Kids and Emetophobia

The most important thing to remember is counter-intuitive to parenthood: don’t reassure the child if they ask questions. Reassurance, when it comes to anxiety disorders, is a real no-no. It’s called a “safety behaviour” and it makes the phobia worse. Think about it like this: if a child asks whether or not you think they might be sick, and you reassure them they won’t be, then the child feels better/calmer. So the kid’s brain goes “wow – I feel so much better when I’m reassured – I’ll ask for reassurance a lot now.” Reassurance also subconsciously tells the child that vomiting really is dangerous.

So if the child asks “will I be sick?” answer honestly: “I don’t know.” Shrug it off like it’s nothing. If you’ve been offering reassurance up until now, the child is going to freak out. That’s ok. Their freak-out won’t last forever. Remain calm – don’t get angry – just explain to them that nobody knows when somebody else will throw up, and besides it won’t hurt you – it’s just yucky and nobody likes it. Be completely nonchalant like it’s not a big deal (because it isn’t)!

I can’t possibly write everything you need to know about kids and emetophobia in one blog, so I’ll try to hit the highlights and give you a few tips to save your sanity. First of all, the best thing you can do is to order the Turnaround Anxiety Program (associate link) along with the Emetophobia Supplement of which I am an editor. It’s written by Chris McCarthy and my good friend and writing partner Dr. David Russ. David and I are busy writing a book to help therapists treat emetophobia. Anyway, check it out!

Very young kids are naturally afraid of vomiting. Unless they’ve been vomiting steadily since a baby, they may not experience it again until they’re two or three at which time they must wonder what the hell is wrong with the universe that this can happen! Parents normally comfort them and tell them that they’ll be ok. They teach them to vomit in the toilet or in a bowl/bin/bucket (the three B’s of not-on-the-carpet). If nothing else happens in that child’s life they may just forget about it, or tell you the next time how much they hate it. However, if there’s any kind of stressor (even a “good” stressor like a new baby or a new room/house) then they can start to channel all their anxiety in vomiting’s direction. You may not be able to identify the stressor but that’s ok because the treatment is the same anyway.

Reassurance-seeking can be tricky. They may ask “is it ok to eat this?” “do you think I’ll have a good day today” or “do I look pale to you?” and other such sneaky questions. Be suspicious of all questions. If repetitive questions are asked, explain to the child that you will answer any question only once. Use the Perry Mason, “asked and answered!” if you have to.

Without reassurance from parents (and clue in the teachers as well), the child will need some strategies to calm themselves down. You’ll find these in the Turnaround Anxiety Program, but briefly they will be such things as breathing more slowly, relaxing your body, art, music, or busying oneself with playing or schoolwork.

One final tip I have is the use of the “Get Out Of Jail Free Cards.” Except not about jail. Let’s take the example of a child missing a lot of school because of emetophobia or always feeling unwell/stomach aches. Decide what’s an acceptable amount of school to miss for an anxious child. Let’s say it’s 4 days per month. So make up 3 cards that say “Get out of school free.” Give them to the child and let THEM decide (no negotiating by you) when to use the cards. If they need to miss school they give you a card and you allow them to stay home, no questions asked (NO questions asked!). I had one client that was afraid to take the school bus so she got 3 “Get a ride to school with mom” cards. Another young boy asked his parents and teacher several times PER HOUR to feel his forehead to see if he felt hot. He got 5 “feel my forehead” cards for the month. In each of these cases both their parents and I were amazed at how well this strategy worked. Before using a card, the child had to decide for themselves if it were worth it to “waste” a card that day. Maybe they didn’t feel so bad after all. Maybe they could make it all day. Maybe they could feel their own forehead. In short, the child learns to solve their own problems and comfort themselves.

