Feeling sick when anxious

[Thatenglishgirl]

I suffer from anxiety and I have done for a while. I feel physically sick in some situations and there have been occasions where I have actually thrown up. I hate it because it limits what I do. There are times when I can't eat because things just build up. I can't explain this to anyone so this is the first time I've actually put it into words.

[Hidden]

Hi

There is a pinned post to the right hand side of the page talking about this anxiety problem I have pasted it you though & put it in this reply I hope it helps

Also we have more than one Anxiety site on HU so I have also copied you the link to Living with Anxiety if you ever feel like coming & saying hello to us you will always be welcome

healthunlocked.com/livingwi...

Take Care

Love

whywhy

Overcoming a fear of vomiting

Specific phobia of vomiting is often misunderstood and regarded as difficult to overcome. It is treatable and the aim of this chapter is to help you understand the phobia – the causes, effects and principles of how you can overcome it. We have included this chapter here because a phobia of vomiting overlaps with health anxiety in terms of excessive worrying, checking and avoidance behaviours.

The name for a specific phobia of vomiting is emetophobia. It is a condition where an individual fears vomiting themselves or fears other vomiting. If you have emetophobia, you may equally fear vomiting alone or in public. You may frequently experience feeling sick but are probably no more at risk of being sick than most people who don't go out and get drunk or than someone who eats foods of a type wholly unfamiliar to them. Neither of the authors have vomited for between twenty and thirty years each and yet we have taken no special precautions to stop ourselves from vomiting.

Fear of vomiting may have become a preoccupation for you and the main thing you think about. Vomiting is associated with overwhelming fear and panic. Some people fear losing control, becoming very ill or that others will find them repulsive. Most people with emetophobia are afraid of themselves vomiting and of others to a lesser extent. Mostly the fear of others relates to the fear they may catch something from them, or it reminds them of vomiting – very few emetophobics are exclusively concerned with the fear of others vomiting. Whatever the focus of vomiting, you are likely to try too hard to avoid a wide range of situations, foods, drinks and activities that you believe might increase a risk of vomiting.

Vomiting upsets many people but to be diagnosed with a specific phobia of vomiting, it must be very distressing and interfere with your life in important ways. For example, it may interfere with an important relationship or your social life. It may prevent you from a desired pregnancy or you may be unhealthily underweight. You may not be able to go on holiday or travel on public transport.

Coping with emetophobia

If you have emetophobia, you are probably avoiding a range of activities or situations. These can be divided into:

a) Avoiding adults and children who could be ill (and deemed contagious) or who may be at risk of vomiting (i.e. drunks who remind you of vomiting). The avoidance might extend to restricting activities of any children who may be in contact with other children.

b) Avoiding situations or activities that present a higher risk of vomiting, such as going on holiday abroad; places where you may see drunks; visiting sick people; travelling by boat or aeroplane; drinking alcohol in normal amounts; crowded places; using public transport; pregnancy; fairground rides; using public toilets or door handles; medication; going to the dentist; anaesthesia. Women with babies might experience a great deal of distress about their child vomiting and want to escape from their child.

c) Avoiding food. This may occur in a variety of ways:

I) Restricting the amount of food that reaches your stomach, thus reducing the amount that might be vomited. Alternatively, a restricted amount is equated with feeling 'full', since continuing to eat once you feel you've had enough could lead to vomiting.

ii) Restricting food in various contexts (i.e. not eating food cooked by someone else or in an unfamiliar restaurant).

Iii) Restricting certain types of food (i.e. shellfish, poultry, curries, dairy products and fried fast food) that might have a slightly higher risk of inducing vomiting. Alternatively, certain foods may have become associated with a past experience of vomiting.

