What It's Like to Live With Emetophobia, a Fear of Nausea
Design by Bella Geraci
Nausea is an unpleasant experience. There is the action of it, obviously. But for people with an anxiety disorder called emetophobia, the mere thought of vomiting can be downright debilitating. Discussions have been circulating on TikTok, with users sharing their personal stories about the fear of throwing up and how it significantly affects their lives.
In one video, captioned “pov: you’re emetophobic,” a creator picks up french fries one by one, only eating the part her hands didn’t touch. Presumably, to avoid consuming germs…because germs could lead to illness…which could lead to vomiting. In another TikTok, a visibly anxious creator shares that she’d just seen someone throw up on the side of the road, which triggered her own fear of throwing up—and caused her to rethink her hibachi dinner plans that night.
Studies estimate that seven percent of women and two percent of men will experience emetophobia at some point in their lives. The fear of vomiting can drastically interfere with people’s lives, causing them to avoid situations they associate with vomiting or engage in behaviors they think will prevent throwing up. Zachary Appenzeller, PsyD, psychologist and founding director of UTHealth Houston Center for Eating Disorders, says the condition is fairly common in his clinical psychology practice. “When you specialize in treating anxiety and OCD, it’s something that’s more than just a handful of patients,” he tells Allure. “It can be incredibly impairing.”
Read on to learn how emetophobia can negatively affect people’s lives, plus doctor-recommended treatments.
Meet the experts:
Zachary Appenzeller, PsyD, is a psychologist and founding director of UTHealth Houston Center for Eating Disorders.
Shmaya Krinsky, PsyD, is a psychologist and founder of Anxiety and Behavioral Health Psychotherapy, a teletherapy clinic
Ashwini Nadkarni, MD, is an assistant professor of psychiatry at Harvard Medical School.
What is emetophobia?
Emetophobia involves a persistent, impairing fear of throwing up or seeing another person throw up, says Shmaya Krinsky, PsyD, psychologist and founder of Anxiety and Behavioral Health Psychotherapy. “In my mind, it can be one of the most debilitating phobias, because there are so many different triggers,” he says, such as eating out, traveling, seeing someone vomit on TV, or even just hearing someone talk about vomiting.
Appenzeller explains that the phobia often develops after an inciting event that forms a negative thought about throwing up. For example, someone with emetophobia may have vomited once in front of people and felt embarrassed, and then associated vomiting with negative feelings. Or a child may have gotten in trouble for not making it to the bathroom to vomit in their youth, so now they may mentally connect throwing up with feeling scared of an angry parent.
No matter the root cause though, emetophobia can significantly impact people’s well-being. Appenzeller explains people with the condition typically engage in avoidance behaviors to protect themselves from getting sick. Some people with emetophobia avoid situations where they think they could become nauseated, like long car rides or roller coasters. “It’s not always that people think they’re going to throw up, it’s the possibility that it could happen is typically what drives most of the avoidance,” says Appenzeller.
Safety behaviors, like excessive hand washing and disinfecting or carrying around anti-nausea medications, are also a hallmark of emetophobia. Some people only take tiny bites of food or drink water after each bite to avoid nausea. In severe cases, people might limit what foods they eat to prevent vomiting or they may limit their intake as much as possible. Appenzeller says this can result in a type of eating disorder called avoidant/restrictive food intake disorder, or ARFID, that can cause malnourishment or severe weight loss. Because of how drastically it can affect people’s mental and physical well-being, the condition can also result in anxiety or depression symptoms.
What it's like living with emetophobia
Everywhere she goes, Claire Busler carries an anti-nausea prescription in her purse—but not because she gets sick a lot. On the contrary: The 32-year-old speech-language pathologist from Bentonville, AR hasn’t thrown up in six years, and she’d like to keep it that way. Even a hint of nausea can set off intense anxiety because Busler dreads the out-of-control feeling that comes with a vomiting episode. Ever since she threw up in public as a kid, she’s had a debilitating fear of vomiting, which she associates with losing control.
