coronavirus and emetophobia

Edit: March 12, 2020. “Cancel Everything” – don’t go out unnecessarily to places where there are a lot of people. Avoid travel. Protect the elderly. End edit.

When Coronavirus was first publicized in January, many of the Facebook pages and chat sites for emetophobia carried the same message: “I’m not afraid of it, because none of the symptoms is vomiting.” In other words, if you’re only afraid of vomiting and not of dying then you’re good. If truth be known, emetophobic people are also afraid of dying – they just don’t realize it. Vomiting=dying in some part of the emetophobic brain. Other forms of dying we feel pretty much immune to, even though there is risk involved. Phobics are naturally unwilling to take any amount of risk as it relates to the thing they fear, even though they’re quite willing to get into an automobile every day.

I was hoping that the conversation might be a bit more realistic, which it has now become: we germ phobics have something to teach the rest of the world – good hygiene! Wash your hands well, and don’t touch your face, meaning the “T-zone” of eyes, nose, mouth. Those are the mucus membranes just waiting for the virus to find its entry point.

With norovirus, touching one’s nose is less likely to infect you, and touching the eyes even less, as norovirus must be “swallowed,” meaning vomit or fecal matter has to make its way to your stomach and intestines. Ew. Coronavirus, on the other hand, just needs to make its way, via your mucus membranes, to your lungs. Gah!

Wearing a mask may help you to remember not to touch your mouth or nose, but as masks are in high demand just now it’s better to leave those for folks who are actually sick. That way, their sneezes and coughs can’t infect anyone else. Gloves are pretty useless because, just like hands, they touch everything and are quickly covered in germs.

Click here to link to a great Washington Post article that talks about the psychology of why refraining to touch our faces is so difficult.

Six Degrees of Separation

There’s a running joke in Hollywood that there are only ever six degrees of separation from any actor to Kevin Bacon. If you’re a real movie buff you can play the game with your friends and try to figure it out.

The Kevin Bacon game works pretty much with any actor, as it’s based on the idea that there are only six degrees of separation from any one person to another on the planet. It got me to thinking…

I find that a lot of my emetophobia clients worry extensively (some much more than others) about the degrees of separation of Norovirus (aka “stomach flu” or “stomach bug”)[1]. What I mean by this is they’re afraid that someone with Norovirus touched this, then that, then what if I touch this, then, that – is “that” contaminated with Norovirus? Here’s an example of what I mean:

  1. Bob has Norovirus
  2. Bob doesn’t wash his hands after using the bathroom. There are Norovirus particles on his hands
  3. Bob opens the door
  4. Bob picks up his keys
  5. Bob opens his car door
  6. Bob drives to the grocery store
  7. Bob gets a grocery cart
  8. Bob grabs a box of granola bars, reads the label, then puts it back.
  9. A few moments later I grab the granola bars and put them in my cart. I buy them and they get put in a bag
  10. I touch the bag handles
  11. I touch my purse handles and keys
  12. I eat a burger without washing my hands
  13. I will get Norovirus.

I now believe that I must wash my hands, my purse handles, and wipe everything item of my groceries or I will catch Norovirus.

Here’s the thing: you won’t. Norovirus is very contagious, true, but what we have here are TWELVE degrees of separation from the Norovirus particles and you. That’s way too many for the virus to still be active. Here’s what can happen at the grocery store:

  1. A kid has Norovirus
  2. The kid doesn’t wash his hands after using the bathroom.
  3. He touches nothing until the grocery cart handle.
  4. You use the cart next and touch the handle.
  5. You put your fingers in your mouth or eat a burger.
  6. You get Norovirus

That’s six, right? So yes – you could get Norovirus this way. But NOT IF THERE ARE ANY MORE THAN SIX. Because I’m actually talking about one item touched by the kid, touched by you (the grocery cart), and I’m also talking about invisible Norovirus particles, not visible poo. Ew. Sorry for that. This is why there are wipes in grocery stores now, for your cart handles.

