While these symptoms should be checked out, they are usually due to anxiety.)
r fear of taking any prescription medication that may have nausea or vomiting as a listed side-effect.
r fear of animals who vomit
r fear of all children (as they vomit more often, sometimes without warning, and they are more prone to viruses)
r fear of pregnancy (due to morning sickness, or vomiting at delivery)
r fear of anesthesia – due to vomiting as a side-effect
r fear of hospitals and nursing homes
r fear of traveling (in case they are motion sick, or someone else is)
r fear of alcohol consumption, or parties where alcohol is consumed
r fear of amusement parks where people may be sick on rides
r fear of television and movies (more and more, vomiting is becoming commonplace in the media)
r fear of psychotherapy (lest it involves exposure therapy they feel they can’t handle)
r fear of a number of jobs, limiting career choices. (Emetophobes also often have difficulty holding down a job, due to the number of sick days they take.)
r fear of sick or injured people no matter what they have, as vomiting can be a symptom of every illness.
r fear of public toilets (as someone may come in there and vomit)
r fear of others’ coughing, burping, touching their stomachs, looking pale, saying they don’t feel well
r nightmares – particularly about vomiting, but night terrors are common as well
r refusal or inability to actually vomit. Most emetophobes do not vomit at all but for exceptional circumstances.
r anger, frustration and despair at not being understood, believed or supported – especially about the severity of the feelings of terror and horror.
When emetophobes encounter someone who is vomiting, or feels ill, they will:
r panic immediately, often with incredible immediacy (The panic attack will not necessarily rise up slowly – so inserting cognitive “tools” is not always a possibility. Again, this depends on the severity of the disorder.)
r become dissociative and completely irrational, often crying, screaming, and sometimes harming themselves or others.
r feel nauseous themselves and be convinced they will also vomit
r run away at high speeds, despite risk to personal safety or the well-being of their children
r refuse to remain in the house, car or enclosed place with the sick person even if it is their own child or a family member who “needs their help”
r if trapped, close their eyes and plug their ears (sometimes for an entire night)
If emetophobes feel nauseous, or believe for some other reason they may vomit they will often:
r refuse to eat or drink (they think they can’t vomit if their stomach is empty)
r assume all gastro-intestinal feelings are nausea, which will lead to vomiting. (This may also extend to mistaken feelings about dizziness, headache, body temperature, etc.)
r refuse medical help (in case they are trapped in a hospital with more sick people)
r refuse medication (in case the side effects are nausea/vomiting)
r panic, and continue to have a series of panic attacks over long periods of time (as they are unable to avoid the stimulus which is their own body)
r assume (incorrectly) that a symptom of the panic attack itself will be vomiting[3]
r pace, cry, beg others to help, run from others, scream, become dissociative, self-mutilate (scratching skin, hair-pulling, cutting), bring harm to others.
r insist on being alone, or insist on having a significant other with them.
r refuse to go near a toilet or other receptacle, or refuse to be anywhere else for unusually long periods of time.
r try a number of over-the-counter medications to control vomiting (Pepto Bismal, Dramamine, Peppermint, Ginger). Some emetophobes ingest large amounts of these remedies over time.
Causes:
Most professionals agree that it is doubtful that any one thing causes anything. Some emetophobes report a traumatic experience with vomiting, almost always in childhood, but many do not. Many psychotherapists assume that sufferers are victims of childhood abuse, sexual or physical. While this is occasionally true, it seems to be no more prevalent than in the general population. (In my own case, I was a survivor of several childhood traumas involving sickness: my mother went into hospital for several months when I was an infant, my brother died tragically in hospital when I was 4, and my father died of cancer – vomiting intensely – when I was 9. Despite all this, every one of 10 non-helpful psychotherapists I saw for the disorder tried to look for another cause, suspected sexual abuse, or could not believe that this history would produce such dramatic symptoms.) Again, it is to be stressed that the details of sufferers’ lives are many and varied. Anxious families, trauma, separation anxiety and/or anxious focusing on the child are common to all sufferers, however these conditions do not always cause anxiety disorders, nor do they always cause this one, so of course there are probably hereditary factors as well. Whatever the root cause, vomiting now presents an unrealistic and horrifying sense of danger to the client. For this reason, safety is a primary issue.
Therapeutic Relationship:
A strong therapeutic alliance is imperative. If you cannot (or your technique demands that you do not) emanate a genuine sense of warmth and compassion, you are not the right therapist for this client. She is as terrified of vomit as you are of an impending, horrible death. Cognitive methods may be utilized but should be applied gently and only in the context of a caring, trusting relationship. When in doubt, revert to client-centered techniques, validation and support.
Be sure before you agree to treat this client that you are comfortable enough yourself with vomiting. Treatment may entail a lot of talking about vomit, listening to sounds of vomit, viewing pictures or videos of vomit and perhaps accompanying the client to an in vivo situation involving vomit. If you can’t handle this, you need to be honest at the beginning and refer the client elsewhere.
Misdiagnoses:
Many emetophobes have been misdiagnosed as presenting with any or all of the following:
r anorexia nervosa (Emetophobes are anorexic, but usually only because they fear they will vomit. They often have no other symptoms of this eating disorder.)
r obsessive-compulsive disorder (Many emetophobes do, in fact, present with symptoms of OCD, but some simply wash their hands excessively for fear of germs that will lead to an illness causing vomiting. A misdiagnosis of OCD is not that important, as treatment is virtually the same, however many emetophobes are distressed at the thought of having more than one mental illness. One of the important things to consider before making a diagnosis is to ensure “if the patient has another Axis I disorder, the content of obsessions or compulsions is not restricted to it”.[4])
r social phobia (Many emetophobes diagnosed with social phobia have no other symptoms of the disorder except that they fear vomiting in public. It may be that they simply have a strong component of shame associated with their phobia.)
r agoraphobia (Agoraphobia is not a codable DSM-IV diagnosis. It can accompany emetophobia, just as it may exist with other disorders. In severe cases, emetophobia limits the sufferer from leaving the house at all for fear of catching a virus or seeing someone vomit.)
r repressed memory (While this may or may not be a bona fide condition, it is not necessarily indicated in cases of emetophobia. Most emetophobes cannot think of one single incident that “caused” their phobia – it seems to develop over time in childhood for a variety of reasons.)
r irritable bowel syndrome (IBS) (Some emetophobes could well have this medical disorder along with their phobia; however the current literature suggests that IBS may be an anxiety-related illness in the first place. Typical remedies or medication for IBS seem to have little positive result for emetophobes.)
r schizophrenia, bipolar disorder, other psychoses, depression. The client should be very carefully screened for severe mental illness with the complete understanding of the symptoms of emetophobia in mind. While some emetophobes are indeed severely mentally ill, many are not and have been diagnosed as such and treated inappropriately.
r PTSD. Symptoms of emetophobia can often be so impressive that the correct diagnosis is PTSD – especially if an incident or incidents of trauma are specifically remembered. Some emetophobes describe nightly nightmares, dissociative incidents, extreme feelings of terror and horror, and debilitating panic attacks. The “flashbacks” with emetophobia are sometimes somatic flashbacks only, depending on whether the disorder is tied to one single incident or time in one’s life.
