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Anna S. ChristieLeave a comment

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.

Anna S. ChristieLeave a comment

WHAT SHOULD YOU DO ABOUT THOSE Movie SCEnes?

You know the routine: close your eyes and plug your ears. Take one finger out of an ear, perhaps saying “LA LA LA LA” very loudly, and grope around for the remote, wildly doing anything to change the channel, mute the show, or whatever. If you can’t do that you ask your significant other to tell you when the scary bit is over. This fear of vomiting can ruin just about everything in life, even your entertainment.

Most people with emetophobia are “lucky” enough to have their partner already in control of the remote and they tell you when you can open your eyes and unplug your ears. They similarly enable you in movie theatres. Notice I put “lucky” in quotation marks but not “enable.” That’s because it is enabling, which is always a dirty word and an unhelpful concept in the big picture. So you may feel lucky in the moment, but this avoidance is making your phobia worse, which is probably the last thing your partner wants for you. I know that my husband was always trying to “help” (there are those quotation marks again) but he was also trying to avoid getting screamed at or me having a meltdown of some kind. 

I have to say that I love-love-love movies. Foreign films are ok but I’m not one to go to a film festival. I like American movies. I know and understand the formula, having taken a course once on scriptwriting. And it makes me happy that the hero or heroine always accomplishes their goal by the end, even if ten minutes before the end it looks like they won’t. I used to go to the movies by myself every Wednesday afternoon for 20 years when I was a minister. I worked pretty much 7 days a week so it was my self-care time. 

I also love television. I grew up in the 1960s where you got one channel in black and white and the whole family sat around the tiny little TV set on Saturdays for Hockey Night in Canada, or Sunday nights for the Ed Sullivan show. By the early 70s my brother and my dad were dead and my sister was married and moved out. So my mother worked hard to buy that colour TV. The first thing we watched was Disney’s “Wonderful World of Colour” and I still remember a warm, happy feeling watching the opening animation. 

Lovers of television and movies are often thought to be lazy bums. “Couch potatoes.” I am unapologetic. I love the genre – the 22 minute sitcom and the 44 minute drama. I’ve never been big into made-for-tv movies but I’m hopelessly addicted to Netflix, Crave and Prime right now. Binge-watching several seasons of an entire show can elicit squeals of delight from me.

I’m not sure when vomiting got to be a thing on TV and in movies. I know that in 1972 the movie The Exorcist came to the theatre in my home town. I was terrified of seeing even the commercials for it. Yes, it was the emetophobia, as I’d heard about the vomiting bit, but also the creepiness of the devil stuff freaked me right out. I did not see it and have not to this day. In 1983 Monty Python came out with The Meaning of Life and I heard about the vomiting scene in it from the psychologist who ran the first emetophobia group I was ever in. Now I have seen that movie since, and the vomiting is so fake it’s pretty ridiculous. 

Vomiting slowly crept into a lot of movies, and a lot of TV shows, both comedies and dramas. I remember going to see The Green Mile in about 2000 and while there’s no actual vomiting in it, the guy opens his mouth and this grey cloud of sort of like flies comes out – it’s supposed to be the evil or pain which he absorbs from others and then it flies out of his mouth and away from him. I remember sitting in the theatre kind of cursing that movie. And crying afterward, because it seemed like emetophobia was going to ruin everything in my life by that point. 

By the early 2000s we had a ton of reality TV so vomiting was one of the things that was, actually, real.

Here’s something I know now but didn’t know then: you can use the occurrence of vomiting in TV shows and movies to actually help your emetophobia, instead of avoiding it and making it worse. You just need a tiny bit of courage and no other skills. 

  1. Tell your significant other that you are going to try to actually watch and/or listen to vomiting scenes from now on.
  2. Decide which you think is easiest to do – look or listen. Let’s say it’s “look.”
  3. You probably know when the scene is coming because people with emetophobia have almost a sixth sense about these things. THAT’S the time to hit the pause button on your remote. Take a deep breath and click “play.”
  4. Plug your ears or mute the sound if you wish, but try to watch the scene. Your anxiety will rise. That’s ok – it won’t hurt you. Just allow your anxiety to be there and don’t try to make it go down. No safety behaviours! Your anxiety will go up, but not too high – it’s just a TV show after all and it can’t hurt you. 
  5. Rewind and watch it two more times. Be proud of yourself.
  6. Carry on and finish the show.

Next time, if you’re brave enough, try listening but with your eyes closed. Then the next time, put the two together and watch it all. Keep doing this. Like, forever. Your emetophobia will be knocked back a bit, and that’s a good thing.

