Anna S. Christie

Let’s talk poop

You didn’t think I’d actually choose a poop picture for this blog, did you? Gaze on this lovely waterfall picture for sixty seconds and breathe slowly. It really helps sometimes.

I’m writing this today because I see so many people on the emetophobia support groups on Facebook really freaking out about poop. Mainly loose poop, which they often call “diarrhea.” The reason they get so anxious is because of course diarrhea and vomiting often go together. If you have norovirus (“stomach bug” or “stomach flu” – even though it’s not actually a “bug” or a “flu”) then you will normally get both. The virus multiplies so quickly and so much that it overwhelms your small intestine and then your stomach. As well, you stop digestion of food. So while technically norovirus is an intestinal virus, you often vomit a few times because the virus triggers a vomit mechanism in your brain to make sure you get as much of the virus out of your stomach and intestines as you can, while your immune system kills off the rest.

That being said, there is another, much more common reason for having loose or very loose poop: anxiety. I know that you’re probably very tired of well-meaning friends and relatives telling you that “it’s JUST anxiety” or “it’s all in your head” because these two things are often said with a tone of not-very-niceness to them. Like they’re fed up of you freaking out and complaining. I can well imagine my poor mother when I was a kid. I don’t know how many times in one day she’d have to explain to me what was actually wrong when I needled her with questions about poop or weird feelings in my digestive system (gas, bloating, acid, heartburn, upset stomach, butterflies, bowels just working properly, grumbling stomach, eating-too-little, eating-too-much, eating-too-many-sweets, eating-too-much-junk-food, not eating at all….).

The honest-to-God truth is, anxiety makes you have loose stool IMMEDIATELY. Like you know how someone is telling a funny story about someone jumping out at them and scaring them and they say “I almost shit myself!” Or I did. (I heard that story from one of my son’s friends once and I laughed so hard the tears ran down my legs.) Well, these aren’t just folklore – the stories are true. If you get a huge fright your bowels can loosen in an instant and then you really have to go.

Loose stool, and other digestive problems that often accompany anxiety, can happen because your brain and your gut are actually connected. And this works both ways. Your brain controls your gut, and your gut also has an effect on your brain. When you have emetophobia or some other anxiety disorders, this can cause what we call a “feedback loop.” So you get an anxious thought (which you may not even be aware of ) and your bowels loosen. The loose bowels make you anxious, so they loosen even more. And so on. Here’s an abstract from a 2013 scientific study:

Within the first few days of life, humans are colonized by commensal intestinal microbiota. Here, we review recent findings showing that microbiota are important innormal healthy brain function. We also discuss the relation between stress and microbiota, and how alterations in microbiota influence stress-related behaviors. New studies show that bacteria, including commensal, probiotic, and pathogenic bacteria, in the gastrointestinal (GI) tract can activate neural pathways and central nervous system (CNS) signaling systems. Ongoing and future animal and clinical studies aimed at understanding the microbiota–gut–brain axis may provide novel approaches for prevention and treatment of mental illness, including anxiety and depression.1

Dr Praveen Gupta, Director & HOD, Neurology, Fortis Memorial Research Institute (FMRI), Gurugram says: “The brain is responsible for sending signals to different parts of the body and hence, plays an important role in keeping all the systems of our body running smoothly. Now, the digestive system is no different. So, when you’re feeling anxious, your neuroendocrine system experiences changes, and this in turn causes changes in the enzymes of your digestive systems. This affects the mobility of the intestine. In fact, a lot of people who have anxiety also suffer from irritable bowel syndrome (IBS).”

Dr Gupta also says that once you’ve taken care of the root cause of your anxiety and feel more at peace mentally, your digestive system will also go back to functioning normally. That is until the next pang of anxiety hits you. All in all, your bowel movements and anxiety are interrelated
If you are experiencing anxiety, in all likelihood you can also end up suffering from digestion-related troubles such as acidity, stomach cramps, and in some cases, even constipation.2

What does all this mean for the person with emetophobia? It means, stop panicking about loose poop. It actually comes from panicking. So just let it happen, and carry on. Try to do some relaxation and breathing exercises to slow down the brain-gut reaction you’re having. You may not be able to, and that’s ok. If you actually contracted norovirus, the diarrhea would be quite severe, almost like you’ve just turned on a tap and water is pouring out. And it would be constant, even every half-hour or so. (So sorry for the TMI – I’m just trying to help.)

I hope at least some of you can find relief from your emetophobia through this blog!

  1. Jane A. Foster and Karen-Anne McVey Neufeld (2013). Gut–brain axis: how the microbiome influences anxiety and depression. Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada.
  2. From Healthshots (Feb 6, 2021) https://www.healthshots.com/mind/mental-health/wondering-why-your-anxiety-makes-you-poop-take-a-deep-breath-and-read-this/

Anna S. Christie

America the Beautiful

I am Canadian – 6th generation. My ancestors were among the first United Empire Loyalists to land in Nova Scotia from Britain in the late 1700s. Among my ancestors is also a First Nation’s woman of the Mi’kmaq tribes of eastern Canada. My family history does not record her name.

In 1925 my grandmother wished to divorce my grandfather for “physical cruelty” but women were not allowed to divorce men for any reason, although a man could divorce a woman for adultery. So grandma packed up a horse and cart with five children and rode all the way to Boston, Massachusetts where she settled for several years until she became a citizen and divorce her husband, as this was allowed in America. After the divorce she returned to Nova Scotia with her two youngest children: one was my mother, age 9.

So I have two aunts and an uncle in Boston, who were much beloved of mine in my childhood. We went to see them every year, often taking my Aunt Sadie with us to Nova Scotia to visit my grandparents. I also have several cousins in Indiana to whom I’m very close. Most of my clients are from the United States.

Needless to say, yesterday was a particularly painful day for all of us who love America – those living there and those who have relatives, friends and much-loved aquaintances – on “both sides of the aisle” as American politicians say. I thought for my blog this week I would just share with you the second verse of a very familiar song. Comments have been turned off.

O beautiful for pilgrim feet,
Whose stern, impassioned stress
A thoroughfare for freedom beat
Across the wilderness!
America! America!
God mend thine every flaw,
Confirm thy soul in self-control,
Thy liberty in law!1

_______________________________________________

  1. Katherine Lee Bates, 1893.

Anna S. Christie

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.

Anna S. ChristieLeave a comment

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.

Anna S. Christie

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/

Anna S. Christie

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.