OCD and Emetophobia: Understanding Their Relationship and Coping Strategies

The word emetophobia might be unfamiliar to you but what it is probably isn’t – vomiting, more specifically, the fear of vomiting. Now, most people don’t like the idea of vomit or vomiting or even thinking about it. But for some people, it’s a fear that goes beyond just not liking the idea of vomiting. 

Emetophobia is a specific phobia characterized by the intense fear of vomiting – you vomiting, someone else vomiting, or even the feeling like you might vomit. It can be a disruptive and debilitating fear.

You’re probably wondering why we might be talking about emetophobia along with Obsessive-Compulsive Disorder (OCD). The fact is, both OCD and emetophobia share a number of characteristics and comorbidity is not uncommon. Some experts have even suggested that emetophobia might actually be a subtype of OCD. 

Both OCD and emetophobia are currently classified as unique disorders and each can create distress and dysfunction. When they occur together, treatment can be complicated. Let’s take a closer look at this relationship and strategies to effectively manage them. 

What is OCD?

OCD is a mental health disorder characterized by unwanted, intrusive thoughts (obsessions) and repetitive behaviors or mental acts (compulsions) that individuals feel compelled to perform to alleviate their distress. These obsessions can range from fears of contamination to intense worries about safety, symmetry, or forbidden thoughts. 

To reduce the discomfort caused by these obsessions, individuals engage in compulsions, which might include washing, checking, counting, or repeating behaviors. These behaviors can take up substantial time and interfere significantly with daily life.

What is Emetophobia?

Emetophobia is a specific phobia involving an extreme fear of vomiting. It can manifest in various ways:

• Fear of vomiting
• Fear of others vomiting
• Fear of situations where vomiting might occur (e.g., public places, hospitals)

Estimates of prevalence for emetophobia vary widely, ranging from less than 1% to about 8.8% of the population. Women are far more likely than men to be affected (4:1). 

When it does occur, the impacts of emetophobia can be significant. This fear can lead to intense anxiety or panic episodes, avoidance behaviors, such as avoiding certain trigger foods, places, or social situations, and can significantly impact quality of life.

Are OCD and Emetophobia the Same?

OCD and emetophobia do share some similarities that can make differentiating between the two challenging. Both disorders involve some form of:

• Obsessive thinking
• Hyperawareness of bodily sensations
• Compulsive behaviors
• Avoidance behaviors
• Heightened anxiety

Despite the similarities, there are distinct differences: 

• Emetophobia is a specific fear related to vomiting.
• OCD involves a broader range of intrusive thoughts and compulsive behaviors.
• People with emetophobia typically experience anxiety in response to specific vomiting-related triggers and may avoid these triggers. People with OCD engage in compulsions to reduce anxiety caused by various obsessions.
• Emetophobia is focused on the immediate fear of vomit/vomiting.
• OCD often involves more abstract or irrational fears about harm, contamination, or morality.

It is also possible for OCD and emetophobia to co-occur. For example, someone with OCD may develop emetophobia-related obsessions, leading to compulsions like excessive handwashing, specific food restrictions, or avoiding certain places to prevent exposure to certain vomiting-related triggers.

Obsessive Thought: "What if I catch a stomach bug from touching that countertop?"

Compulsive (OCD-related) Behavior: Person engages in excessive cleaning of the countertop (repeatedly spraying disinfectant and wiping until it is “just so”) or repeatedly washing their hands after touching the countertop. 

Emetophobia Behavior: Avoids that area or refuses to eat foods that were placed in that area to reduce the risk of vomiting or catching the “bug” that would trigger vomiting. 

Strategies for Coping with OCD and Emetophobia

While living with OCD and emetophobia is challenging, there is help for managing them. The treatment for both OCD and emetophobia is a combination of Exposure and Response Prevention (ERP) and mindfulness/self-care practices. 

Exposure and Response Prevention (ERP)

ERP, the gold standard for treating OCD, is a specialized form of CBT that differs from traditional “talk therapy” or general CBT. It is also used to treat emetophobia. ERP involves gradually exposing the person to their obsessive fears without allowing them to engage in compulsions. Over time, this helps reduce the anxiety associated with the obsessions.

Medication

Medication is generally not used to treat specific phobias like emetophobia. However, medication is sometimes used to help relieve other symptoms like anxiety or depression or GI issues while you’re working in treatment. For example, Selective Serotonin Reuptake Inhibitors (SSRIs) are commonly prescribed for OCD to help regulate serotonin levels and reduce anxiety.

