Your non-negotiable trifecta for any outing: Zofran, hand sanitizer, and a level of hypervigilance that would make Sydney Prescott look like a sleepy kitten.
You’ve made being germ and vomit free your J-O-B, and you’re quietly enraged, because the more you tighten your grip on control, the more out of control you feel.
But letting your guard down feels like a dangerous, unforgivable failing; failing to prevent something your mind says is “preventable” — and that feels like free-falling into a black hole of fear, uncertainty, and despair.
So you keep squeezing.
I know you feel out of control — your anxiety has you wheels up, erratically crashing through major intersections of your life — and you don’t know what else to do. You need a partner who can help you find your way back to the life you were building before your fears took hold.
This is the work that I do, and I’m really good at it.
My approach is evidence-based, and I offer in-session and between-session support and accountability. Our work will be organized, strategic, and exciting, culminating in you showing up as the parent/partner/person you want to be.
Reach out, so we can talk about what’s possible: contact Dr. Sara Nett to learn more about her approach to helping with fear of vomiting, germs, illness and contamination.
If you want to read more about fear of vomiting, germs, illness and contamination (or you just want to continue feeling seen), visit the blog or keep reading.
If you know enough to know that you are in the right place, and you want to discuss what’s possible if we work together, hit this “Contact” button, and we’ll make a plan to connect.
What is Emetophobia?
No one likes to vomit, but emetophobia goes beyond vomit aversion. It’s best described as a debilitating fear of vomit and vomiting that affects every aspect of your life. People with emetophobia are consumed by their fear of vomiting, preoccupied with preventing illness that might lead to vomiting, and living their lives constantly on guard.
Emetophobia is largely internal and often invisible to others. In fact, many people with emetophobia keep their suffering a secret from others and feel extremely isolated and alone. Some common features of emetophobia are:
Mental preoccupation with vomiting: this may include intrusive thoughts, worry and rumination about vomiting, someone else vomiting, and preventing contact with things that could lead to vomiting.
Hypervigilance: constantly monitoring one’s own body for signs of nausea or illness, monitoring others for signs of nausea or illness, and scanning the environment for potential threats related to vomiting.
Physical symptoms, including things like accelerated heart rate and breathing, physical tension, sweating, nausea and stomach discomfort; physical symptoms are triggered by anxiety and anticipation of vomiting or encountering vomit.
Avoidance: people with fear of vomiting often avoid certain “trigger foods;” they avoid people who they deem higher risk, including children (especially those in daycare settings), people who work with children (teachers), people who work in medical settings or care for sick people (nurses, doctors, etc.), people who appear unwell, people who have recently traveled or used public transportation, and people who have recently complained of symptoms or experienced illness; people with emetophobia avoid places and activities associated with higher incidence of vomiting, including traveling by car, train, bus, or airplane, visiting amusement parks and state fairs, schools/classrooms, libraries, restaurants, indoor play spaces, swimming pools, children’s birthday parties, and places where alcohol is served.
Side note (and you won’t find this in the DSM): The clients I work with often describe a general avoidance of feelings/discomfort, one that typically began when they were very young. To read more about this common underlying characteristic: https://www.bepsychotherapy.com/blog/fear-of-vomiting-runs-deeper-than-you-think
Is emetophobia a type of OCD?
Emetophobia and OCD are two distinct conditions, but there is often a high degree of overlap. Both conditions feature things like intrusive and obsessive thinking and avoidance, checking, and reassurance seeking. If you have emetophobia, you may or may not meet criteria for a diagnosis of OCD. The good news — the treatment for emetophobia and OCD uses the same therapeutic framework — Exposure and Response Prevention (ERP; more on this below) — and many of your symptoms can often be addressed simultaneously, rather than having to treat these conditions one at a time.
Emetophobia and OCD in Motherhood
Experiencing fear of vomit, germs, illness and contamination in motherhood can make parenting feel scary, sad, confusing, and exhausting. Being present with your family and participating fully in activities and events is really difficult when your nervous system is responding as if you are in imminent danger. Mothers with these fears often feel sad, overwhelmed, angry and ashamed. They often say things like, “It’s like I’m stuck between a rock and a hard place. I’m supposed to be present with my family — experiencing joy and togetherness — but I have to keep everyone safe from possible exposure, and it feels impossible to do both.”
Emetophobia and OCD often develop during childhood and adolescence. Many women who wish to conceive delay pregnancy, due to fears associated with known triggers, such as “morning sickness” and eventually facing the prospect of having young children who are likely to vomit.
Fear of vomiting and germs often worsens during pregnancy and early parenthood, due to a number of factors, which can include both biochemical and hormonal changes during pregnancy and the postpartum period, as well as increased anticipation of triggers and a heightened sense of responsibility related to safety. Many of the mothers I work with say they were able to “get by” without treatment before pregnancy or motherhood, but seek treatment because “getting by” without consequences to their own mental health, their partner relationship, their ability to be present with their kids and family, is no longer possible (and creating much pain and suffering). It’s often that gap between the parent the wish to be — and the parent they see living in fear — that prompts reaching out for help.
Related articles written by Dr. Sara Nett:
Why do fears of vomit, germs, illness and contamination persist and grow over time?
People with emetophobia and OCD often begin to fear vomiting, germs, and illness during childhood or adolescence. Sometimes there is a specific event or series of events that leads a person to develop this phobia, but not always. When people are afraid of something, they naturally avoid it, and when we avoid things we are afraid of, fears tend to get bigger over time. As fears get bigger, the need to avoid grows stronger. You can see a cycle developing here, right? The bigger fear gets, the more we avoid; the more we avoid, the more afraid we become. What we are able to do over time without fear and discomfort shrinks, and our lives get smaller and smaller over time.
What treatments work?
As an emetophobia specialist, clients often come to me having been in therapy for many years, even decades. They feel frustrated and hopeless, and they fear that they are “too far gone” to be helped. If this is you, I want you to know that there is no such thing as “too far gone” and that you are not the problem. The problem is that most therapies fall short of successfully treating emetophobia, and even the most well-meaning therapist (who hasn’t been properly trained) may actually suggest therapies that are ineffective or even counterproductive.
If you have emetophobia, you need Exposure and Response Prevention (ERP). In ERP, a warm, supportive, and skilled therapist will help you slowly begin to approach your fears without escaping, avoiding or engaging in compulsions or rituals. With consistent practice, you will learn a lot about your anxiety and how it works, and when you begin to avoid less, you will begin to learn what you can tolerate, and what is possible for your life. While treatment is challenging, an emetophobia expert helps pace the approach, allowing it to remain doable, and helping clients experience increasing success and mastery over time. When working with a true expert and putting in the work, clients are often surprised at how quickly they begin to experience transformation.
Related articles, written by Dr. Sara Nett:
How does ERP work?
ERP works because it targets the thing that feeds emetophobia and OCD — avoidance. You can think of avoidance like throwing gasoline on a fire. The more you avoid, the higher the flames grow.
ERP works by helping people take stock of how avoidance is limiting their life, especially in the places that matter to them most. A skilled ERP therapist will help clients develop a specific and concrete plan for approaching previously avoided people, places, and activities at a pace that allows for consistent progress and mastery without overwhelming their nervous system. An experienced ERP therapist knows how to communicate with clients about pacing and adjust the approach to keep clients engaged and progressing without overwhelm.
“Dr. Nett — Who do you help?”
I help women and mothers who fear vomiting, germs, illness and contamination. My clients have emetophobia, contamination OCD, and all of the shades of gray in between. This includes women who are contemplating pregnancy.