PS – ANNA’S TOP 3 GOAT LIST – IN ORDER

Movies: 1. Schindler’s List 2. Star Wars IV 3. O Brother Where Art Thou

TV Shows (Dramas): 1. Downton Abbey 2. Breaking Bad 3. The Sopranos

TV Shows (Comedy): 1. Big Bang Theory 2. Seinfeld 3. Friends

Anna S. Christie

I’m Afraid to Get Vaccinated

It seems to be all people can talk about on the Facebook emetophobia support groups and the emetophobia discussion forums: 

“Will the vaccine make me throw up?” 

“Will the second vaccine make me vomit?” 

“I’m afraid I will vomit with the vaccine.” 

“Has anyone else got the (Pfizer, Moderna, J&J, AstraZeneca) vaccine? Did you get sick from it?”

Frustrated moderators have tried in vain to put all the vaccine questions in one post and/or encourage people to search the page before posting the same question again and again. I can understand their frustration as my inbox and text messages have blown up with similar concerns. I can also understand the fear. I wasn’t even thinking twice about whether or not I’d vomit until reading all the anxiety online. And I’m not even afraid of vomiting any more! I had to remind myself of that and giggle a bit about it. (So far I’ve had the first AtraZeneca shot and all I got was body aches and fatigue for a few days.)

The thing is, phobics and others with anxiety disorders and/or OCD have a hard time taking any risk. We all know this because of the way people feel when sending kids to school or staying in the same house as a sick person, even though you pretty much have to swallow bits of their poop or vomit to catch it yourself. Pretty low risk. Who here reading this, ever puts their fingers in their mouth? Or up their nose? Especially after touching anything at all except their own phone in bed at night.

I can reassure you all that I’ve read hundreds and hundreds of emetophobics testify to the fact that they weren’t sick with the first or second vaccine of any of the varieties offered by the American, Canadian, or UK government. Emetophobics just don’t vomit with trivial things like other people do. If you have emetophobia I can pretty much guarantee that you won’t be sick from ANY of the following:

Fever

Headaches

Pregnancy

Labour and delivery

Overheating

Anxiety

Stage fright

Worry

Eating one bite of anything (undercooked meat, moldy bread, outdated dairy)

Vaccinations

Since people with emetophobia are naturally anxious people, it makes sense that many of you will have anxiety about getting vaccinated for a couple of other reasons. Let’s examine each one. First of all, both the Johnson and Johnson and AstraZeneca vaccines have been associated with blood clots, and one woman, who was improperly treated, has died. About 15 people have presented with the blood clots but the rest received the correct treatment and did not die. So far, all those affected have been women under the age of 50, and all of them were eithera) obese b) on birth control pills c) on thyroid medication or d) on blood pressure medication. The blood clots are associated with a low platelet count, so if you’re given a blood thinner such as Heparin you could bleed out and die (which is what happened with the one woman who died). SO if you don’t fit into any of the categories above you have nothing to worry about. If you do get a blood clot and tell them at the hospital that you just received x vaccine and not to give you Heparin, then you have nothing to worry about. ALSO your chances of getting a blood clot and dying are literally one in 6 million, and those odds get better with each passing day. Your chances of getting Covid-19 and getting the same exact blood clots are 1 in 5. 

FIVE.

Secondly, many of you have expressed that you don’t want the vaccine because it was developed too fast and not enough people have had it and/or enough time has passed. I do respect anyone’s decision, whether they have emetophobia or not, to not get the vaccine. So long as you know that you’ll have to wear a mask (two if you are exposed to a variant in your area) and socially distance from people and remain isolated for long enough that your country reaches herd immunity (approximately 80% vaccinated). That could be at least 2 years. 

These vaccines were not actually “rushed” as many people think. We can all thank the Chinese for sequencing the virus (I don’t know what that means either but apparently it was a ton of people working day and night on it) and sharing that sequence to the world. The pharmaceutical companies have also been working on this type of vaccine and its basic structure for a long, long time – about 30 years, to be exact. The technology is called synthetic messenger RNA (mRNA), an ingenious variation on the natural substance that directs protein production in cells throughout the body. Once the drug companies (Pfizer and Moderna) were presented with a viral sequence, they just “plugged it in” to their already developed mRNA platform (the other vaccines use DNA, rather than RNA as it’s more stable at lower temperatures). None of these vaccines are traditional in the sense that they do not inject you with a small amount of the virus (living or killed) to get your immune system to identify it later. Trials began early in 2020 on human subjects to get the dosage right, then in the next phase over 70,000 people received the same dose of vaccine that you will receive. 

As of this writing, over 1 BILLION people world-wide have been vaccinated. A few have had an allergic reaction, which can be treated right at the vaccine sites while you wait. One woman has died after receiving the wrong treatment for a blood clot. 

So what are you waiting for?

Anna S. Christie

Is this chicken cooked?