Treatment:
The standard treatment for emetophobia, as any anxiety disorder, is Cognitive-Behavioral Therapy involving gradual exposure. The problem with this unusual disorder is that it can be quite difficult to build a hierarchy of fears for exposure that the client feels comfortable with. All-too-often the therapist errs by beginning with a fear too far up the hierarchy, or jumping “steps” and scaring the client off. It cannot be emphasized enough how afraid these clients are. They are afraid to take medication, afraid to try exposure, and afraid to talk to you! A gentle, caring manner is therefore imperative no matter what the treatment. Here is a hierarchy that may be appropriate, complete with resources:
The client draws a picture of a stick-man with a line coming out of the mouth
a) if this is too difficult, begin with a stick-man with an open mouth, or no mouth, or a speck coming out of it…etc.
b) the client may then be able to progress to drawing “vomit” or making the stick-man look more like he’s vomiting.
Writing the word “vomit”, or saying it. Note: many clients are far too terrified to do this step – therefore it needs to be broken down into smaller ones such as:
a) writing “v****” (and staring at it) [sometimes even “v” elicits panic]
b) writing “vo***”
c) writing “vom**” , etc.
Listening to a tape of someone pretending to cough (This may also be far too frightening for a client – ask if he will listen to it with the volume very very low, then gradually higher. Explain that it is only someone pretending to cough.)
Listening to a tape of someone making gagging noises.
Note: I wouldn’t recommend the therapist record these noises of himself. The client needs to feel safe with the therapist. It should be easy enough to get someone else to do it.
Looking at pictures, one at a time, printed out from the following website: www.emetophobia.bravehost.com Be sure to explain to the client exactly what they are going to see. The pictures begin with funny cartoon-types and progress to graphic scenes of vomiting. Extremely graphic pictures can be found at www.ratemyvomit.com (This is a silly website apparently designed by teenagers who often enjoy too much alcohol. You may want to take a look at it and desensitize yourself before treating the client!)
Videos: order the video of “Exposure to Vomit” from www.ambassadorvideo.com . It was prepared for a CBT centre in Sheffield, England. You may also wish to preview some scenes from popular films (there are a variety to choose from, and the client will be able to tell you what kind of scenes are most troublesome.) A list of films with scenes of vomit can be found at www.emetophobia.org
In Vivo: If possible, arrange to accompany the client to a hospital ward or emergency room as a volunteer. This would be very advanced work, and is tricky to arrange, however. (I was able to do it, as I’m trained as a chaplain – but I realize it’s not so easy for everyone.) One emetophobe I spoke to reported that her therapist was able to arrange for someone who was a recovered emetophobe to come into the therapy session and vomit. This is probably a rare find, however!
Other Treatment:
As the client is working on the exposure, the therapist will want to explore feelings, issues and relationships using whatever technique she is most comfortable with. As well, she should be coached in relaxation, and the nature of panic attacks. Do not forget or underestimate the degree of terror this client is experiencing, however. They are most easily scared away. Cognitive therapy eventually helps the client understand that it is flawed thinking to associate vomiting with danger (even death).
Since your client has undoubtedly presented you with this paper, he is probably already as informed as you are about treatment by now. Be sure to discuss your treatment approach honestly and openly with the client. Try to discern what he thinks about exposure therapy, and how frightened he is of it. Remind him that he does not have to try to deal with what’s at the top of the hierarchy – only with the first step. Reassure him that you will not force him to move farther up the hierarchy until he is completely ready.
If you are trained in EMDR, many have found this to be an excellent technique to “get at” the underlying emotions and root causes. I personally enjoyed great success with EMDR, even though it was not any sort of “instant” or “miracle cure”. It was, however, an important part of an overall treatment program. Some emetophobes have reported similar experiences with hypnosis. (However, many report disappointment that hypnosis or EMDR alone did not lead to a “cure”, as promised.)
Medication
In extreme cases or where there are other presenting disorders (agoraphobia, OCD, depression) anti-anxiety medication may be indicated. Many emetophobes will respond well to it, however I would like to point out that a number of them who correspond with me on the internet report their tremendous fear of taking the medication and their reluctance to tell their psychiatrist (out of shame or fear of her anger). One sufferer’s psychiatrist continually upped the dosage and then wondered why it wasn’t working. The truth was the patient wasn’t taking it. If you need to prescribe such medication, you may wish also to prescribe a powerful anti-emetic for the first couple of weeks, and reassure the patient that it will work, and he will absolutely not vomit. Be as gentle, caring and open as you can, letting the patient know that if he is too afraid to take the medication, you will not be angry or abandon him. You will simply try something else.
Treatment Time
In severe cases, emetophobia cannot be successfully treated in 8-10 standard sessions. In my own case, even as a trained counselor myself, it took me over 10 years to figure out that promises of a “quick fix” left me feeling disappointed, guilty or insulted – and certainly not treated. Once I was able to afford long-term therapy, and to commit to it, I participated in over 25 hours of therapy before I was even able to tell my therapist the exact nature of my fears (most of the things written on this page). It took me close to 35 hours to trust him enough to agree to begin any sort of treatment. 60-70 hours later, I consider myself cured.
I do not mean to imply that a shorter treatment time, especially in milder cases, will not bring significant symptom relief. Genuine care, cognitive work, gradual exposure. This is the tried-and-true formula that seems to bring the best results. Motivated clients who can commit to and afford longer treatment will have a greater chance of experiencing overall emotional growth and will be less likely to see recurrence of symptoms under stress.
Do NOT:
Whatever you do, do NOT suggest to the client that he should vomit in order to get over the phobia. This is akin to telling someone who has been raped that their goal is to be raped again to see there's no reason to fear it. Many sufferers and psychotherapists alike have tried various forms of this “flooding” – none of them have reported success, more than a temporary relief of symptoms or fleeting reassurance. Almost always it results in re-traumatization. It is always unhelpful to start at the very top of the hierarchy of fears. Often even the therapist suggesting this might be a good idea some day down the road will result in the client running like mad. I have talked to hundreds of emetophobes over the years and not one of them has ever experienced a reduction in anxiety levels after an episode of vomiting – whether by chance, or intentionally induced.
