Author: Anna S. Christie

Winter is coming…

Maybe John Snow didn’t know anything, but people with emetophobia know a lot, and probably too much about winter viruses. Every year, October-March they probably freak out just a little bit more than usual. Perhaps not everyone with emetophobia but a lot of people for sure. I just thank God that there was no internet back when I had emetophobia so I didn’t know anything about norovirus. The kids got sick with it a couple of times but I didn’t know where it came from and I didn’t do anything special like cleaning or not eating, and I never caught it from them. Ah the 80s!

The worst of these dreaded viruses is, of course, norovirus. Misnamed “stomach flu” (because it isn’t a “flu”), or stomach bug or winter vomiting virus in the UK, norovirus is the most feared and dreaded thing for people with emetophobia. It’s almost like being exposed to ebola (which kills 90% of the people who get it). It’s not, of course. Norovirus only kills people if they get dehydrated and can’t or don’t get medical help. Normally that’s the very elderly, the very young, those with compromised immune systems and those who are very weak and sick. People with emetophobia are normally healthy red-blooded folks, so why is it so frightening? Let’s examine the problem.

Norovirus is usually harmless. It’s 24 hours of misery which nobody signs up for and nobody likes. You may vomit several times, eventually with nothing in your stomach and you can’t rest because you’re running to the bathroom with diarrhea like someone turned on a water tap every half hour or so. If you’re lucky, you won’t get both of these things at the same time but a lot of people do. And then they tell everyone how awful it was, and grossly exaggerate to be funny or get sympathy.

HOW DO YOU CATCH IT?

Noroviruses are spread through the oral-fecal route which sounds every bit as disgusting as it actually is. If you catch it you’ve probably swallowed someone’s poop. Well, microscopic particles of it. You only need about 10 particles to catch the disease, and these ten would fit on the tip of a pin and still not be seen. In order to swallow it, you have to put your hand in your mouth. There are lots of ways people put their hands in their mouth:

• Licking their fingers when something yummy is on them.
• Licking their fingers to turn a page or pick up a card
• Biting their nails
• Biting a hangnail or little piece of skin
• Kids sucking their thumbs
• Picking their nose

HOW DOES IT GET ON YOUR HANDS?

• When someone is sick with either vomiting or diarrhoea they flush the toilet and it sprays up in the air, landing on toothbrushes, countertops, floors, tubs, toilet flusher handles and the seat
• Someone is sick on a floor and it sprays several metres in the air around them. It lands on all sorts of surfaces – it may even land on your mouth and you lick your lips later.

You touch these surfaces or put them in your mouth (toothbrushes, silverware in the kitchen if they were sick in there).

HOW TO PREVENT NOROVIRUS

It’s pretty easy to prevent contracting it. Just never put your hands in your mouth unless you’ve just washed them with soap and warm water for at least 20 seconds and rinsed. If you’re standing in a room and someone vomits near you don’t lick your lips until you’ve gone and washed your face. Then put on a mask if you’re caring for someone who has it. Masks prevent the spray from getting on your mouth and also prevent YOU from putting your hands in your mouth. Also, never eat things with your hands unless you’ve washed them (pizza, buns, snacks, etc.)

Wash your hands after using the bathroom and before eating. Use plain soap and water. Anti-bacterial soap doesn’t help as norovirus is not a bacteria. Hand sanitizers are generally ineffective if they’re alcohol-based. Get one that has benzalkonium or benzethonium chloride for your car or any place you can’t wash.

SOME NOROVIRUS FACTS

Norovirus incubation period is 12-48 hours depending on viral load.

People are infectious for about 2 weeks after getting it as they shed it in their stool.

Myths: You CANNOT catch it because you walk beside, work beside, socialize with, kiss or hug someone with norovirus.

You can’t prevent your kids from getting it at school or daycare, so don’t even try. You can look after kids and not get it though, so try to focus on that and not worry.

IF YOU WOULD LIKE TO START YOUR RECOVERY from emetophobia, Anna Christie (the world’s leading specialist) is offering 10 online classes. There are just 2 spots left for classes on Wednesday at 4:15pm Pacific (7:15pm Eastern) beginning October 2nd. Info and register here: www.emetophobiahelp.org/classes. A new set of early classes begins November 7th at 10am Pacific (6pm UK time) – info to follow shortly.

Unfortunately…

I was meeting with a client the other day that I hadn’t seen for a while, and they were asking me some questions about how long it would take to fully recover. I found that almost all my responses began with “unfortunately.” Then earlier today I sent an email response to someone, and that, too, started with “unfortunately.” I started to reflect on how many times I said that word, and what it means for people with emetophobia to hear it.