NOPE.

I belong to almost all of Facebook’s emetophobia groups, and by far this is the most common question. Sometimes it’s chicken, and sometimes it’s other types of meat. There are also questions about how long something was out of the fridge, freezer, or how something should be cooked. These are legitimate concerns. A lot of what emetophobics worry about isn’t, and I seldom if ever address it. But undercooked chicken can definitely make you sick. It can happen within 1-2 hours, or as long as 24 hours. Other meats, like sausage, can make you ill, when undercooked, up to several days later.

Chicken is particularly tricky as it must be cooked thoroughly, but not allowed to dry out (74C for chicken parts; Beef only has to be seared on the outside, as various diseases such as e.coli are only on the outside of the beef, not the inside. But chicken can have salmonella all the way through the meat. Anything that’s been chopped up such as hamburger or sausage MUST be cooked to the proper internal temperature. There’s a trend in the United States to eat hamburgers “medium rare” which is all fine and dandy so long as the meat hasn’t been contaminated in the slaughterhouse or butcher shop. I travelled to Paris some years ago where the steak is served tar tar (raw) which sounds scary because you sure as heck don’t want to buy a steak in the United States and serve it raw. But in France, beef that is sold for tar tar has been carefully slaughtered and butchered so as not to contaminate it. In order to assure this, you have to slaughter cattle one at a time. In America (and Europe for regular beef) cattle are slaughtered on an assembly line that resembles the making of an automobile. If you were ever to visit such a place, you’d be a vegetarian for life. Well, ok. I have and I did and I was, but I was only vegetarian for about 8 years until the slaughterhouse faded from my memory.

Pork is its own thing – at one time it had to be cooked to 71C/160F. You’re unlikely to get salmonella or e.coli. from pork, but there used to be certain parasite larvae within the meat that will attach to your intestines after which the parasites will migrate to skeletal muscle, but sometimes to heart, lungs or brain. Pig farming has come a long way, however. Yes, pigs are kept in small enclosures like most chickens and dairy cows. But unlike the latter, pigs are housed on concrete slats washed down several times a day. Humans must sanitize and wear clean overalls to even enter the “barns.” So they’re not digging up and eating dirt, rats or garbage anymore. The chance of parasites is virtually nil. If you keep your own pig in your own pigpen and feed him leftovers, then when you cook him, cook him to 71C/160F. If you buy your pork at the grocery store, it is now safe to cook it to anywhere between 63C/145F and the previous 71C/160F. The same parasite once found in pork IS present in wild game such as bear, wild boar, horse, dogs and several more.

The thing to keep in mind is that you can’t tell if any meat (or anything else) is cooked properly without a food thermometer such as the one through the link on Amazon, above. They’re inexpensive and easy to use. You want to make sure you get a digital one. The other thing you need is a proper chart to tell you what temperature each type of food should be cooked to. There’s nothing worse than eating dry or rubbery chicken because you’ve cooked the living hell out of it just to make sure. It’s so simple – just insert the thermometer and ensure your meat hits the minimum temp.

If someone else cooked your meat, at home and not at a restaurant, you may need to be more careful. I’ve been to many a barbecue in my day where hamburgers were served raw in the middle. If possible, go for a steak (always ok if seared on a barbeque) or a hot dog. Never give a child a homemade hamburger without cutting it in half and ensuring the centre has no pink at all. This is one time when you can tell if it’s cooked by looking at it. Perhaps better to tell your host you’re vegetarian and bring your own veggie burger patty to the barbeque. That’s what I started doing after a while. My husband always threw all caution to the wind, would eat the garbage if I fried it up, only started handwashing during Covid, and never vomited for 32 years (that was after drinking a few wee drams of Cape Breton whiskey 8 years ago. He’s now labeled the box “for cleaning bicycle chains”).

Restaurant food is far safer. Perhaps I’m speaking as a Canadian who owned a restaurant at one time. It was actually a bakery, but we served breakfast and lunch sandwiches and soups. We also made our own pastry cream and other cake fillings. The health inspector was strict and brutal. We needed to take a “FoodSafe” course first, to even get a license. Then she showed up at any time (usually the worst, busiest time) to do surprise inspections. We always got a “low risk” inspection review and rating, which was the best you could get. I was grateful for my history of emetophobia as I’d committed most of the food-safe facts to memory long before! I am not familiar with the health regulations in the United States although a little internet exploring and I came up with this January 12, 2021 blog which seems to imply that the regulations are exactly the same, but restauranteurs are not necessarily required to take a FoodSafe equivalent course. These regulations may have changed by the time you’re reading this.

This chart is not so much for safety as optimal freshness and taste.
For safety you can add a day easily in the fridge, and double the time in the freezer.

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.