Mental Illness 2012; volume 4:e3 Treatment of a woman with with emetophobia, the avoidance response must be very distressing and have a significant Correspondence: Ad de Jongh, Department of emetophobia: a trauma focused impact on the person’s life. As a result, emeto - Behavioral Sciences, Academic Centre for approach phobics have a tendency to avoid a wide array Dentistry Amsterdam, Louwesweg 1, 1066 EA of situations or activities that they believe Amsterdam, The Netherlands. Ad de Jongh might increase the risk of vomiting. For exam - E-mail: [email protected] Department of Behavioral Sciences, ple, they may avoid crowded places from which they fear they cannot quickly escape in case of Key words: specific phobia, vomiting phobia, ACTA, University of Amsterdam and emetophobia, EMDR. nausea or vomiting, such as shops, boats, air - Vrije Universiteit Amsterdam, planes, concerts and hospitals. In addition, The Netherlands; Received for publication: 28 August 2011. they may not be able to go on holiday or travel School of Health Sciences, Revision received: 2 December 2011. on public transport, but the avoidance behavior Accepted for publication: 2 December 2011. Salford University, Manchester, UK could also pertain to avoiding adults or chil - dren who may be ill (and, therefore, regarded This work is licensed under a Creative Commons as contagious) or who are at risk of vomiting Attribution NonCommercial 3.0 License (CC BY- NC 3.0). (e.g. people who are drunk). The avoidance Abstract might extend to using public toilets or door ©Copyright A. de Jongh, 2012 handles, medication, going to the dentist, Licensee PAGEPress srl, Italy A disproportionate fear of vomiting, or eme - restricting the activities of their children who Mental Illness 2012; 4:e3 tophobia, is a chronic and disabling condition may be in contact with other children, or to doi:10.4081/mi.2012.e3 which is characterized by a tendency to avoid a certain food which they believe could cause wide array of situations or activities that might vomiting, which may lead to being significant - increase the risk of vomiting. Unlike many ly underweight. 4,6,7 among a group of 7 patients. 3 Up to 13 sessions other subtypes of specific phobia, emetophobia The sudden nausea and anxiety in emeto - were conducted in which the participants were is fairly difficult to treat. In fact, there are only phobia seems to have many similarities with asked to repeatedly view video sequences. The a few published cases in the literature. This panic disorder 8 and agoraphobia. 6 The differ - author noted that a subgroup of patients paper presents a case of a 46-year old woman ence between emetophobia and panic disorder, required a greater number of sessions because with emetophobia in which a trauma-focused however, is that the panic caused by emeto - treatment approach was applied; that is, an phobia is usually of much shorter duration fear returned between the exposure sessions. approach particularly aimed at processing dis - than that of panic disorder. Furthermore, the This observation is in line with the results of turbing memories of a series of events which avoidance behavior of emetophobics covers a an internet survey among 56, mostly female, were considered to be causal in the etiology of much wider range of situations than seen in individuals which showed that those who suf - her condition. Four therapy sessions of Eye agoraphobia, including the avoiding of drink - fer from emetophobia are likely to have under - Movement Desensitization and Reprocessing ing alcohol, becoming pregnant, contact with gone a wide range of previous treatments but (EMDR) produced a lasting decrease in symp - sick people and people with a degree of unpre - with fairly limited success. 6 tomatology. A 3-year follow up showed no indi - dictability, like children or the mentally handi - Eye Movement Desensitization and Repro - cation of relapse. capped. 6 More specifically, the behavior of cessing (EMDR) is a recommended treatment emetophobics is primarily aimed at the pre - for posttraumatic stress-disorder or PTSD. 16,17 vention of nausea and vomiting and not, as is Given that emetophobics frequently report a the case of agoraphobia, to avoid situations childhood onset, often following exposure to Introduction where the thought comes to mind of not being distressing experiences of vomiting or seeing able to get help when misinterpreting bodily others vomit, 6 and that EMDR is capable of A phobia of vomiting, or emetophobia, is a signs of anxiety. resolving disturbing memories of a wide variety condition characterized by a disproportionate If left untreated, emetophobia is likely to of events, including those that explain the onset fear of vomiting or other people vomiting, and persist. Knowledge on how emetophobia of phobic conditions, 18 one might argue that is generally associated with an overwhelming should be