The thing is, we all wish there were a magic cure, a quick fix, a pill, a mantra, a relaxation technique…something…. anything that would stop this cycle of anxiety and panic that we experience day after day after day.

I often get people in my Facebook group (“Emetophobia No Panic”) who ask for “tips and tricks.” I know it’s an expression, more or less, but I have to say I really don’t like it. I want to scream “THERE ARE NO TIPS OR TRICKS!” but instead, of course, I begin my response with “unfortunately…”

To save myself valuable time and energy, here is my list of “unfortunatelies” for folks with emetophobia, followed by a number of “the good news is-es”.

• Unfortunately there is no “cure” for emetophobia, because it is not a disease. We can cure pneumonia and gonorrhea but emetophobia we need to recover from, and we need to maintain our recovery.
• Unfortunately there is no drug that stops you from panicking with emetophobia.
• Unfortunately recovery takes time. Think years, not months.
• Unfortunately recovery takes dedication, commitment and hard work.
• Unfortunately you’re not afraid of puppies, so at the end of treatment the people with a puppy phobia are going to go get a puppy, and we just get to vomit.
• Unfortunately the only evidence-based treatment for emetophobia is exposure and response prevention.
• Unfortunately in order to recover you will have to give up all of your safety behaviours, and avoidance behaviours
• Unfortunately you will eventually have to watch videos and listen to sounds of vomiting as part of your treatment

The good news is…..

• You don’t ever need to vomit in order to recover
• Emetophobia is highly treatable
• CBT with exposure has been shown in scientific studies to help people with emetophobia lead normal lives
• Exposure therapy is done slowly and gently beginning with just looking at words and reading sentences
• More and more therapists are becoming aware of emetophobia
• There are several good self-help books on the market now
• My writing partner, Dr. David Russ and I wrote a clinical manual for therapists on how to treat emetophobia.
• I’ve been contracted to write a memoir/self-help book which is due out in 2026.
• Lots of people have overcome emetophobia, including me!

Spring/Summer Norovirus Facts

Spring is here, summer is coming, and people with emetophobia are far less anxious about catching the dreaded norovirus (also known as “stomach flu” “stomach bug” etc.). Although everyone knows that these viruses can be hanging around at any time of the year, it’s generally true that summer is a much calmer time of year for people who have a fear of vomiting (emetophobia).

So, I thought it might be a good time to talk a little bit about noroviruses: what are they, how are they spread, what prevents them, and so on. A few years ago, I had a microbiology major write a piece about noroviruses on my website and I edited it to keep the facts but present them in a less scary way than the CDC does. The CDC and other public health sites write their articles for the people who don’t take the necessary precautions to stop the spread of disease. People with emetophobia are the opposite of that – they take too many precautions and never spread around disease!

First of all, it’s important for people with emetophobia to remember that if you don’t have kids in daycare or school, or you don’t work in a daycare or school or nursing home then it’s very rare to catch a norovirus. Kids don’t wash their hands properly at school, and touch surfaces where infected kids have touched all the time. No amount of coaching, teaching or threatening them will really help so if you’re doing that with your kids you could maybe lay off that unless you want them to also get emetophobia.

Noroviruses are spread through the fecal-oral route, which is a nice way of saying that you must literally swallow someone’s bodily fluid (poop or vomit particles) in order to get norovirus. If someone vomits in the room with you, it may splash and tiny, microscopic particles of it land on your lips or on surfaces. You may sniff them up your nose and down your throat as well, although this is less common. If someone has diarrhea from norovirus and flushes the toilet without closing the lid, the particles can circulate in the air and have the same effect, landing on surfaces like countertops, taps, light switches, doorknobs or even cups and toothbrushes. Sitting beside a child in the bathroom when they’re sick is often a way to contract a norovirus from them. Wearing a mask will stop this from happening, as it also stops you from putting your hand in your mouth for some reason (biting nails, picking at teeth, absent-mindedly). You can get norovirus on your hands directly if you’re in that bathroom and then go eat a sandwich before washing hands as well.

The best prevention for catching norovirus is to wash your hands with plain soap and water. As well, if someone is sick with a virus try to keep them using the same bathroom and don’t have anyone else go in there. Once they’re well, a simple solution of bleach (1 Tablespoon to a quart/liter of water) sprayed on surfaces and left for two minutes will kill everything. Throw out the toothbrushes and get new ones if they were on the counter, and don’t store toothbrushes there anymore.

If you’ve swallowed norovirus particles the incubation period is 24-48 hours depending on viral load. The particles can stay on surfaces and infect people for 9 or 10 days so think about two weeks. That is the same amount of time that people shed norovirus in their stool which can still infect people. Diapering is a common source of catching a norovirus after it appears to have left the house.

