Back to square 1?

[DeeDee412]

I've had anxiety and panic disorder (as well as emetophobia) since 2011 (emetophobia all my life). I got therapy and help and was doing so so well. I found a new boyfriend and he was so uplifting and helped me so much that i didn't have a single panic attack for months! Then he moved to Canada for a year, and things started to become difficult. Because of him leaving i noticed my panic disorder coming back, i was having attacks again and i felt so low and annoyed because of it because i was doing so well! Then i took a huge step for anxiety and plucked up the courage to go out there and visit him in Canada. I took myself to the other side of the world. Out there i had a mix of good and bad times anxiety wise, but it came back stronger, after coming home he stopped communication with me and then ended the relationship without giving me a proper explanation as to why. Since then (June 2014) i have been an anxious mess, i'm now back at uni, and i know he is returning home soon and its making me go crazy, i'm having a panic attack every day, and usually more than one. I ALWAYS gag and retch and its so embarrassing, especially whilst out in public, I cant stop physically dry heaving and its really affecting my social life and being able to attend lectures. Feel like ive gone completely back to square one. I feel so low and worthless and just rubbish Another person i thought that cared about me just walking out my life. Anyone else gag/retch? and if so how do i prevent this?! The only thing i have to do is make myself gag so that it goes away.

Help please x

[Hidden]

Hello

I have just copied & pasted this information of another post as I do not suffer with this but I do hope it helps

I have also suffered from intense nausea and the retching and spent ages locked away in my house. I wouldn't go anywhere or see anyone so I lost all my friends. It was a pretty miserable time so I can identify with what you're saying.

It varies from person to person as to whether throwing up is a cure for emetophobia. Some people say that it is, some people say that it makes the phobia worse. When I did CBT, we treated it as a fear of anxiety (the anxious thoughts/sensations which all related to vomiting) rather than a fear of vomiting.

I was recommended a book to read through CBT. It's based on ACT (acceptance and commitment therapy) and it uses techniques such as expansion in order to allow you to let the unpleasant sensations go through your body and accept them. It's called The Happiness Trap and its by Dr. Russ Harris.

Also this is a pinned post that is at the right hand side of the page maybe something in this will help to

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.

Hope this helps x

[DeeDee412 in reply to Hidden]

Thank you so much for your effort of finding this even though you don't suffer yourself! I will look into buying this book!

Can't thank you enough Really appreciate it. I hope i get better soon and that this is just a tough phase that will pass! x

[cazadoo]

You are hurting. You need to figure out how to stop the hurt from the boyfriend. Put yourself first. Oh and if he ended it like that then he did you a favour... it shows more about what person he is than you x

[DeeDee412 in reply to cazadoo]

You are right, i know i'm hurting and i know i'm better off without someone like that in my life, it's just so hard to get rid of the hurt and the after effects and come out better on the other side! I think i'm worrying so much because he's home soon and he lives so close to me The thought of seeing him again sparks my anxiety a lot. Thank you for your kind words and i hope this horrible phase passes soon! It's such a pain.

Thank you so much