“The DSM-V (Diagnostic and Statistical Manual, 5th Ed., 2013) provides specific diagnostic criteria for specific phobia from the American Psychiatric Association:
- Unreasonable, Excessive Fear: The person exhibits excessive or unreasonable, persistent and intense fear triggered by a specific object or situation.
- Immediate Anxiety Response: The fear reaction must be out of proportion to the actual danger and appears almost instantaneously when presented with the object or situation.
- Recognition the Fear Is Irrational Not Required: In previous DSM editions, adults with specific phobias had to recognize that their fears are out of proportion to reality, but children did not. The 2013 edition now says the adult patient no longer has to recognize the irrationality of their behavior to receive a diagnosis.
- Avoidance or Extreme Distress: The sufferer goes out of her way to avoid the object or situation, or endures it with extreme distress.
- Life-Limiting: The phobia significantly impacts the sufferer’s school, work, or personal life.
- Six Months Duration: In children and adults, the duration of symptoms must last for at least six months.
- Not Caused by Another Disorder: Many anxiety disorders have similar symptoms. Therefore, your therapist must rule out other disorders before diagnosing a specific phobia.”
Other Indicators of Emetophobia
- Most all emetophobic people can easily diagnose themselves. The phobia has a very early onset, in childhood. Many emetophobics cannot remember a time when they were not terrified of vomit/vomiting.
- Although not criteria for diagnosis, emetophobia will normally be marked by any or all of the following characteristics which are avoidance and safety behaviours
- asking (parents) for reassurance
- checking “best before” dates on foods
- excessive cleaning with bleach, etc.
- excessive hand-washing
- carrying and using hand sanitizer
- pressuring family members to wash hands or use hand sanitizers
- carrying mints, gum, water or other “safety” items
- carrying OTC (over-the-counter) medications such as Gravol (dramamine), ginger tablets, Pepto Bismal, etc.
- carrying prescription anti-emetics
- avoiding places, people or things that might be “contaminated”
- driving one’s own car or not taking passengers
- avoiding types of foods deemed “unsafe”
- avoiding types of restaurants deemed “unsafe”
- avoiding dental procedures
- avoiding medical tests
- avoiding public restrooms
- avoiding taking prescription medication (if “nausea” or “vomiting” is listed as a possible side-effect)
- avoiding playgrounds, schools, nursing homes or other places deemed “contaminated”
- avoiding public transportation
- avoiding children
- throwing away items, even valuable ones that are deemed “contaminated.”
- Despite whether the client is afraid of vomiting themselves, or only of seeing/hearing someone else vomit, the diagnosis is the same.
Diagnostic and Assessment Tools
King’s College London has three tools listed on its site – with free access to all of them. Click here.
Emetophobia and OCD
Emetophobia seems to be quite often and to varying degrees, comorbid with Obsessive Compulsive Disorder, especially Contamination Subset. Some emetophobia sufferers have other symptoms of OCD such as counting or checking.
Many emetophobics diagnosed with OCD are upset that they have “more than one thing wrong with them.” As so little research has been done on the subject, we don’t know exactly how it behaves. But after working with over one hundred emetophobic clients, I can safely say that every one of them has some pieces of an OCD diagnosis as well. One study (Veale et al, 2015) suggests that emetophobia should actually be a subset of OCD. The good news is that the treatment for both anxiety disorders is exactly the same: CBT (Cognitive Behavioural Therapy) with ERP (Exposure and Response Prevention).
Emetophobia and Depression
As with many anxiety disorders, emetophobia can also be comorbid with depression. Evidence-based treatment (CBT) is the same, however if depression is serious and/or if the client is suffering from a Major Depressive Episode, then the depression must be addressed first.
Emetophobia and Eating Disorders
Emetophobia can lead a person to eat very little, and only eat specific “safe” foods causing malnutrition. A diagnosis of anorexia nervosa is incorrect, as the emetophobic person will not have a distorted body image or seek to attain one. However, particularly in children and adolescents, the anorexic behaviour must be addressed first, and if there is significant weight loss then it needs to be considered a medical emergency and hospitalization with tube feeding is often in order.