Here are the items you don’t want to touch, then put your hand in your mouth:

  1. Anything in someone else’s bathroom, or yours if someone in your house has Norovirus: toilet flusher, taps, soap dispenser, paper towel dispenser, countertops, cups, toothbrushes, toiletries or makeup, door handles.
  2. Doorknobs
  3. Other people’s phones (your phone is fine)
  4. Light switches (especially in bathrooms)
  5. Elevator buttons
  6. Gas pumps
  7. Other people’s hands

 For all you emetophobia folks out there, let’s review how you might catch Norovirus:

  1. Someone with Norovirus throws up within ten feet of you. That’s about the radius that the aerosolized particles can travel, although it’s more like seven feet to the side. (Now you know why it’s so contagious in schools.)
  2. Diarrhea in a toilet can become aerosolized when the toilet is flushed. It can land on toothbrushes across a room.
  3. Someone in the food production business doesn’t wash hands and touches your salad or hamburger bun.
  4. You touch something from the list, above, don’t wash your hands, then put your hands in your mouth. You could theoretically catch it from putting your finger in your nose, but it’s highly unlikely, and even more unlikely you’d catch it from touching your eye. Zero chance from touching your face.

There is more information on the Norovirus page of my website including myths about how it is caught. The truth is, most Norovirus is spread by children. They suck at handwashing. Apparently so do caregivers in nursing homes.

The good news is that it’s really easy to get the virus off your hands – you just wash them with plain soap and water. Emetophobia folks will tell you about all the things that kill Norovirus, but if you wash your hands before putting them in your mouth you really don’t need to worry.


[1] Noroviruses are neither a “flu” nor a “bug” – those are just sayings.

Being Thankful

As an emetophobic, it can be hard to truly appreciate the holidays. You often have to travel by car or plane, stay at someone else’s house, eat food cooked by someone else, and put up with all the family members including little ones who can be germy to say the least.

Our Canadian Thanksgiving has passed now, but I am aware that most of my clients are from the USA, and their Thanksgiving is looming. Not being thankful, in fact not enjoying oneself, can bring with it guilt and shame. Everyone else is having a good time sharing food and wine, stories and games. You might be curled up in a chair away from people staring at your phone, not wanting to eat. “Waiting.”

Many ask me if I have any “tips” for getting through the holidays. I do not. Recovering from a serious anxiety disorder such as emetophobia is not about tips or five steps to a cure, or a quick fix. It is a slow, methodical process; a road that is straight uphill. Let me share this with you, however: you can do it. You can get through the holidays; you can cope with whatever happens. You know darn well you’re going to wash your hands and not put them or anything you’ve touched in your mouth anyway. So the chances of YOU getting sick are pretty much non-existent. If other people are sick that would be upsetting, but nothing bad will happen to you. You may be afraid, but you’ll be ok. Try to remember this – write it on a little card, perhaps, and take it with you for the weekend. Refer to it whenever you feel your anxiety start to rise.

What about being thankful? Everyone else will talk about being thankful for food (probably not you) and for family (even those germy kids?) and for other various aspects of privilege. You may feel that while you’re suffering so much, you don’t feel very thankful for your life at all. When I was a kid, I made the same wish blowing out the candles on every birthday cake: I wish I didn’t have this phobia! I figured the wishing didn’t work. But here I am at 61, nearly twenty years completely free of it. So maybe it worked after all. It just wasn’t instant.

Here are a few thanksgivings to ponder:

  1. I am thankful that I live in America (or any other country that celebrates Thanksgiving). There is treatment for emetophobia here.
  2. I am thankful that I live in the information age, so I can find out lots about emetophobia right at my fingertips.
  3. I am thankful that I live in the age of Social Media, so I don’t feel alone with this and it’s pretty easy to have someone to “talk to.”
  4. I am thankful that people are studying emetophobia and conducting research all the time, so it may be easier to get treatment very soon.
  5. I am thankful that people are working diligently on developing a Norovirus vaccine!