Restricting food may lead to being very underweight, which may have a number of physiological consequences and be a further factor in increasing anxiety and nausea. You may have a number of 'safety seeking behaviours' which are things you do that you believe will prevent yourself or others from being sick. These include:

* excessive checking of sell by dates and the freshness of food

* seeking reassurance

* excessive cooking of food

* excessive washing of hands

* excessive cleaning of the kitchen area with anti-bacterial sprays and gels; superstitious behaviours such as 'not stepping on a 13th stair'

* repeating a word or action a certain number of times to prevent yourself from vomiting

* taking anti-nausea medication

* sucking antacids, ice or mints

* frequently drinking bottled water or a sugar fizzy drink. May also be a way of checking whether you are going to be sick (i.e. if water's going down then nothing can come up).

Might also be telling yourself certain things in your head, such as reassuring yourself you or someone else will not be sick. Even though it's impossible, you may attempt to mentally control the reflex action of vomiting. These appear to work in the sense that you do not vomit but they have the unintended consequence of increasing your awareness of feeling sick. They make you more preoccupied with vomiting and more anxious. This becomes a vicious circle as you feel more nauseous and so on. In short, it is your solutions that have become the problem and are now keeping the fear going.

The cause of emetophobia

We don't know what causes emetophobia but some people may be more genetically predisposed to developing it than others. Emetophobia is more likely to occur in women – men with emetophobia are very uncommon.

Developing a specific phobia of vomiting is highly understandable given the way that humans (and animals) can become easily conditioned after food poisoning or an infection and are more likely to avoid situations that remind them of vomiting. Vomiting as a baby or a child can be panic inducing (i.e. by making associations with the feeling of suffocating, choking or death). Even if you know these associations are not valid as an adult, they are still powerfully linked in your mind. However these associations can be unlearnt and the 'ghosts of the past' can change.

Specific phobias such as insects or heights are relatively common and occur in about 10% of the population. It is important to differentiate anxiety or disgust of vomiting (which is very common) from a specific phobia of vomiting (which is relatively uncommon). In very large surveys of specific phobias, only one study asked about a phobia of vomiting; and this phobia was found to be relatively uncommon, affecting 0.1% of the population. It is hard to say exactly how many people have a specific phobia of vomiting since some may be misdiagnosed as having OCD or health anxiety. Many people with emetophobia are too ashamed to talk about their problem. It is nonetheless agreed that specific phobias of vomiting are generally more handicapping than other specific phobias and are more difficult to treat.

Emetophobia may be linked to other conditions. You may feel demoralized or clinically depressed. Some people restrict their food, believing that a range of food may cause vomiting. You may then become very underweight which is why some people with emetophobia are misdiagnosed with anorexia nervosa and are treated inappropriately. No long term follow up studies have been done. Many people with emetophobia have a chronic condition. If left untreated, the condition is likely to persist.

If you have emetophobia, you might be asking yourself 'why do humans and animals have to vomit?'. Vomiting is an adaptive process that increases your chances of survival if you are ill. If you are infected, vomiting is beneficial and prevents disease by getting rid of toxins. Rats are the only animal which cannot vomit. This is one of the reasons why rat poison is so effective. Try to view your ability to vomit as protecting you. If you couldn't vomit, then you'd be more prone to illnesses.

Perceptions of vomiting

Some people with emetophobia believe that if vomiting does occur it was last for many days. In fact, after an infection or food poisoning, it usually lasts at the most a day or two. Others believe that they can influence or control their vomiting in an almost magical way. But as we have seen, the act of vomiting is a primitive reflex act. There is no evidence that you can stop yourself from vomiting – if you are going to vomit, you will vomit. It might feel as if you have stopped yourself from vomiting but in reality, in such instances you would not have vomited in the first place.

People with emetophobia tend to focus on the risk of infection or food poisoning but the reflex can be triggered by a wide variety of triggers around the body (including mechanically in gynaecological problems; a extremely stretched gall bladder or stomach; by certain drugs; metabolic problems that act on the brain stem; extreme fear; severe pain; certain smells can all influence vomiting in the right context).

Treatments available

There has been very little research on the best treatment for emetophobia. Anti nausea medication is often prescribed at the request of people with emetophobia but this doesn't solve the problem and is usually unhelpful in the long term because it reinforces the idea that you can control vomiting and vomiting must be avoided at all costs. We suspect that anti nausea medication acts as a placebo.