As a final word, I want to point out something that may be obvious to most of you: when a child has problems, you must address them in priority order. First, is the child actually sick or in pain? They must be taken to a doctor and be checked out that there’s nothing physically wrong with them. Don’t diagnose anxiety right off the bat. Are they eating? Losing weight? This is a medical emergency. Are they sleeping properly and for long enough? If not, this needs to be addressed, even with medication. Lack of sleep is serious. Are they going to school every day? If not, you must address this with their teachers and perhaps look at alternatives for their education, at least until their anxiety is under control. Are you seeking professional help for them for their phobia/anxiety? You must – anxiety disorders are not something a child just “outgrows” – they need help in coping with it. Finally, are they socializing with other kids such as playing sports, music, dance, or just hanging out with them? This is important for children. Hopefully, you find good therapeutic help for them to lessen their anxiety so that they can participate in life again, and enjoy their childhood.

an emetophobia thanksgiving

Today is Thanksgiving Day in America. As I’m Canadian I can only reflect back to our Thanksgiving which was in early October. It’s not as big of a holiday here. Family don’t fly home for it – we save that for Christmas, and we don’t have a history involving pilgrims or our First Nations people. It’s scheduled at the time of the traditional harvest. But interestingly, we have the same food! The turkey, the pumpkin pie, the green bean casserole, even sweet potato puree with those little marshmallows toasted around it. And of course, we also give thanks. At our house we do the go-around-the-table-stating-what-you’re-thankful-for thing. With three children, three of their spouses and seven grandkids it takes a bit longer now. Every once in a while someone says something not so typical and we go “oh…ahhh.”

Today I’m thinking of my beautiful clients, present and past. I thank God that because of them I have meaning in my life, and a great passion, and with my husband’s illness and Covid and him being retirement age, I have an income which pays our bills. I am also able to live out my calling, which, corny as it sounds, is “to help people.” I will never forget the feeling of having emetophobia when I was young, and not only could I not get help for myself but how helpless it felt that there just wasn’t anyone who could help anybody with it. In 1983 I was privileged to be part of Dr. Claire Phillipps’ original emetophobia study and group treatment program. She published her findings around 1985, one of the first in the world to publish about emetophobia (we didn’t even know the word “emetophobia” at the time). When I started working as a therapist in 2010, treating exclusively emetophobia on Skype (another word nobody knew at the time), I could find only about ten research articles on the phobia, and just one other psychotherapist who was treating it – Dr. David Veale in London, UK. He is a psychiatrist and has now become an emetophobia researcher force to be reckoned with. Many of the studies published today (still only about 60) have his name in the group at the top. I thank God for him. Perhaps if he is a religious man, he might thank God for me as he points people and therapists to this website all the time.

Enough about me, though. How about the people still suffering with emetophobia? We’re told not to gather this year, no thanks to Covid-19, and if your family decided to honour that guideline, then perhaps as an emetophobic you’re pretty happy. All those people, especially the germy little kids, amIrite? And the food! Heavy, greasy gravy, sweet desserts never mind the sheer volume of it. I’m sure there are people with emetophobia reading this who are nodding their heads and heaving a sigh of relief (dare I say, thanksgiving?) that it’s not happening.

Yes, it’s 2020, the year of the global helldemic. Sickness, death, isolation, job loss, George Floyd (and so many others), conspiracy theories, economic disaster, civil unrest in the streets, Trump losing/winning/stealing/being robbed of the election. But there’s the vaccine! Unless you’re suspicious of vaccines, that is indeed something to be thankful for. Kamala Harris – someone who represents something, that about half the country is thankful for. As someone with emetophobia, can you even think on these things, or does the phobia grip the very life out of you, day after day after day?

The poet and all-around amazing human being, Maya Angelou, once said “[in a time of crisis] first, thank God.” I remember hearing her say it on Oprah early in 1996. I nodded and smiled and thought it was so wise and wonderful. At our church we met in small groups every week and we decided to start each group time with this phrase “First, thank God…” Then I got cancer. It was diagnosed on a Thursday and I was leading a small group that night. I didn’t think of it until I was driving there. I could not think of a single thing at the time to be thankful for. I had young children; I was only 37.

At the group I cried as I stumbled through the opening. A young woman, new to the faith, timidly offered up “I’m thankful you live in Canada.” Yes, of course. We have some of the best cancer treatment in the world here, and it’s all free. This opened a pandora’s box of thanksgivings. My family. My children. My job. My faith. Today I can certainly offer up thanksgiving that I’m still alive and healthy 24 years later.

If you are so inclined, what can you thank God for today? Allow me to make it a bit more challenging: apart from your partner, your children, your family, your health care, your job (house, car). What are you thankful for apart from these things? Think on it long and hard. After all, you’ve got lots of time that would normally be spent arguing with your drunk uncle who’s either 1) a Trump supporter, or 2) a flaming liberal snowflake.