This whole blog may sound quite frightening to someone with emetophobia, but if you really think about it, it’s pretty much impossible to catch a norovirus as long as you wash your hands before you put them in your mouth or before eating something with your hands.

Trigger Warnings

Are trigger warnings a good idea? The short answer to this question is “yes” – but in the case of emetophobia and triggering words, they only help you for the short-term. For long-term helpfulness, we need a little more exposure and a lot less trigger warnings.

With emetophobia, I look at it like this: skipping over a Facebook post or missing out on a lecture, podcast or blog because of a trigger warning is really unfortunate. Already with emetophobia, we tend to make our world smaller and smaller.  The age-old principle of “get back on the horse” widens for those who are afraid to never being near horses, not wanting to go on farms lest horses are there, never taking a drive out of the city, to eventually not wanting to watch TV or movies in case there are horses, to finally being triggered by even the word “horse.” 

Should blog posts and podcasts and such have trigger warnings if they use the word “horse?” How could people know who and what we’re afraid of, as there are many rare phobias out there. I once knew someone with emetophobia who got triggered by the word “orange” because of a previous vomit experience where she was wearing an orange T-shirt. Not only did the T-shirt trigger her, but she couldn’t go into the grocery store because of all the orange things there and eventually she wouldn’t go outside and it extended finally to the word “orange.” 

I belong to several Facebook groups about emetophobia. I enjoy many of the posts, and try to add any helpful comments that I can. Seldom do I read “panic posts” or those with pictures of food asking if it looks cooked. But there are many more and often the answer to someone’s question may need to include any of the following words, which are not to be spelled out unless you post a trigger warning:

• vomit
• puke, barf, etc. etc.(synonyms for “vomit”)
• nausea
• sick, sickness, being sick
• diarrhea
• norovirus
• stomach bug
• bug
• poop (that was a new one to me this past week)

We are supposed to abbreviate all of these words like this: “vxx” so as not to trigger people. I abide by the group rules, even though I don’t agree with them. 

Trigger warnings were originally intended to be about content, concepts, ideas and so forth. So for example, if sexual assault were to be discussed, it would be helpful to give a trigger warning for that so that (originally, students) could prepare themselves for the content they were about to hear. In extreme cases, alternative learning may have had to be provided for students with PTSD that was severe and/or relatively new.

If I am about to discuss a touchy subject with a guest on my podcast, such as one that we did about sexual assault, then a trigger warning is absolutely called for. Nobody expects to be hearing about sexual assault on an emetophobia podcast for one thing. People should be able to at least prepare themselves.

Abbreviating words has always seemed very extreme to me, even though, as I said, I endeavour to do it on groups that have this as a rule. I remember when seeing the word “vomit” in any context gave me a jolt of electricity. But a story with the word in it was far, far worse. If I read a story about someone vomiting in a book (bear with me, there was no internet at the time), I might even break down crying. The story would stay with me for years. I still remember all of them. 

From Wikipedia: Among people without traumatic experiences, “trigger warnings did not affect anxiety responses to potentially distressing material in general.” Studies disagree on whether trigger warning cause transient increases in anxiety in those without traumatic experiences. For participants who self-reported a posttraumatic stress disorder (PTSD) diagnosis, or for participants who qualified for probable PTSD, trigger warnings had little statistically significant effect.¹

Here’s my point: stories need trigger warnings; words should not.

If you have a fear of vomiting, then the only way out of that fear is to slowly and gradually exposure yourself to things that make you anxious that have to do with vomiting. The first of all those things is the word “vomit.” If you can’t see that word without some anxiety and you’ve read this far, you’ve been triggered a number of times by now. That’s ok. The first thing I do with my clients is have them write out the word, and any other triggering words or phrases, in huge bold letters with a marker on a piece of copy paper. Fill the whole sheet with just one word. Then pin it up all over your house. In the bathroom, your bedroom, the kitchen, everywhere. You may need several copies if you don’t have many words that upset you. 

Read the words every time you pass by them. Don’t say to yourself “it’s just a word” or “it’s just ink on a page.” That’s a safety behaviour and it’s not the point. The point is to just get used to seeing and hearing these words over and over and over again. Usually people’s family members are ready and willing to help by using the words in a sentence every chance they get. They need to make sentences up – like “the clouds are vomiting rain today” or “Charlie was vomiting out words all afternoon.” I promise you, within a week, you won’t care what words you see online and you won’t need trigger warnings. 

Meanwhile, we’ll both keep using them where we’ve agreed to.