Mindfulness and Relaxation Techniques

Mindfulness practices can help you to remain present and reduce the intensity of intrusive thoughts. Mindfulness strategies that may help include:

• Deep breathing exercises
• Progressive muscle relaxation
• Meditation or guided imagery

Create A Support Network

Whether its supportive friends and family or a support group, connecting with others who understand your experiences can provide emotional relief and safety. Support groups, both in-person and online, offer a safe space to share fears, coping strategies, and successes. You’ll connect with others who have similar experiences and may offer insight into how to manage your situation. 

Practice Self-Compassion and Acceptance

Dealing with OCD and emetophobia together can be exhausting. It’s easy to feel overwhelmed and frustrated. Self-compassion, the ability to acknowledge one’s shortcomings or failures without criticism or judgment, but rather with kindness and understanding, is a powerful deterrent to self-judgement and negativity and enhances resiliency and emotional well-being. 

Acknowledge Your Efforts

Living with OCD and emetophobia requires tremendous resilience. Recognize the hard work you’re doing to manage your symptoms. 

Give Yourself Grace

Progress is never linear or all-or-nothing. If you have a rough day, remind yourself that it’s part of the journey and does not diminish the progress you’ve made. 

Managing co-occurring disorders requires patience and self-compassion. Recognize that progress is gradual, and setbacks are part of the journey. Practicing self-kindness can reduce feelings of shame and guilt often associated with these conditions and help you regain control after a setback. 

When to Seek Professional Help

If OCD and emetophobia are significantly interfering with your daily living, there is help. Signs that it might be time to seek professional help include:

• Persistent social avoidance
• Inability to eat a balanced diet due to fear of vomiting
• Compulsions that take up significant time and attention
• Heightened anxiety that impacts your personal or professional life

Look for a therapist who specializes in OCD and phobias who can offer individualized treatment plans that address both conditions. 

OCD and emetophobia can be challenging to manage, especially when they coexist. However, with the right combination of therapy, coping strategies, and support, you can reduce anxiety and regain control over your life. Remember, every small step toward facing your fears is a victory.

If emetophobia and OCD are disrupting your world, there is help, and the good news is, you don’t even have to leave home. Online therapy is effective and eliminates unnecessary barriers to seeking help. Our online therapists specialize in OCD and related phobias and can help you find effective ways to manage your symptoms and put you on the path to healing. Ready to learn more? Connect with one of our therapists today. 

References

1. Sykes, M., Boschen, M. J., & Conlon, E. G. (2016). Comorbidity in Emetophobia (Specific Phobia of Vomiting). Clinical psychology & psychotherapy, 23(4), 363–367. https://pubmed.ncbi.nlm.nih.gov/26017849/

2. Becker, E. S., Rinck, M., Türke, V., Kause, P., Goodwin, R., Neumer, S., & Margraf, J. (2007). Epidemiology of specific phobia subtypes: findings from the Dresden Mental Health Study. European psychiatry : the journal of the Association of European Psychiatrists, 22(2), 69–74. https://pubmed.ncbi.nlm.nih.gov/17157482/

3. van Hout, W. J., & Bouman, T. K. (2012). Clinical features, prevalence and psychiatric complaints in subjects with fear of vomiting. Clinical psychology & psychotherapy, 19(6), 531–539. https://pubmed.ncbi.nlm.nih.gov/21695748/

4. Weg, A. H. (n.d.). Emetophobia: Fear of Vomiting as an Expression of OCD. International OCD Foundation. https://iocdf.org/expert-opinions/emetophobia-fear-of-vomiting-as-an-expression-of-ocd/

5. Del Casale, A., Sorice, S., Padovano, A., Simmaco, M., Ferracuti, S., Lamis, D. A., Rapinesi, C., Sani, G., Girardi, P., Kotzalidis, G. D., & Pompili, M. (2019). Psychopharmacological Treatment of Obsessive-Compulsive Disorder (OCD). Current neuropharmacology, 17(8), 710–736.  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7059159/

6. Boschen, M. J., & Jones, K. (2024). A clinician’s quick guide to evidence-based approaches: Emetophobia (specific phobia of vomiting). Clinical Psychologist, 28(1), 75-78. https://www.tandfonline.com/doi/full/10.1080/13284207.2023.2295276#abstract

7. https://my.clevelandclinic.org/health/diseases/25115-emetophobia-fear-of-vomiting

8. MacBeth, A., & Gumley, A. (2012). Exploring compassion: a meta-analysis of the association between self-compassion and psychopathology. Clinical psychology review, 32(6), 545–552. https://pubmed.ncbi.nlm.nih.gov/22796446/