There is no evidence that psychiatric medication is of any benefit in emetophobia. On the other hand, there is a rationale for a type of medication called selective serotoneric reuptake inhibitor (SSRI) in those with severe symptoms that overlap with health anxiety and OCD and who have not got better with CBT. Nausea is a potential side effect of a SSRI which may mean that it is an unacceptable approach for some.

There is a lot of evidence for the benefit of CBT in other phobias and health anxiety. CBT can be adapted for treating a specific phobia of vomiting. You may have experienced CBT in the past that has not been helpful but its success may depend on who is delivering it and the approach used. There is no evidence in the scientific literature for the benefit of hypnotherapy in emetophobia (other than one case report). There are no miracle cures for emetophobia – overcoming the condition is hard work on the part of the individual with emetophobia. Having emetophobia can make life very restricted and part of your therapy will focus on helping you to do what is important in your life despite your fears. Over time the degree of distress and preoccupation with vomiting will decrease and your life will become more manageable. There are no risks or side effects of CBT other than the experience of anxiety and having old memories.

Self help

As illustrated in this book, CBT consists of a structured program of self help, enabling you to get a good understanding of how the fear might have developed and how your solutions have now become your problem and keep the fear going. It is based on an understanding that people with emetophobia have had one or more bad experience with vomiting from childhood. Sometimes such an experience can be remembered, sometimes not. These memories have become associated with fear. Past experiences of vomiting and their triggers become fused with the present so that they are re-experienced as if they are about to be repeated. Once the link with the past experience is learnt, the anticipation of vomiting leads to anxiety. However anxiety also causes nausea and other stomach symptoms. This becomes linked to the idea of vomiting and losing control which in turn is associated with extreme fear and past experiences of vomiting, leading to a vicious circle.

There are various ways that people with emetophobia cope with the idea of vomiting. These are not bizarre – it is a very natural and understandable response to fear.

a) You may try to avoid thoughts and images of yourself or others vomiting and feelings of nausea.

b) You are more vigilant than the average person in monitoring threats (i.e. people who could be ill or an escape route).

c) You become excessively self focused in order to monitor nausea.

d) You worry, try to reassure yourself and mentally plan escape routes from others who might vomit.

e) You may think in a 'magical way' and try to 'neutralize' thoughts and images vomiting in a way that you believe will stop you from vomiting.

f) You may use safety-seeking behaviours including compulsive checking and reassurance seeking.

All these ways of coping make you feel that you have more control in your ability to stop yourself from vomiting or that you are doing something to reduce uncertainty. However, they will have the unintended consequence of increasing your preoccupation and frequency of thoughts about vomiting and symptoms of nausea and make you more anxious, leading you into a vicious circle.

What you can do

The firs t step is to analyse the problem from the perspective above to gain an understanding of what is keeping the problem going. The solution therefore involves some combination of:

a) gradually dropping your avoidance and safety-seeking behaviours using the principles of exposure. This includes allowing yourself to experience thoughts and images about yourself and others vomiting. You should not be asked to induce vomiting – this is not necessary. But it will be important, for example, to deliberately enter situations that you avoid and do some exposure in your imagination to yourself vomiting or other people being sick.

b) Refocusing your attention externally and to stop checking for people who might be ill.

c) Understanding your motivation in worrying about vomiting and not engaging with your intrusive thoughts or images.

d) Questioning the magical thinking and excessive responsibility in believing you can influnce your vomiting. The key issue is acceptance of the idea that one day you may vomit.

e) It may also be helpful to update your early memories and images of vomiting so that they are no longer viewed as relevant now. This is usually done with a trained therapist.

