Emetophobia (from ancient Greek, emetos meaning “to vomit” and phobos “fear”) is an intense and irrational fear or anxiety about vomiting. This fear of vomiting is said to be one of the most common phobias in the world. Yet it is often not taken into account by the clinician, considered as an original passing fad, or as a fear among others.

At first glance, this phobia of being afraid to vomit is surprising among all phobias. Little known, it is often not taken into account by the clinician. According to the literature, its frequency is around 0,1% of subjects, mainly female.

Beyond the simple fear of vomiting in public, emetophobia extends to the fear of seeing someone vomiting, of hearing about vomiting, of looking at pictures relating to vomiting, of catching a disease that could trigger it. vomiting, or simply having nausea. It leads patients to fear a whole series of situations likely to promote vomiting: journeys by bus or car, pregnancy, medical waiting room, class of students, etc.

Emetophobia can become very disabling socially. Half of women avoid pregnancy for fear of nausea and vomiting that could occur. 75% of patients do not have a normal diet and adopt specific dietary rituals to protect themselves from infections or restrict their intake.

Emetophobia has often been considered only as a comorbidity (accompanying manifestation). The authors noted its frequent association with three other types of anxiety disorders: social phobia, agoraphobia, and panic disorder. These anxiety disorders could start with emetophobia before progressing to their full form.

Who is concerned ?

Patients are present on the Internet, especially in forums that they organize to support each other, and in which they call themselves “emeto”. Reading their exchanges reveals the importance of their distress and their desperate quest to heal themselves.

In services for adolescents, this phobia presents itself as a resistant and potentially serious symptom on the physical level. The functional discomfort that it causes and its difficulty in taking care of it plead for a better knowledge of this symptom, which can sometimes worsen, lead to aphagia (inability to swallow) and require urgent hospitalization.

If emetophobia increases in adolescence, like many bodily symptoms, it often begins in childhood, in a latent phase, on average around the age of 9 years. The etiopathogenesis of this disorder is poorly characterized. Nevertheless, this symptom is anchored in the very body of the subject. The question of separation appears in the background of the symptom of emetophobia.

This fear is expressed by the fear of an event: vomiting. One part of the body would separate from another part, thus creating an intracorporeal rupture. This physical fear is associated with other forms of anxiety in these patients, such as separation and abandonment anxiety.

Everything happens as if they were afraid of vomiting on the one hand and afraid of being separated from their loved ones on the other. Losing the primordial bond established with the first parental figure of the origins could have as an embodied fear the fear of losing a bodily element. What link can we suppose between abandonment, or separation, and this symptom of fear?

Abandonment anxieties have an important place in all cases of anxiety disorders. Parents perform a function of reassurance and protection in the event of illness or fear. Would the fear of vomiting, considered as a dangerous situation, have arisen in the aftermath of an infantile, lived or phantasmic scene, during which the child felt alone in the face of his distress? We can suppose that an association was established between the fear of abandonment and the fear of vomiting, of being ill, of being alone without being able to benefit from parental assistance.

The recourse to hospitalization is frequently proposed because of the sometimes severe somatic and anxious state, in particular in the event of aphagia or worsening of malnutrition. These hospitalizations are sometimes difficult to carry out, probably because of the anxiety of abandonment reactivated by the separation that they impose. Care must ensure that the continuity of the education of adolescent patients who might drop out definitively is maintained.

The treatment is essentially based on a psychotherapeutic approach. Cognitive and behavioral therapies are particularly recommended but others may have their place such as EMDR, in order to address the traumatic history.

In some cases, additional medication can be useful: anxiolytics or antidepressants.