The goal of therapy is not for the client to vomit – it is for the client to be free from anxiety. In my own case, once my anxiety was reduced, my flawed thinking was restructured, and I could recognize body feelings as normal I no longer spent time thinking about vomiting and began to enjoy life. When I did vomit (some 10 years later) I was anxious for a few minutes only, then realized after it was over that I was in no danger. I have not feared it ever since, nor have I vomited since.
In most cases, reassuring the client that her vomiting is not necessary for the treatment will go a long way in establishing trust. The same is true for family members and friends.
Fear of Seeing Others Vomit Only
This form of the phobia is extremely rare, so much so that very little is written about it at all. It is theoretically easier to treat, because gradual exposure works so well. However, I would submit that the root of this form of the disorder is exactly the same as for those who fear vomiting themselves. Unfortunately, since there is little research to draw upon, I have no scholarly or scientific evidence upon which to make this conclusion. I can, however, tell you about my own experience and perhaps it will be helpful:
When I was an adolescent, and into my early 20s my symptoms were pretty typical, as described in this paper. However, the thought of seeing someone else vomit was always the most disturbing to me and led me to intense avoidance. After my first treatment program, at about the age of 25, I no longer feared vomiting myself. However, the fear of seeing another vomit intensified. It was almost as if all the anxiety became “channeled” into this fear. Nearly 20 years later, when I finally found a competent therapist who could help me, I quickly became desensitized to seeing another vomit, yet simultaneously more afraid of vomiting myself!
I came to realize that the fear of seeing another vomit was really the fear that this would lead me to vomit, especially in front of someone else. The fear of both others and myself were clearly linked. I was not consciously aware of this for some time, however, because the intense panic actually seemed to mask the idea that I was feeling disgusted, or stimulated to vomit. So part of treatment for me was the cognitive awareness that seeing someone vomit would not make me vomit. After that, I spent some time exploring what it would mean for me to vomit in front of someone else: my flawed thinking was that it would show I was a vile, putrid, worthless human being that anyone would abandon and no one could possibly love. Addressing this cognition through emotion-focused work and original grief work was perhaps the most valuable part of the overall treatment for me.
Further Information:
For further information or discussion, professionals may contact me at annachristie@shaw.ca. I am willing to speak to you over the telephone at no charge.
References:
Bourne, EJ. The Anxiety and Phobia Workbook, Harbinger, Oakland, 2000.
Bowen, Murray. Family Therapy in Clinical Practice, Aronson, Northvale (NJ), 1978.
Campion, J. 2003. I was so scared of being sick, I starved myself. Zest. July/03: 42-43.
Klonoff EA, Knell SM, Janata JW. 1984. Fear of nausea and vomiting: the interaction among psychosocial stressors, development transitions and adventitious reinforcement. J Clin Child Psychol 13: 263-267
Lipsitz, JD, Fyer, AJ, Paterniti, A, Klein, D. 2001. Emetophobia: Preliminary Results of an Internet Survey. Depression and Anxiety 14: 149-152.
Lydiard RB, Laraia MT, Howell EF, Ballenger JC. 1986. Can panic disorder present as irritable bowel syndrome? J Clin Psychiatry 47: 470-473.
McFayden M, Wyness J. 1983.You don’t have to be sick to be a behavior therapist but it can help: treatment of a vomit phobic. Behav Psychother 11: 173-176.
Morrison, J. DSM-IV Made Easy: The Clinician’s Guide to Diagnosis, Guildford, New York, 2001.
Phillips HC. 1985. Return of fear in the treatment of a fear of vomiting. Behav Res Ther 23: 45-52.
Notes:
[1] Diagnostic and Statistical Manual of Mental Disorders-IV. Published by the American Psychiatric Association, the DSM-IV is the world’s standard for evaluation and diagnosis of mental health disorders. (Morrison, p. 1)
[2] Morrison, p. 260
[3] The DSM-IV does not list vomiting as a symptom of panic attacks. (Morrison, p. 252) Bourne (p. 119) lists “I’m going to throw up” as an example of “catastrophic thoughts” only, and does not list vomiting as a “body symptom” of panic attacks (p. 118).
[4] Morrison, p. 266
How to Find a Therapist
HOW TO FIND A THERAPIST TO HELP YOU OVERCOME EMETOPHOBIA
© 2005 Anna S. Christie
Do not reproduce without permission
This “how to” piece is my opinion only – speaking as one who has been successfully treated for this disorder after suffering terribly for nearly 40 years. My personal story is here also. It is entitled “CURED OF EMETOPHOBIA”. (Scroll down to find.) Since I went to 10 different therapists over the years and got worse instead of better as a result, I offer my learnings to you so that you don’t have to suffer needlessly as I did for so many years. The psychotherapeutic community really let me down, but in the end I used the criteria below and found a fabulous therapist who basically saved my life. I now see another one who is equally fabulous and gives to me new life and insight as I continue to grow as a human being.
First of all, you must be willing to go to therapy. Perhaps this sounds obvious, but believe it or not many people go because they are pressured by friends or family members, and really do not believe therapy will help them. It will of course – the only cases of people being successful at overcoming this phobia are from people who have done it with the help of a qualified professional. (There are lots of these stories!) You may get some mild relief of symptoms on your own, but complete “cure” is unlikely. If, on the other hand, you do not go willingly to therapy or believe that you CAN be cured, then it is also extremely unlikely that you will be. Save your money and energy for a time in your life when you are ready to believe it, and ready to do the work.
HOW TO FIND A GOOD THERAPIST: First of all, print out the information about emetophobia on this website AND ALSO the survey results on the following website (it is very scientific): http://www.gut-reaction.freeserve.co.uk/survey-results.htm Make a copy! In my opinion, the “gut-reaction” website has a very negative “tone” and it conveys the message that successful treatment is impossible. I have emailed the webmaster with my story, however she denies that I TRULY suffered from the disorder, and continues to post the question: “have you ever been cured of emetophobia? We want to hear from you.” Apparently, they do not! (Denial is a powerful thing!) Nonetheless, the “gut-reaction” people have done an excellent survey and the results are quite interesting.
Next, get referrals for several therapists - maybe from a doctor, minister, friends,
yellow pages, etc. In Canada, qualified therapists are registered. This means they have an “R” after their name, somehow – a registered psychologist, registered social worker, registered clinic counselor. The registration means they have been properly trained and are accountable to the registering body. This may not be the same in the U.S.A. or U.K. But make sure the person is a proper therapist and not someone who’s just hung out a shingle (which is not illegal in Canada!)