Why can’t I burp?

Inability to burp is a medical condition known as retrograde cricopharyngeus dysfunction (R-CPD). According to one of my clients who suffers with this condition, many folks with R-CPD are also emetophobic. I’m not sure what the connection is, but I can well imagine how uncomfortable it makes you feel to have trapped gas in your stomach, bloating and painful gas in your colon. Never mind that your incidence of flatulence (farting) would be much higher than the average person.

People with R-CPD have a type of deformity in their upper esophageal sphincter, which cannot relax so as to release the air bubbles. When we eat or drink, that sphincter muscle relaxes for a second. It’s also supposed to relax in order to burp.

Every once in a while I’ve felt like I can’t burp when I need to, and it’s not a nice feeling at all. Sometimes it can even be painful. For those of you with children, remember the lengths we would go to in order for our newborn to burp after feeding for a few minutes? Patting or rubbing (or downright pounding on) the back, sitting baby up, laying him down then sitting him up, putting her over our knee on her stomach and on and on it goes. If you don’t get the burp up, you’ll pay for it a few hours later (well, technically the baby will pay for it with extreme discomfort, but you’re the one enduring hours of screaming).

Some people with R-CPD experience nausea, hypersalivation, really bad hiccups, difficulty breathing and excessive flatulence. Much like emetophobia, people with R-CPD are often misdiagnosed as having IBS or acid reflux, but the treatments for these don’t help. If you think that you’re actually suffering from R-CPD, you need to get a formal diagnosis from a gastroenterologist. The best way to do this is to have the doctor look down your throat (esophagoscopy) or do a swallow study.

Once diagnosed, there is a treatment that can help. Botox is injected into the sphincter muscle which weakens it for a few months. This may eliminate the problem or at least make it much better. After this treatment, you can burp and keep practicing burping so that when the Botox wears off you’re still able to do it. Some people with less severe R-CPD can learn to burp without the Botox and after a lot of practice they can do it well enough to eliminate the problem.

Emetophobics with R-CPD will feel much relief once they receive treatment. Burping will help diminish their feelings of nausea and bloating which can be very triggering of anxiety.

For more information, visit https://laryngopedia.com/

I’m Afraid to Get Better

I’ve had many clients over the years gingerly tell me that at least part of them is afraid to get over the emetophobia. I know their reasoning before I even ask. “You’re afraid that if you get better, you won’t be so careful, and you’ll end up getting sick.” 

“Yes.”

Most of them understand that this doesn’t make sense, but many do not. Either way, they’ve been embarrassed to tell me. I blame a lot of it on other therapists who have been judgmental of them in the past when they’ve come in for emetophobia treatment. In fact, many therapists who don’t understand emetophobia or how to treat it have told their clients that they just don’t want to get better. They usually conclude this when they can’t think of what to do with these clients that to help them. 

Sometimes the refrain is picked up by parents who are also at their wits’ end about what to do with an emetophobic child who doesn’t want to eat, drink, go to school or go to therapy. They conclude that the child/teenager doesn’t want to get better or is afraid to get better so they’re not “trying.” 

I do get it. I remember at least thinking that I might be afraid to get better when I had emetophobia. Yet I desperately wanted to get better. I knew it wasn’t logical – after all, if you get better that means you’re not afraid anymore, so whether you’re “careful” or not, it really doesn’t matter if you get sick because you’re not afraid of it anyway. That may have been too confusing a sentence. Sorry! Think of it this way: a person has a severe phobia of puppies. Especially those fluffy, bouncy, slobbery Golden Retriever puppies. Ya, these guys:

Yes, there are many people terrified of them. They have panic attacks just like you, and they do everything they can to avoid going anywhere where they might see one, and they never watch Disney movies and close their eyes during most TV commercials. If one of these phobics accidentally stumbled on this page they’d be crying right now from seeing that picture. Don’t even say in your head that you think it’s ridiculous!!!! These things aren’t logical, as you well know. 

Okay, so now imagine that someone who has a phobia of puppies comes to me for treatment. On intake, they whisper gingerly that they’re afraid to get over the phobia because if they do, they might end up not caring any more and then they’ll just go get a puppy some day. 