We shall now describe the process as experienced by an individual with emetophobia. Nicki had suffered from an excessive fear of being sick since she was eleven years old. She could recall waking up one night and suddenly violently vomiting all over her bedroom floor. At the time she felt helpless and it felt like an age before she managed to call her mother to her bedroom. She wondered if this particular moment of being sick gained particular significance in her mind as she had just started attending senior school. Her main way of coping until she sought help was to keep the range and quantity of foods very restricted. This had left her looking thin and pale. Although there were frequent rows at home about this, ultimately her parents became defeated and accomodated her special eating habits.

Nicki's main reason for seeking help, at age 24, was because she was in a long term relationship and hoped that they would eventually have a child. Her partner complained regularly about the fact that they could never go out for a meal together, let alone go to a pub or even the cinema because of Nicki's fears of someone being sick or catching a bug. She was still slightly underweight. She became extremely preoccupied by watching for reports in the media about a norovirus which causes stomach upsets and she had a friend who also had a vomit phobia whom she frequently talked with and gave reassurance about not vomiting.

Nicki began her recovery by drawing up a list of the things she did excessively or avoided because of her fear of vomiting and nausea. This is shown in the diagram.

She saw a cognitive behaviour therapist and agreed to tackle her problem 'as if' it was a problem of fear, rather than a problem of being imminently sick. With the support of her partner, she steadily dropped each of her safety seeking behaviours and gradually faced up to situations. She gradually reintroduced the foods she avoided and the amount she ate so she began to reach a normal weight. She stopped constantly drinking bottle water.

Whenever she was in social situations and after eating, she made a concerted effort to focus her attention on to the world around her rather than monitoring the sensations in her body (for example the feelings of nausea) or whether other people looked as if they might be feeling ill. When she experienced intrusive images of being sick then she leant to experience them without repeating any mantra that she was not going to be sick. She learnt to accept that she had very limited influence on her ability to control vomiting and eventually gave up all her checking and excessive monitoring. She had to ban all discussions of feeling sick with her friend. She found it helpful with her therapist to revisit the experiences of vomiting as a child using an approach called 'imagery rescripting'. In her image she was able as an adult to be compassionate and caring towards her child when she was sick. When she finished therapy she remained somewhat anxious about vomiting but it was not something she was preoccupied by and she was able to function in her normal activities. She eventually took the plunge and got pregnant. During pregnancy she experienced some morning sickness but was not actually sick. When her daughter was born, she had normal illnesses such as diarrhoea and vomiting. This was a big test for Nicki and she had some top up sessions in therapy. But she managed to care for her baby appropriately by not escaping or ringing up her partner to come to rescue her. She allowed herself to fully experience the thoughts and feelings of vomiting without trying to distract herself and without refusing to look at her baby. Later in the year she went on holiday abroad for the first time.

[suffolkrelic in reply to Hidden]

Thanks whywhy, I really needed to read that. I also have that sheer fear and dread of vomiting, so much so that it greatly dictates my life and what I can do, I struggling to leave the house because I get so nauseous when I do and then just start panicking.

[Hidden in reply to suffolkrelic]

Hi suffolkrelic

Sorry to hear you are struggling a little at the moment , I know the member that wrote this piece that I pasted on the reply has had counselling & it really did work for them , I am not sure if this is something you have had or thought about having maybe ?

I am glad by me pasting it that it may have helped someone , I did look back & think wow that is long maybe members wont want to read all that but glad you did

I don't know if you have been & had a look at us on Living with Anxiety on HU but I will paste the link & if you ever feel like coming & say Hi you would always be most welcomed

Take Care

xxx

healthunlocked.com/livingwi...

[Paul-D]

Hi. It's a rotten feeling not being your old self. I know quite a bit about suffering with anxiety as I have it too.

Can I ask if you have spoken to your Doc about it. I'm not advocating pills being the answer but perhaps getting referred to your local mental health team and talk it over with them would be a step in the right direction? I should have done that years ago but for all the wrong reasons I didn't.

Get help or at least talk it over with your partner or a trusted friend. Anxiety affects so many people. I did my best to bluff it out to begin with but had to drink more and more just to function. I saw my Doc about it and he prescribed antidepressants for me. There are different types so it can be trial and error with them if you and your Doc decide to go down that road.