Select a handful of therapists in your area who are trained in a basic cognitive-behavioral approach ("CBT") This is a standard, accepted education for psychotherapists. Avoid people who promise "quick fixes" or
someone who advertises in one particular approach only (i.e., "a hypnotist"
or "thought-field therapy (TFT)" or "Gestalt" or "NLP") There is nothing
wrong with psychotherapists who INTEGRATE these other things - in fact they
can be very helpful, but one approach is just too narrow. Also avoid
psychoanalysts ("analysts") as this approach, if it ever did work, would take
about 10 years (no exaggeration). I personally have found psychiatrists to
be quite unhelpful, but I have heard of a few who are very good. You need to research this carefully. Although I personally am trained in Bowen Family Systems Therapy, I would not recommend seeing a Family Systems therapist for this disorder (or any other that involves “pathology” – reactions in the body). They usually do not use a cognitive-behavioral approach as a basis.
The latest advance in psychotherapy is EMDR (eye-movement-desensitization-and-reprocessing). Therapists trained in EMDR must be registered therapists first, so no one does exclusively EMDR. I had very good success with EMDR, but again, avoid a therapist who claims he or she can cure you in one EMDR session, or even 6-8. This may work for phobias of dogs, spiders or flying, but emetophobia is more complex. I would ask if they do EMDR, and if they do - put a check in the "pros" column by their name). For more information about EMDR go to www.emdr.com
THIS IS IMPORTANT: be prepared to see 3 or 4 of these therapists you have now selected, and pay them for one session (you can do some "interviewing" on the phone,
as to qualifications, and a bit of weeding out, but then you may have to see several to
choose.) You need to pick the therapist that you "click with" - plain and
simple. Someone who you just LIKE - usually this person is warm, friendly,
and you feel a sense of genuine caring coming out of them - someone you will
be able to fully trust in time. Quite often clients or patients are so
ashamed of their problem that they allow therapists to be arrogant, rude, or condescending toward them, and assume this is acceptable. It is not. This is a huge decision and you’ll be giving of your time, energy, money and “soul” to this person. Be sure that he or she is right for you.
The therapist should be willing to read all the pages you print out, and
discuss them in an initial session that is more like a business
meeting. Client and therapist should both be "on the same side of the table
looking at the problem" (so to speak) and should be able to discuss the
kind of treatment, and what the therapist thinks of the disorder. The
therapist should be open to learning along with the client. (Look for indications of arrogance, indifference or inflexibility here - you don't need that - move on to the next interview.)
The last, and most important piece of advice I have is that it is
imperative that you as a client understand that the therapist will not "fix"
you – in other words - just showing up at therapy for an hour a week will
not make the phobia go away. Treatment is ultimately the responsibility of
the client, and the therapist is there as a coach and guide and a caring
support (like a good parent). He or she is like a trekker leading you to the top of
Mt. Everest - but YOU still have to make the climb. This may involve reading
books, journalling, exploring painful feelings, courageously facing the past
as well as gradual exposure to the stimulus. Gradual exposure takes a certain amount of courage, but the key is that it is indeed GRADUAL – you should not be asked to expose yourself to more than you can bear at any given time. It is done in small steps called a “hierarchy of fears”. If any step DOES seem too frightening, then you and your therapist need to break down the step into smaller steps that are accomplishable. Your therapist must challenge you, but ultimately will protect you from being overwhelmed or re-traumatized. He or she should be supportive and compassionate at all times.
Sadly, there is no "cure" for emetophobia, or any other anxiety disorder - by this I mean that there is no pill or surgery or simple treatment that will make it "just go away", even though that is our wish. But the good news is that there IS a cure for emetophobia and many other mental illnesses. The cure is you. It takes incredible hard work, courage,
commitment and determination to overcome this -- but it IS possible, and the results are life-giving and filled with great joy, peace, and a sense of accomplishment and personal growth that will last a lifetime.
© 2005 Anna S. Christie
Do not reproduce without permission
This “how to” piece is my opinion only – speaking as one who has been successfully treated for this disorder after suffering terribly for nearly 40 years. My personal story is here also. It is entitled “CURED OF EMETOPHOBIA”. (Scroll down to find.) Since I went to 10 different therapists over the years and got worse instead of better as a result, I offer my learnings to you so that you don’t have to suffer needlessly as I did for so many years. The psychotherapeutic community really let me down, but in the end I used the criteria below and found a fabulous therapist who basically saved my life. I now see another one who is equally fabulous and gives to me new life and insight as I continue to grow as a human being.
First of all, you must be willing to go to therapy. Perhaps this sounds obvious, but believe it or not many people go because they are pressured by friends or family members, and really do not believe therapy will help them. It will of course – the only cases of people being successful at overcoming this phobia are from people who have done it with the help of a qualified professional. (There are lots of these stories!) You may get some mild relief of symptoms on your own, but complete “cure” is unlikely. If, on the other hand, you do not go willingly to therapy or believe that you CAN be cured, then it is also extremely unlikely that you will be. Save your money and energy for a time in your life when you are ready to believe it, and ready to do the work.
HOW TO FIND A GOOD THERAPIST: First of all, print out the information about emetophobia on this website AND ALSO the survey results on the following website (it is very scientific): http://www.gut-reaction.freeserve.co.uk/survey-results.htm Make a copy! In my opinion, the “gut-reaction” website has a very negative “tone” and it conveys the message that successful treatment is impossible. I have emailed the webmaster with my story, however she denies that I TRULY suffered from the disorder, and continues to post the question: “have you ever been cured of emetophobia? We want to hear from you.” Apparently, they do not! (Denial is a powerful thing!) Nonetheless, the “gut-reaction” people have done an excellent survey and the results are quite interesting.
Next, get referrals for several therapists - maybe from a doctor, minister, friends,
yellow pages, etc. In Canada, qualified therapists are registered. This means they have an “R” after their name, somehow – a registered psychologist, registered social worker, registered clinic counselor. The registration means they have been properly trained and are accountable to the registering body. This may not be the same in the U.S.A. or U.K. But make sure the person is a proper therapist and not someone who’s just hung out a shingle (which is not illegal in Canada!)
Select a handful of therapists in your area who are trained in a basic cognitive-behavioral approach ("CBT") This is a standard, accepted education for psychotherapists. Avoid people who promise "quick fixes" or
someone who advertises in one particular approach only (i.e., "a hypnotist"
or "thought-field therapy (TFT)" or "Gestalt" or "NLP") There is nothing
wrong with psychotherapists who INTEGRATE these other things - in fact they
can be very helpful, but one approach is just too narrow. Also avoid
psychoanalysts ("analysts") as this approach, if it ever did work, would take
about 10 years (no exaggeration). I personally have found psychiatrists to
be quite unhelpful, but I have heard of a few who are very good. You need to research this carefully. Although I personally am trained in Bowen Family Systems Therapy, I would not recommend seeing a Family Systems therapist for this disorder (or any other that involves “pathology” – reactions in the body). They usually do not use a cognitive-behavioral approach as a basis.