Did that make you scratch your head? But it’s the same thing, right? EVERYONE with a phobia is afraid to get better in case they stop being “careful” to avoid what they fear. What if someone gets over their spider phobia and just throws caution to the wind and starts gardening? What if someone with a clown phobia gets better and just starts going to kids’ birthday parties? You’re getting the idea, right? And yes, I know that if you’d rather be afraid of puppies or clowns or even spiders for that matter right about now.

So first of all, the obvious: if you don’t have emetophobia you won’t care if you get sick, or risk getting sick because you won’t be afraid of vomiting anyway. But secondly, and I speak from experience here, you’re not going to just let all hell break loose and start licking the bottom of your shoes or your fingers after shaking hands with sick people or whatever. I’m no longer afraid of vomiting but I sure as heck don’t like it. I might risk eating something that seems wonderful if I’m not sure about it or who cooked it, but I don’t want Norovirus – I had it ten years ago and it wasn’t very nice: the worst part for me was the fever, chills, exhaustion and body aches. So even though I don’t fear vomiting any more, I still wash my hands before I eat and I don’t put my fingers in my mouth or nose unless I’ve just washed my hands thoroughly for 20 seconds and not left my living room.

Get better, ok? Don’t be afraid of it! Getting better is awesome.

Safety Behaviours

Do Safety Behaviours Work?

Along with avoidance of the feared stimulus (nausea, someone else saying they feel or were sick, seeing something associated with vomiting), a safety behaviour is something that you actively do to avoid vomiting at all costs. Some examples of typical safety behaviours are:

  • Sucking on mints
  • Taking ginger (candies, tablets, tea)
  • Drinking ginger ale or another fizzy drink
  • Sipping water
  • Chewing gum
  • Sniffing peppermint or eucalyptus essential oils
  • Taking an OTC stomach medication such as Gravol (Dramamine), Pepto Bismal, Divol, Tums,
  • Taking a prescription anti-emetic such as Ondansetron (Zophran)
  • Taking a prescribed “Rescue Medication” tranquilizer such as Xanax, Ativan
  • Taking prescribed stomach medications such as Omeprazole
  • Carrying a plastic bag in your purse or pocket at all times
  • Carrying a “safety kit” with any of the above items with you at all times
  • Wearing a face mask before Covid-19
  • Washing hands, changing clothes, showering
  • Opening doors or pressing buttons with your sleeve
  • Checking “best by” dates on food
  • Drinking alcohol, smoking marijuana, taking illegal drugs
  • Asking someone for reassurance, when you know what they’ll say every time
  • Practicing large muscle relaxation and/or slow breathing not to calm down, but so you won’t vomit
  • Needing to be with or talk to a “support” person when anxious/nauseous.

How many of these can you relate to? Are they helpful or do they work? Well, what if I told you that they most certainly don’t work and that you should really try to slowly give every one of them up? I imagine that might make you very anxious. Without working with a therapist, it might be difficult to give these up on your own. It is the same with avoidance behaviours – stopping them is really difficult without some sort of professional help. Nevertheless, there are determined people out there who are reading this right now who can do it if they try!

So, do safety behaviours work? The answer is yes and no. Yes, they make you feel better in the moment. They calm you down. Some of them most certainly prevent vomiting although the odds of you vomiting without them are pretty slim anyway. But no, they don’t work to lessen your anxiety and in fact most of them will make your anxiety worse over time. So the more you use these behaviours the worse your phobia will get. Let’s look at why that is.

Engaging a safety behaviour presupposes the wrong thing: that the problem is vomiting. I’m sure it will surprise many of you to hear that vomiting is not the problem. Vomiting is normal, natural and neutral. It isn’t dangerous or harmful. It can’t hurt you, so there’s no need to avoid it or fear it. (I know that’s not what you actually think right now; I’m just pointing out the logic.) The problem is anxiety. Your anxiety around vomiting is what’s not normal. It’s way out of whack for what vomiting is – just a yukky, unpleasant thing that nobody likes. There are many of these things in the world: diarrhea, Pap tests, proctology exams, colonoscopies, doing your income tax, picking up dog poop, flossing your teeth. None of these is dangerous or harmful, but if the universe could eliminate any one of them we’d all be happy about it.

Anxiety/fear/terror should be reserved for dangerous things like alligators, grizzly bears, home invasions and nests of gigantic furry venomous spiders. It doesn’t have any place in the normal yet yukky things of life. Your emetophobic brain has somehow mixed up vomiting with all the other deadly things you need to be terrified of. So you avoid it at all costs and then come up with these safety behaviours to keep you “safe.” The thing is, you ARE safe, whether you vomit or not! But I know it doesn’t feel that way.