What Causes Emetophobia?

This post has been moved from my previous website.

Like any other phobia or anxiety disorder, the exact cause is unknown. Why do some people develop a phobia of dogs after being bitten by a dog as a child, but others do not? Some folks remember a traumatic incident involving vomiting when they were young. Perhaps they were vomited on, or they vomited in school and were embarassed. Yet this happens to many children and not all develop phobias. So although scholars do not know the exact cause, there are many things they do know.

  1. Phobics have a genetic predisposition to anxiety. Probably your mother, father, or one of your grandparents was an anxious person. It may be an aunt or uncle. Whoever it is, it’s in your family. That person may have been able to hide it, but it will be there. Genetics (nature) only accounts for about half of the cause, however. The other half is experience (nurture).
  2. Most emetophobics that I have spoken with online (thousands) or worked with as my own clients (over one hundred) had something happen to them in childhood that disrupted the normal resolving of attachment with their mothers. When I say “resolving” I mean that as babies we have a very close attachment to our moms, however with the passage of time this naturally resolves and we begin to trust the world, other people, and can manage on our own (“independence”/”interdependence”). The disruption of the attachment resolve does not need to be dramatic, however it certainly can be: death, abuse, neglect, abandonment (trauma). It can be something quite minor: mom returns to work, mom is in hospital having another baby, mom is concerned with her ailing parent. It can also be a trauma or attachment event that happens before you were old enough to remember. Adoption is a one example. 
  3. Regardless of your genetics or your childhood experience, there are three major factors that turn these into a phobia, and keep the phobia going: 

I believe that one of the reasons that the fear of vomiting presents as so severe in most cases is that we naturally “avoid” vomiting throughout our lives. It just doesn’t happen that often. Young children vomit more often as their gut has not yet fully developed. But by about 13 your gut is an “adult” and you may only vomit once every 10 or 20 years. This kind of avoidance cannot be helped, so the factors of safety behaviours and anxious thoughts are  much more prevalent in keeping emetophobia going or getting worse. There are two types of safety behaviours, and there is disagreement among scholars as to whether both are problematic for emetophobia or just the first one:

  1. SAFETY BEHAVIOURS TO AVOID VOMITING
  2. SAFETY BEHAVIOURS TO AVOID PANIC (CALMING DOWN)

Let me begin by saying that I only believe that safety behaviours which avoid vomiting (germs, norovirus) are problematic, and behaviours to avoid panic and calm down such as slow breathing, muscle relaxation, etc. are a big part of the way out. 

Some common examples of emetophobia safety behaviours are:

  1. ​OTC medications (Dramamine/Gravol, Pepto Bismal, Tums)
  2. Prescription medications (Zofran/Ondansetron, Ativan, Xanax)
  3. Ginger, gingerale, ginger tea
  4. Mints, gum
  5. Sipping water
  6. Excessive cleaning (bleach)
  7. Excessive hand-washing or using hand sanitizer
  8. Not touching doorknobs, light switches, gas pumps
  9. Not touching your face
  10. Running away/avoiding sick people

There can be any number of others. The problem is that as soon as you employ a safety behaviour and don’t vomit, your brain will assume that the safety behaviour “saved you” and the situation was actually a dangerous one that you avoided this time. In reality, the situation wasn’t dangerous at all, because vomiting isn’t dangerous. Nobody likes it, but it’s actually helpful to you as opposed to a danger to you.

SLOW, DEEP BREATHING, relaxing large muscle groups, meditation, or imagining yourself going through a situation like a “normal” person are behaviours used to calm oneself and I do not consider them safety behaviours. Some schools of thought disagree with me, but I’m not alone in this idea. Learning to truly relax in the face of what I once considered was danger, was the way I got over my phobia.