The latest advance in psychotherapy is EMDR (eye-movement-desensitization-and-reprocessing). Therapists trained in EMDR must be registered therapists first, so no one does exclusively EMDR. I had very good success with EMDR, but again, avoid a therapist who claims he or she can cure you in one EMDR session, or even 6-8. This may work for phobias of dogs, spiders or flying, but emetophobia is more complex. I would ask if they do EMDR, and if they do - put a check in the "pros" column by their name). For more information about EMDR go to www.emdr.com
THIS IS IMPORTANT: be prepared to see 3 or 4 of these therapists you have now selected, and pay them for one session (you can do some "interviewing" on the phone,
as to qualifications, and a bit of weeding out, but then you may have to see several to
choose.) You need to pick the therapist that you "click with" - plain and
simple. Someone who you just LIKE - usually this person is warm, friendly,
and you feel a sense of genuine caring coming out of them - someone you will
be able to fully trust in time. Quite often clients or patients are so
ashamed of their problem that they allow therapists to be arrogant, rude, or condescending toward them, and assume this is acceptable. It is not. This is a huge decision and you’ll be giving of your time, energy, money and “soul” to this person. Be sure that he or she is right for you.
The therapist should be willing to read all the pages you print out, and
discuss them in an initial session that is more like a business
meeting. Client and therapist should both be "on the same side of the table
looking at the problem" (so to speak) and should be able to discuss the
kind of treatment, and what the therapist thinks of the disorder. The
therapist should be open to learning along with the client. (Look for indications of arrogance, indifference or inflexibility here - you don't need that - move on to the next interview.)
The last, and most important piece of advice I have is that it is
imperative that you as a client understand that the therapist will not "fix"
you – in other words - just showing up at therapy for an hour a week will
not make the phobia go away. Treatment is ultimately the responsibility of
the client, and the therapist is there as a coach and guide and a caring
support (like a good parent). He or she is like a trekker leading you to the top of
Mt. Everest - but YOU still have to make the climb. This may involve reading
books, journalling, exploring painful feelings, courageously facing the past
as well as gradual exposure to the stimulus. Gradual exposure takes a certain amount of courage, but the key is that it is indeed GRADUAL – you should not be asked to expose yourself to more than you can bear at any given time. It is done in small steps called a “hierarchy of fears”. If any step DOES seem too frightening, then you and your therapist need to break down the step into smaller steps that are accomplishable. Your therapist must challenge you, but ultimately will protect you from being overwhelmed or re-traumatized. He or she should be supportive and compassionate at all times.
Sadly, there is no "cure" for emetophobia, or any other anxiety disorder - by this I mean that there is no pill or surgery or simple treatment that will make it "just go away", even though that is our wish. But the good news is that there IS a cure for emetophobia and many other mental illnesses. The cure is you. It takes incredible hard work, courage,
commitment and determination to overcome this -- but it IS possible, and the results are life-giving and filled with great joy, peace, and a sense of accomplishment and personal growth that will last a lifetime.
Norovirus Facts - Don't be Afraid, Get the Facts!
Definitions
Norovirus: The latest term for all “Norwalk-like viruses”, according to the Center for Disease Control (CDC).
Stomach flu: Norovirus – actually a misnomer, as these viruses are not influenza or “flu”.
“Stomach viruses” (“sv”) or “winter viruses”: Noroviruses
Gastroenteritis: Any illness involving vomiting and diarrhea – these symptoms may be caused by Norovirus or by a bacteria. Hence, “viral gastroenteritis” or “bacterial gastroenteritis”. Bacterial gastroenteritis is not contagious.
Virology
Noroviruses (genus Norovirus, family Caliciviridae) are a group of related, single-stranded RNA, non-enveloped viruses that cause acute gastroenteritis in humans. Norovirus was recently approved as the official genus name for the group of viruses provisionally described as "Norwalk-like viruses" (NLV). Currently, human noroviruses belong to one of three norovirus genogroups (GI, GII, or GIV), each of which is further divided into >25 genetic clusters.[1]
How it works
1) You ingest the virus by viral particles from feces or vomit entering through your mouth, or nose, or perhaps by touching your eyes.
2) In your stomach, it doesn't do anything.
3) In your small intestine, the virus begins to multiply, which may take from 12-28 hours before you show symptoms. The lining of your intestine has appropriate attachments for the virus. It attaches itself and releases its genome (bio genes). Those genes shut down the cell and start taking control in order to make more viruses. So your cells are a factory for the virus replicating.
4) Your cells then "explode" or lyse. Then it keeps going to more cells, etc.
5) While this is happening your immune response recognizes that cells are dying and T-cells allow your body to mount an immune response against it. They go to B-cells and produce antibodies. The antibodies travel to the small intestine and inactivate the virus.
6) The vomiting is a secondary response. It's your body's way, evolutionarily, to respond to an infection. It doesn't actually do anything to help you. (This is probably why, if you can stop the vomit response with anti-emetic drugs or even from anxiety...then it doesn't make the course of the virus any worse. ) There is no need to “get the virus out of there”, as it’s not in your stomach anyway – it’s in your intestinal tract. The brain may allow you to "not vomit" if you convince it to. While this is a fine idea when infected with norovirus, it’s not if you’ve ingested a chemical poison.
Incubation Period
24-48 hours after ingestion of the virus. Symptoms have been known to appear as early as 12 hours.
When is it contagious?
Once the virus has been ingested and is incubating, it is possible to shed it through stool, without yet showing symptoms. This is one reason why the virus is so highly contagious – people don’t know they have it, yet they spread it to others through poor hygiene (not washing their hands after defecating, and touching others or touching surfaces.)
People are also contagious for at least 24 hours after the symptoms disappear. There have been virus particles found in the stool samples of people who have been infected some time after this as well, however it is not known whether enough viral particles are secreted in order to infect someone else. (There are too many variables at this point: strength of the virus, number of particles, strength of others’ immune systems)
The person who had the virus becomes immune to this year’s particular strain and secretes antibodies with the virus so it isn't contageous anymore to him, even though it is highly contagious to others.
Transmission
The only way to catch one of these viruses is through the fecal-oral route. This means you have to "swallow" the virus particles contained in feces or vomit of someone who has the virus. “Swallow” means to ingest it into your gastro-intestinal system which can be through your mouth or nose, or potentially (but not likely) by rubbing your eyes. You cannot breathe it in. That is absolutely impossible. It is possible, however, for someone to vomit near or beside you, and the aerosol "spray" droplets come up and touch your eyes, nose or mouth. Then you can get infected.