The road to recovery is long and hard with emetophobia. One important part of the journey, however, is slowly giving up your safety behaviours so your brain comes to realize that you’re just as safe without them as with them. You also need to slowly stop avoiding the things you’ve been avoiding. Either with a therapist or on your own, you also need to slowly change your thoughts from the catastrophic “OMG vomiting is horrible/terrible/awful/the worst thing ever” to something more normal such as what your non-emetophobic friends think about it (ask them, write down what they say, memorize it, replace your catastrophic thoughts with these thoughts every time you think them.) It will take time, but eventually it will work.

Once you come to realize that anxiety is your real problem, you can focus your energy on working on that, instead of on preventing vomiting. This will make your phobia better, which is really what you want.

There is a ton of information on this website that will help both you and your therapist get your anxiety under control!

Chemotherapy

Emetophobia and Chemotherapy

I took some liberties with the Halloween videos available on Canva this week – lol!

Pretty much since the birth of the internet I’ve been finding and talking to people with emetophobia. My first computer experience with internet was 1996, and by 1998 I discovered, after 39 years, that my phobia had a name and that there were other people like me! By the year 2000 I was a moderator of “emetophobia.org” – a discussion forum that quite quickly went to 10,000 members. There was no such thing as Facebook groups at that time. This website had so much traffic that you could go there any time of the day or night and find someone with whom you could talk. Thank goodness for time zones!

The great thing about a discussion forum (which still exists, by the way) is that topics can be organized into sections, and you can view the topics to see if you’d like to partake of that conversation. Now, Facebook groups have pretty much taken over the emetophobic community. Our latest podcast was about the pros and cons of social media support groups.

Despite changes in how emetophobics talk with one another online, there is always this question, “What would you do if you got cancer? How could you deal with chemotherapy?” Usually the responses are something to the tune of “I’d rather die.” Sound about right? It’s not.

I found the breast lump when I was just 37. My youngest of three children was only 11 years old. My world came crashing down, for a number of reasons only one of which was being freaked out about having to have chemotherapy. I had had some treatment, but I was still terrified of vomiting. I had always told myself that I would rather die than vomit, and thus I would rather die than take chemotherapy. I was serious about this. But let me tell you something: when death looks you right in the face, with a ghoulish sneer and an open door to utter darkness, you’ll take the chemo.

The reason we say we’d rather die than vomit is that our amygdala at the back of our brains is responsible for our survival and whenever it gets triggered it shouts out just one message: “Danger! You’re going to die!” With a phobia, for some reason the wiring in our brain isn’t just right and when we experience the phobic stimulus (nausea or someone else vomiting) our amygdala gets triggered. So we avoid vomiting at all costs, the way we avoid certain death. We believe that vomiting and death are pretty much equal and because we’re not faced with death we fear vomiting more. Avoiding death is pretty simple when you’re young and healthy.

But then actual death comes along. And suddenly they’re not equal anymore, and somewhere in our messed-up brains something clicks as if to say, “ok so vomiting isn’t really as bad as death and I sure don’t want to die.”

I went through surgery, chemo and radiation. The chemo was nowhere near as bad as they make it out to be on TV or in the movies. I only had to have chemo one time (four treatments, three weeks apart). I did get very tired and felt like hell for 2-3 days. They gave me a powerful anti-emetic – Ondansetron (Zofran) – at the time it was $30 a pill but I would have sold my cat, my dog and my TV set for it if I had to. I did not vomit. And this was in 1996 – they have much better, more efficient chemo now and a whole host of anti-emetics in addition to Ondansetron. They can give you a cocktail of about four or five of them at once if need be.

I never had a trace of cancer again. Since 1996 I’ve conquered my emetophobia, seen three children graduate university, watched my daughter dance on stage in Germany as a professional ballerina, held 7 grandchildren in my arms and loved each one like they were my own, celebrated 39 years with my husband, bought a beautiful house, been to Paris, had two wonderful and successful careers in which I helped a lot of people, published two books with a third on the way, and probably a thousand other things I never would have done if I’d said I’d rather die than have chemo. Trust me, life is so much better than death.