Think about your mental health team though. Who knows, just talking about it may help you no end.

I hope today is a better day for you and you can relax and think about doing something positive about your anxiety. Just don't let yourself suffer needlessly. Take care.

[suffolkrelic]

Dude this sounds so much like me, although I've never actually thrown up as a result of anxiety, I certainly feel like I'm going to, I even carry a sick bag around with me everywhere I go to throw up in. It is hard to explain to people the sheer panic and dread I feel when I believe I'm going to be sick, they say I should reassure myself that it won't actually happen but it's pointless trying to convince me since I'm in such a panic and at that point I'm not thinking rationally, just the panic. It limits me also so much, every time I do anything I get nausea really bad, I struggle to leave the house and constantly worry about what sort of future I'll have. It also makes eating very difficult, especially eating around other people. I've been trying to over come, going out little by little, a little further each time. But it's so hard and takes so long, I'm already 30yrs old, don't work and still live with my parents. I feel so depressed and alone all the time and dread that this is my future.

[HaveAGood]

Hey ThatEnglish Girl,

I have suffered from panic attacks for over 20 years and often have similar feelings. Can start with stomach churning, nausea and on rare occasions even being sick. The latter, at times of extremes panic, is pretty alarming.

I have had CBT (very helpful), been to the doctor (less so, but confirmed that these feelings are pretty common) and I am going to try hypnotherapy soon.

Things that could help.

1. Peppermint - I have found chewing gum sugar-free peppermint gum really helps during an attack. Often removes the nausea. Ginger biscuits can also help.

2. Breathing exercises - There are a lot of free apps for Android and iPhone that counts your breathing. I have them all on my phone ready to bring out during an attack. I also practice daily.

3. Uni of the West of England produces a very good free app - search under 'axiety'. I studied here, so I like it.

4. Join Anxiety UK charity for more support.

I first went to my doctor 20 years ago asking for CBT and there was a long waiting list. The NHS is now getting its act together on this and my doctor claims the waiting list in my area is just 2 weeks.

Good luck. I know how you feel, I am still suffering. The good news is that it can't halm you and you won't die (even though it can feel like that when you are being sick!)

[hairyfairy]

I have emetophobia, & although people often say that you have no control over the vomit reflex, this isn`t true, maybe children can`t control it, but you cab learn how to do so. I can remember being sick from a virus when I was 10 in school in front of all my classmates. I felt so humilliated & and ashamed, they bullied me about it for months afterwards. I couldn`t bear to be taken ill in public, I`d rather die!

[Alyssa03]

I have the same issue as you except your terrified of throwing up I'm convinced that I'm Allergic to everything and I'll stress for 2 hrs after eating something constantly check my throat check my heartbeat per min chug water it's awful. It's paralyzingly and it's hard because I'm pregnant and I need certain vitamins and nutrients for my baby. Even if I have had it before it doesn't matter because an allergy can occur at any time. Some days are better then others but it's awful there's days I tell myself I'm never eating ever again. I have a constant fear of my throat closing up and I'm pretty sure that's where this phobia of being allergic to everything comes in. It doesn't matter what others tell me I cant shake the feeling of complete dread. I have dealt with anxiety and panic attacks for awhile some months I'll be great then I'll hit rock bottom again and each time y hole keeps getting deeper. Idk it's hard and I can def relate to you. Feel free to msg me back. Maybe we can help each other get over this horrid issue.

[slie]

I think this might relate to my case. When i used to be with my girlfriend every time we were together (especially alone) i got nauseous and felt like vommiting. The only way to feel better was to throw up but then i felt weak and of course it wasn't fun throwing up. So every time i was about to see her i didnt eat anything for the last maybe 5 hours and then it was as if i had no problem at all (besides being hungry). Now that we have broken up i get the same nausea with every girl i approach. The strange thing is thing is this only happens at this specific occasion and generally im not an anxious person at all. Could this be emetophobia?