Myths
It is ABSOLUTELY IMPOSSIBLE to get infected in any of the following ways:
1. Being “near” someone who has it, including co-workers or friends
2. Being on a plane with people who have it
3. Breathing the same air as someone who has it
4. Being in the same building as someone who has it
5. Walking past a pool of vomit on the floor, road or sidewalk
6. Through having sexual relations with an infected person
7. Through a cut in your skin
8. Through your rectum or genitalia (as in, on a toilet)
9. Kissing someone who is not yet showing symptoms (note: it may be possible to catch it from someone who has recently vomited by kissing them, as viral particles may be in their mouth from vomitus. But the virus is NOT transmitted through saliva)
10. Number 6, above, applies similarly to sharing cups or utensils with someone as well.
NOTE: I would not recommend that you share drinks or utensils with someone if you know they’re sick. Besides, many other diseases can be transmitted this way – and some are more serious than norovirus. However if you have done so, then find out later that they have subsequently developed symptoms of a norovirus, there is no need to fear.
Transmission from surfaces
The virus can be active outside a host (person) on surfaces such as counters, toilets, faucets, doorknobs and even clothing. It is unknown exactly how long the virus can live on such surfaces, as this depends on the number of viral particles, temperature, and the nature of the environment. However, you can't catch anything by just touching a doorknob. You would have to put your hand into your mouth or on your nose afterward. Therefore, hand-washing is imperative to prevention of transmission.
NOTE:
The main reason for all the Norovirus outbreaks is poor hygiene, i.e., people defecating and not washing hands afterward, then contaminating surfaces or foods.
Is is “airborne”?
Norovirus is NOT airborne. Some news reports and even family doctors mistakenly report that it is, probably because it’s possible for airborne vomitus droplets to infect others, and thus they get facts somewhat confused. In other words, if you’re standing near someone who vomits, the airborne “spray” from the vomit splashing will contain millions of viral particles and may infect you. This is not the same thing as a technically “airborne virus”. You CANNOT catch it from breathing the air of an infected person.
If your doctor or any other source tells you it is airborne in the sense that one can catch it by only breathing air, please ask them exactly what they mean, how they think the virus is transmitted, a technical/scientific source for their claims and the technical virology IN WRITING that is contrary to what the world-renowned Center for Disease Control has discovered. (Then have them post that technical information here, and I will gladly eat my hat and take up another profession.)
Frequency
CDC estimates that 23 million cases of acute gastroenteritis are due to norovirus infection, and it is now thought that at least 50% of all foodborne outbreaks of gastroenteritis (“food poisoning”) can be attributed to noroviruses.
Among the 232 outbreaks of norovirus illness reported to CDC from July 1997 to June 2000, 57% were foodborne, 16% were due to person-to-person spread, and 3% were waterborne; in 23% of outbreaks, the cause of transmission was not determined. In this study, common settings for outbreaks include restaurants and catered meals (36%), nursing homes (23%), schools (13%), and vacation settings or cruise ships (10%).
Most foodborne outbreaks of norovirus illness are likely to arise though direct contamination of food by a food handler immediately before its consumption. Outbreaks have frequently been associated with consumption of cold foods, including various salads, sandwiches, and bakery products. Liquid items (e.g., salad dressing or cake icing) that allow virus to mix evenly are often implicated as a cause of outbreaks. Food can also be contaminated at its source, and oysters from contaminated waters have been associated with widespread outbreaks of gastroenteritis. Other foods, including raspberries and salads, have been contaminated before widespread distribution and subsequently caused extensive outbreaks.[2]
Waterborne outbreaks of norovirus disease in community settings have often been caused by sewage contamination of wells and recreational water.
Note that upon careful examination of stats from the CDC, there is no significant rise in outbreaks of Norovirus over the years. When it’s a slow news week, the press loves to get a hold of this and fear-monger. The number of people infected in any given area poses no higher risk to any one individual than if only one person is infected. Proper hygiene (handwashing and not touching mouth or nose) will prevent infection regardless of how many others in your geographic area are sick.
Immunity
Once you’ve had this year’s strain of the virus, no matter how mild your symptoms, you will be immune. You are susceptible to next year’s strain, however. Research is currently being done which implicates that those with blood types other than O are more immune to noroviruses than those with O-type.
Food Poisoning
Over half of all "food poisoning" in restaurants is actually noroviruses transmitted through unhygenic cooks or food handlers. You can therefore catch a norovirus from someone who claims they “only have food poisoning”.
Cleanup
The simplest, easiest and best way to kill norovirus on surfaces is with a chlorine bleach solution of 1 tablespoon of bleach to 1 litre or quart of water. There are other chemicals that kill norovirus as well, but most are ridiculously expensive and not necessary. Bleach is not a cheap compromise – it’s the best thing out there.
Temperature
Noroviruses die at 65 degrees Celsius or 150 degrees Fahrenheit. The virus may survive freezing.
Rotavirus
Rotavirus is different than Norovirus. To make a lot of technical facts quite simple, basically, you don't need to worry about rotaviruses. Why?
1) Adults will rarely if ever vomit from rotavirus infections. This is because all people have had rotavirus by the time they were 5 years old (even mildly, or when you were very young.) There is some form of immunity for adults and they will not be severely affected by these viruses, and
2) You can't prevent the spread of them anyway. No need to spray Lysol or wash your entire child's wardrobe or whatever because soap and antibacterial stuff like Lysol or Purell have no effect on the virus. It is spread the same way as noroviruses - (oral-fecal route), and may be present in some respiratory secretions (coughing on someone)….so there is NO WAY you can keep children from getting it – it’s just too contagious. Even if children wash their hands frequently, they commonly put their hands in their mouth, nose and eyes.
So if you hear about a rotovirus outbreak or your kid gets it, you can remain completely calm (well, about yourself. Your child can dehydrate quickly, so you may have to seek medical attention for him because he can die from dehydration.) But you won't vomit if you catch it, and there's nothing you can do to prevent it.
Vaccine
The virus's genetic profile changes often, meaning the proteins on its outside shell change constantly. Currently there are no vaccines for norovirus, although scientists are working on it. I believe a vaccine has recently been developed (February, 2006) for Rotavirus.
Proper Handwashing Technique
Handwashing is the best way to prevent spreading and catching a norovirus. Hands should be washed in the following way:
1) Use warm water (or even cold – but not hot as you would have to have it so hot it would burn you to kill the virus)
2) Use MILD soap. Antibacterial soap has no effect, as norovirus is not a bacteria.
3) Wash hands for at least 20 seconds (you can sing the ABC song all the way through)
4) Rub palms, backs of hands, knuckles to palms, webbing of fingers, thumbs, wrists
5) Rinse well. You are washing the virus down the sink – you are not “killing” it.