Rachel Garcia, a 29-year-old publicist from Atlanta, developed emetophobia after seeing a classmate throw up on a field trip in second grade. Since then, she’s had a panic attack any time she started feeling nauseated. Garcia got sick with COVID-19 a few years ago, and her worst symptoms were gastrointestinal. “The pandemic was already scary, and I ended up in this spiral where I’d panic every day,” she says.
Both Busler and Garcia know what it’s like for emetophobia to disrupt their routines—for example, both have avoided restaurants and potlucks, favoring food they prepare themselves, and they prefer not to eat foods they associate with sickness, like seafood. Busler, who works in a school, says her fear has interfered with her work, too. If she hears a stomach bug is going around—common among her students—she feels paralyzed with anxiety. “I have a recurring nightmare that my coworker or partner has it, and then I’m exposed,” says Busler.
How can you treat emetophobia?
If the fear of nausea or vomiting is debilitating, it may be time to seek out professional support from a therapist. While avoiding throwing up might feel comforting in the moment, Appenzeller says it actually reinforces the fear, potentially making emetophobia worse. For that reason, one of the best treatments for phobias is a type of cognitive-behavioral therapy called exposure response prevention (ERP), which Krinsky says involves “putting people in situations that are distressing to them and preventing them from engaging in safety behaviors.” Over time, exposing yourself to the object of the phobia can reduce anxiety by desensitizing people to their fears, explains Ashwini Nadkarni, MD, assistant professor of psychiatry at Harvard Medical School.
One study found addressing the underlying trauma with a type of therapy called eye movement desensitization therapy (EMDR) may also help, but the majority of research on phobias (and specifically emetophobia) is about cognitive behavioral therapy, which focuses more on addressing thoughts and behaviors. Studies show cognitive behavioral therapy (and specifically ERP) can lead to significant symptom reduction.
In the case of emetophobia, someone might simply say the word “vomit” or imagine themselves throwing up. Then, over time, they’d engage in more triggering behaviors, like going on a car ride or eating at a restaurant. In extreme cases where it’s medically appropriate—for example, if a person doesn’t have an eating disorder or another medical condition—a therapist might encourage someone to actually throw up as part of ERP.
Exposure therapy should be done in a careful, supportive way, which is why it’s a very systematic process (and why it’s important to see a therapist who’s trained in this therapy). “There’s a process where you create a hierarchy of all the different triggers and rate them on a scale of perceived distress,” says Krinsky. “You don’t want to start too easy or too hard, or you’ll burn them out and they might quit. You want to help them be successful and slowly work their way up.”
It’s also important to note that emetophobia is an anxiety disorder—and Nadkarni says it can coexist alongside other mental conditions, such as major depressive disorder and obsessive-compulsive disorder. “Medication management can also be helpful in reducing the intensity of the fear response and level of anxiety someone may be experiencing,” she says.
Not all therapists treat phobias, especially emetophobia. Some might not be trained in therapies that help with phobias, and others might not be comfortable addressing vomiting in sessions. Look for a therapist who specifically treats anxiety disorders (which includes phobias), and in your initial consultation, ask if the potential therapist is open to or has experience treating emetophobia.
What has helped people recover from emetophobia?
After her COVID-19 experience, Garcia decided to seek out exposure therapy for her anxiety, which she says helped her realize her worst thoughts aren’t always true. She’s also taken a daily medication for her anxiety and panic, which she says has helped. Garcia is currently pregnant—something she used to fear due to the possibility of morning sickness. She did get sick once in her first trimester, but Garcia says that was an exposure in and of itself. “I’ve learned that just because I feel sick doesn’t mean I’m in imminent danger,” she says.
Busler’s symptoms tend to ebb and flow. Right now, she’s doing better—she hasn’t taken anti-nausea medication in months—but she recognizes the importance of seeking support for her mental health and is open to seeing a therapist if it begins interfering with her life again.
While emetophobia can be difficult to live with, as Garcia and Busler can attest to, it’s also treatable—as with any anxiety disorder. “You don’t have to be in therapy for years to be able to be treated,” Krinsky says. “Notice, and then take that step to reach out.”
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