treated is limited, partly because of emetophobia is also responsive to EMDR. sense of losing control, becoming very ill, or the lack of any controlled trial on the (relative) Among the types of phobias that have been that others will find them repulsive. efficacy of treatment strategies for this condi - reported as being successfully treated by using Individuals with this condition have a tenden - tion. In fact, there are only a few published EMDR ( e.g. phobias of traffic, snakes, moths, cy to check and monitor interoceptive stimuli cases in the literature. Treatments that have spiders, mice, injections, dental treatment, and such as nausea that in turn makes them more been reported include the use of (combina - choking), 19-21 there is one case report in the lit - likely to feel sick. 1 tions of) hypnotherapy, 9-10 cognitive behavior erature in which EMDR was used to treat a fear Estimates about the prevalence of emetopho - therapy including stimulation of nausea or of nausea and vomiting. 22 This approach led to bia suggest that it is a rare condition occurring vomiting, 11,12 the use of counter condition - complete remission of complaints following only in about 0.1% of the population. 2 Conversely, in ing, 13 interoceptive exposure, 1,14 exposure in one session of EMDR. its milder form, fear of vomiting is fairly com - vivo to cues of vomiting, re-scripting of past The aim of the present case study was to fur - mon in the community with estimates of point aversive experiences of vomiting, behavioral ther explore the clinical usefulness of EMDR prevalence rates ranging from 3.1 to 8.8%, and experiments, dropping of safety-seeking for treating emetophobia. To provide the read - women being four times more likely to suffer behaviors, and role play of vomiting using the er with an impression of how the therapy was from fear of vomiting than men. 3,4 smell of vomit. 15 experienced by the client, special attention Emetophobia belongs to the category of spe - It would seem that emetophobia is a condi - was paid to her personal notes and the cogni - cific phobia (Other Type) according to the cur - tion that is relatively hard to treat. The most tive, emotional and behavioral changes that rent edition of the Diagnostic and Statistical comprehensive treatment study used repeated she reported by e-mail both during the period Manual of Mental Disorders. 5 To be diagnosed exposure to film footage of people vomiting she was in therapy and at follow up. [page 10 ] [Mental Illness 2012; 4:e3] Case Report aspects of it. The client must focus specifically mess on the table, the moment that my class Case Report on the most distressing image and a dysfunc - mate vomits all over the table . The feeling that tional negative belief of oneself in relation to this picture evoked in Debbie was one of pure Subject the image, as well as accompanying emotions powerlessness (NC= I am powerless ), and Debbie is a 46-year old office worker who had and bodily sensations. A core feature of the pro - appeared to be emotionally charged (SUD=8). been suffering from an excessive and unrea - cedure is the performance of eye-movements. After starting the EMDR procedure, an intense sonable fear of vomiting for as long as she could Typically, the therapist moves his or her fingers flow of thoughts immediately started in remember. She had always done everything in back and forth in front of the client, asking him Debbie’s mind. She quite rapidly associated her power to avoid seeing other people vomit, or her to track the movements with the eyes the event at the kindergarten with other rele - 27 including her own children, as she was afraid while concentrating on the trauma memory. vant events related to the main one. Thoughts that it would make her want to throw up herself. Following the image and negative cognition and memories arose that were associated with Debbie, therefore, avoided all kinds of situa - (NC), access to the emotional and somatic Debbie’s early school years. During the second aspects of the memory takes place. After each tions, among which visits to hospitals, and set, she suddenly burst into tears when she series of eye movements (termed a set ) the watching certain television programs and films, realized how much fun she had actually client is asked to report emotional, cognitive, from fear of seeing people that might feel missed because as a child she was always so somatic and/or imagistic experiences until unwell, and who therefore might vomit. fearful. In the following set, Debbie saw all internal disturbances reach a SUDs (subjective Because Debbie had gradually been avoiding kinds of nice things, jars of paste and such that unit of disturbances scale ranging from 10 to 0) more and more of these situations in her daily had once been present in her kindergarten of zero and adaptive and positive cognitions life, her world had shrunk considerably.