6) Turn off taps with paper towel, and use paper towel to open doors, then throw out the paper towel.
7) Wash hands after using the rest room, and before eating – about 5 to 10 times a day.
8) Do not rub too hard, use water too hot, harsh soaps or wash hands excessively – this will make your hands raw, and make it harder to wash viral particles away anyway.
9) Alcohol-based gels, wipes or sprays do not kill norovirus (such as “Purell”) Certain hand cleaners have recently been developed which do – check their websites or email them to ask. However nothing is more effective than proper handwashing.
Treatment
Noroviruses are normally quite unpleasant, but not dangerous to otherwise healthy adults. Children are at some risk for dehydration. Consult your doctor for treatment if you are concerned. (Do not attempt to diagnose and/or treat any illness with information from the internet.)
Summary
If you never put your hands in your mouth, nose or eyes, you cannot contract a norovirus. Ensuring that your hands are properly washed before eating, or before putting them in your mouth, ensures that you will not catch it as well. There is no need to fear if you hear that someone at work, or a friend you’ve visited has come down with the virus. You can’t catch it by simply being near someone who has it.
No matter how much of an “outbreak” of the virus is in your geographic area, you are at no greater risk of catching it than if only one person has it. Good hygiene will ensure you are safe.
Author
I am not a medical doctor, nor a Ph.D. I have done specific research at the University of British Columbia, under the supervision of Ph.D. professors on Noroviruses. My area of research and study in post-graduate work is microbiology.
….AB
-edited for style and expression by Sage
[1] From the Center for Disease Control website, www.cdc.gov
[2] ibid
Norovirus: The latest term for all “Norwalk-like viruses”, according to the Center for Disease Control (CDC).
Stomach flu: Norovirus – actually a misnomer, as these viruses are not influenza or “flu”.
“Stomach viruses” (“sv”) or “winter viruses”: Noroviruses
Gastroenteritis: Any illness involving vomiting and diarrhea – these symptoms may be caused by Norovirus or by a bacteria. Hence, “viral gastroenteritis” or “bacterial gastroenteritis”. Bacterial gastroenteritis is not contagious.
Virology
Noroviruses (genus Norovirus, family Caliciviridae) are a group of related, single-stranded RNA, non-enveloped viruses that cause acute gastroenteritis in humans. Norovirus was recently approved as the official genus name for the group of viruses provisionally described as "Norwalk-like viruses" (NLV). Currently, human noroviruses belong to one of three norovirus genogroups (GI, GII, or GIV), each of which is further divided into >25 genetic clusters.[1]
How it works
1) You ingest the virus by viral particles from feces or vomit entering through your mouth, or nose, or perhaps by touching your eyes.
2) In your stomach, it doesn't do anything.
3) In your small intestine, the virus begins to multiply, which may take from 12-28 hours before you show symptoms. The lining of your intestine has appropriate attachments for the virus. It attaches itself and releases its genome (bio genes). Those genes shut down the cell and start taking control in order to make more viruses. So your cells are a factory for the virus replicating.
4) Your cells then "explode" or lyse. Then it keeps going to more cells, etc.
5) While this is happening your immune response recognizes that cells are dying and T-cells allow your body to mount an immune response against it. They go to B-cells and produce antibodies. The antibodies travel to the small intestine and inactivate the virus.
6) The vomiting is a secondary response. It's your body's way, evolutionarily, to respond to an infection. It doesn't actually do anything to help you. (This is probably why, if you can stop the vomit response with anti-emetic drugs or even from anxiety...then it doesn't make the course of the virus any worse. ) There is no need to “get the virus out of there”, as it’s not in your stomach anyway – it’s in your intestinal tract. The brain may allow you to "not vomit" if you convince it to. While this is a fine idea when infected with norovirus, it’s not if you’ve ingested a chemical poison.
Incubation Period
24-48 hours after ingestion of the virus. Symptoms have been known to appear as early as 12 hours.
When is it contagious?
Once the virus has been ingested and is incubating, it is possible to shed it through stool, without yet showing symptoms. This is one reason why the virus is so highly contagious – people don’t know they have it, yet they spread it to others through poor hygiene (not washing their hands after defecating, and touching others or touching surfaces.)
People are also contagious for at least 24 hours after the symptoms disappear. There have been virus particles found in the stool samples of people who have been infected some time after this as well, however it is not known whether enough viral particles are secreted in order to infect someone else. (There are too many variables at this point: strength of the virus, number of particles, strength of others’ immune systems)
The person who had the virus becomes immune to this year’s particular strain and secretes antibodies with the virus so it isn't contageous anymore to him, even though it is highly contagious to others.
Transmission
The only way to catch one of these viruses is through the fecal-oral route. This means you have to "swallow" the virus particles contained in feces or vomit of someone who has the virus. “Swallow” means to ingest it into your gastro-intestinal system which can be through your mouth or nose, or potentially (but not likely) by rubbing your eyes. You cannot breathe it in. That is absolutely impossible. It is possible, however, for someone to vomit near or beside you, and the aerosol "spray" droplets come up and touch your eyes, nose or mouth. Then you can get infected.
Myths
It is ABSOLUTELY IMPOSSIBLE to get infected in any of the following ways:
1. Being “near” someone who has it, including co-workers or friends
2. Being on a plane with people who have it
3. Breathing the same air as someone who has it
4. Being in the same building as someone who has it
5. Walking past a pool of vomit on the floor, road or sidewalk
6. Through having sexual relations with an infected person
7. Through a cut in your skin
8. Through your rectum or genitalia (as in, on a toilet)
9. Kissing someone who is not yet showing symptoms (note: it may be possible to catch it from someone who has recently vomited by kissing them, as viral particles may be in their mouth from vomitus. But the virus is NOT transmitted through saliva)
10. Number 6, above, applies similarly to sharing cups or utensils with someone as well.
NOTE: I would not recommend that you share drinks or utensils with someone if you know they’re sick. Besides, many other diseases can be transmitted this way – and some are more serious than norovirus. However if you have done so, then find out later that they have subsequently developed symptoms of a norovirus, there is no need to fear.
Transmission from surfaces
The virus can be active outside a host (person) on surfaces such as counters, toilets, faucets, doorknobs and even clothing. It is unknown exactly how long the virus can live on such surfaces, as this depends on the number of viral particles, temperature, and the nature of the environment. However, you can't catch anything by just touching a doorknob. You would have to put your hand into your mouth or on your nose afterward. Therefore, hand-washing is imperative to prevention of transmission.
NOTE:
The main reason for all the Norovirus outbreaks is poor hygiene, i.e., people defecating and not washing hands afterward, then contaminating surfaces or foods.
Is is “airborne”?
Norovirus is NOT airborne. Some news reports and even family doctors mistakenly report that it is, probably because it’s possible for airborne vomitus droplets to infect others, and thus they get facts somewhat confused. In other words, if you’re standing near someone who vomits, the airborne “spray” from the vomit splashing will contain millions of viral particles and may infect you. This is not the same thing as a technically “airborne virus”. You CANNOT catch it from breathing the air of an infected person.
If your doctor or any other source tells you it is airborne in the sense that one can catch it by only breathing air, please ask them exactly what they mean, how they think the virus is transmitted, a technical/scientific source for their claims and the technical virology IN WRITING that is contrary to what the world-renowned Center for Disease Control has discovered. (Then have them post that technical information here, and I will gladly eat my hat and take up another profession.)
Frequency
CDC estimates that 23 million cases of acute gastroenteritis are due to norovirus infection, and it is now thought that at least 50% of all foodborne outbreaks of gastroenteritis (“food poisoning”) can be attributed to noroviruses.
Among the 232 outbreaks of norovirus illness reported to CDC from July 1997 to June 2000, 57% were foodborne, 16% were due to person-to-person spread, and 3% were waterborne; in 23% of outbreaks, the cause of transmission was not determined. In this study, common settings for outbreaks include restaurants and catered meals (36%), nursing homes (23%), schools (13%), and vacation settings or cruise ships (10%).
Most foodborne outbreaks of norovirus illness are likely to arise though direct contamination of food by a food handler immediately before its consumption. Outbreaks have frequently been associated with consumption of cold foods, including various salads, sandwiches, and bakery products. Liquid items (e.g., salad dressing or cake icing) that allow virus to mix evenly are often implicated as a cause of outbreaks. Food can also be contaminated at its source, and oysters from contaminated waters have been associated with widespread outbreaks of gastroenteritis. Other foods, including raspberries and salads, have been contaminated before widespread distribution and subsequently caused extensive outbreaks.[2]
Waterborne outbreaks of norovirus disease in community settings have often been caused by sewage contamination of wells and recreational water.
Note that upon careful examination of stats from the CDC, there is no significant rise in outbreaks of Norovirus over the years. When it’s a slow news week, the press loves to get a hold of this and fear-monger. The number of people infected in any given area poses no higher risk to any one individual than if only one person is infected. Proper hygiene (handwashing and not touching mouth or nose) will prevent infection regardless of how many others in your geographic area are sick.
Immunity
Once you’ve had this year’s strain of the virus, no matter how mild your symptoms, you will be immune. You are susceptible to next year’s strain, however. Research is currently being done which implicates that those with blood types other than O are more immune to noroviruses than those with O-type.
Food Poisoning
Over half of all "food poisoning" in restaurants is actually noroviruses transmitted through unhygenic cooks or food handlers. You can therefore catch a norovirus from someone who claims they “only have food poisoning”.
Cleanup
The simplest, easiest and best way to kill norovirus on surfaces is with a chlorine bleach solution of 1 tablespoon of bleach to 1 litre or quart of water. There are other chemicals that kill norovirus as well, but most are ridiculously expensive and not necessary. Bleach is not a cheap compromise – it’s the best thing out there.
Temperature
Noroviruses die at 65 degrees Celsius or 150 degrees Fahrenheit. The virus may survive freezing.
Rotavirus
Rotavirus is different than Norovirus. To make a lot of technical facts quite simple, basically, you don't need to worry about rotaviruses. Why?
1) Adults will rarely if ever vomit from rotavirus infections. This is because all people have had rotavirus by the time they were 5 years old (even mildly, or when you were very young.) There is some form of immunity for adults and they will not be severely affected by these viruses, and
2) You can't prevent the spread of them anyway. No need to spray Lysol or wash your entire child's wardrobe or whatever because soap and antibacterial stuff like Lysol or Purell have no effect on the virus. It is spread the same way as noroviruses - (oral-fecal route), and may be present in some respiratory secretions (coughing on someone)….so there is NO WAY you can keep children from getting it – it’s just too contagious. Even if children wash their hands frequently, they commonly put their hands in their mouth, nose and eyes.
So if you hear about a rotovirus outbreak or your kid gets it, you can remain completely calm (well, about yourself. Your child can dehydrate quickly, so you may have to seek medical attention for him because he can die from dehydration.) But you won't vomit if you catch it, and there's nothing you can do to prevent it.
Vaccine
The virus's genetic profile changes often, meaning the proteins on its outside shell change constantly. Currently there are no vaccines for norovirus, although scientists are working on it. I believe a vaccine has recently been developed (February, 2006) for Rotavirus.
Proper Handwashing Technique
Handwashing is the best way to prevent spreading and catching a norovirus. Hands should be washed in the following way:
1) Use warm water (or even cold – but not hot as you would have to have it so hot it would burn you to kill the virus)
2) Use MILD soap. Antibacterial soap has no effect, as norovirus is not a bacteria.
3) Wash hands for at least 20 seconds (you can sing the ABC song all the way through)
4) Rub palms, backs of hands, knuckles to palms, webbing of fingers, thumbs, wrists
5) Rinse well. You are washing the virus down the sink – you are not “killing” it.
6) Turn off taps with paper towel, and use paper towel to open doors, then throw out the paper towel.
7) Wash hands after using the rest room, and before eating – about 5 to 10 times a day.
8) Do not rub too hard, use water too hot, harsh soaps or wash hands excessively – this will make your hands raw, and make it harder to wash viral particles away anyway.
9) Alcohol-based gels, wipes or sprays do not kill norovirus (such as “Purell”) Certain hand cleaners have recently been developed which do – check their websites or email them to ask. However nothing is more effective than proper handwashing.
Treatment
Noroviruses are normally quite unpleasant, but not dangerous to otherwise healthy adults. Children are at some risk for dehydration. Consult your doctor for treatment if you are concerned. (Do not attempt to diagnose and/or treat any illness with information from the internet.)
Summary
If you never put your hands in your mouth, nose or eyes, you cannot contract a norovirus. Ensuring that your hands are properly washed before eating, or before putting them in your mouth, ensures that you will not catch it as well. There is no need to fear if you hear that someone at work, or a friend you’ve visited has come down with the virus. You can’t catch it by simply being near someone who has it.
No matter how much of an “outbreak” of the virus is in your geographic area, you are at no greater risk of catching it than if only one person has it. Good hygiene will ensure you are safe.
Author
I am not a medical doctor, nor a Ph.D. I have done specific research at the University of British Columbia, under the supervision of Ph.D. professors on Noroviruses. My area of research and study in post-graduate work is microbiology.
….AB
-edited for style and expression by Sage
[1] From the Center for Disease Control website, www.cdc.gov
[2] ibid
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