Q. In the past few years she was sick last time (with norovirus), and my 16-year-old daughter developed an acute phobia of vomiting. She is otherwise confident, an extroverted, sociable teenager and is prone to normal mood swings, but she is increasingly worried about the extent to which this has impacted her life..
When she appears to leave her comfort zone, she often calls me in a state of distress. I can usually calm down by suggesting that she streamlines how she feels, focus on her breathing, and take breathing techniques to follow her box breathing techniques and whether she is heading for anti-bone or not. That direction.
Recently, she has been feeling sick many times and has been asked to be collected early from school. I can usually “talk her,” but it appears to occupy much of her thought process.
I was suffering from bulimia so I was relieved that her phobia should also mean that she wouldn’t follow that route, but she confessed a bit of self-harm, which is what worries me. Is it connected? Most of my adult life, taking antidepressants, is eager to make sure she doesn’t follow that path. I’m worried that my mental health issues may have somehow affected her.
Nora
A. emetophobia is a severe fear of vomiting, seeing others vomiting, or feeling nauseous. Like your daughter, the patient is functionally impaired and can avoid situations (rational and unreasonable) who fear that he can eat or catch anything that could cause vomiting. I have worked with women who wanted children but have avoided pregnancy because they feared a painful illness.
There are many possible causes, including what you learned. For example, when you see parents or caregivers showing intense fear of vomiting, as you would describe with your daughter, past disastrous experiences of vomiting can cause phobia, especially in childhood.
Emmetophobia usually presents cognitive and emotional patterns associated with anxiety. The patient is visually impaired, constantly monitors signs of nausea, shows avoidance behaviors to reduce the risk to anything that can lead to devastating thoughts (such as “If you vomit, die”), and to cause vomiting, and compulsive behavior – forced behavior – hand washing, excessive checks of dietary symptoms.
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Given that feeling sick is an important symptom of anxiety (in combat/flight survival mode, you are linked to your body when you are preparing to throw away the extra load to be lighter and therefore faster), this all produces self-fulfilling prophecies.
The history of bulimia and associated mental health conditions allow you to understand your fear that your daughter will have a similar struggle. Has it caused some difficulty for my daughter? Blaming yourself will never be useful to you and your daughter, and from what you actually explained, you will clearly support you in providing the right advice when you call you when she panics. But the problem is, while you continue to be her No. 1 Coping mechanism, she will never develop her own coping abilities.
Since bulimia often involves purges, we might assume that emetics and bulimia are the exact opposites. However, despite the contradictions, emetophobia, bulimia, and self-harm can be interrelated via shared underlying psychological factors such as anxiety, perfectionism, and problems of control. The core issue that brings together all three actions is emotional regulation linked by the need to be controlled through maladaptive coping strategies to process emotions.
As adults, we know that errors in control are both seductive and dangerous. In reality, we have little control over our lives, so our ability to tolerate pain, roll with punches, be adaptable and flexible – the ability to demonstrate resilience is a key life skill. We recommend that these are fundamental areas where your daughter needs support to develop healthier than unhealthy anxiety management skills.
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An evidence base for treating anxiety-based difficulties includes cognitive behavioral therapy (CBT), which reconstructs thoughts in daughter’s case of vomiting. Dialectical Behavior Therapy (DBT) for Emotional Regulation, replacing avoidance and self-harm with healthier coping strategies. And while practicing anxiety management techniques, I gradually became exposed to vomit-related experiences and fears of places. You can find therapists specializing in anxiety, DBT, or emethophobia (see bps.org.uk) or visit Support Charity Emeti Action (emetaction.org).
Supporting your teenage daughter with emethophobia, self-harm tendencies, and security-seeking behavior can be overwhelming, but your role as a mother is invaluable. The key is to help you build long-term coping skills to manage anxiety and pain. You are not responsible for correcting her emotions, but you can allow her to challenge the need to feel control (an important life skills) and develop the ability to emotionally regulate in a healthy way.
She constantly seeks security, so it’s important to examine her feelings without overly accepting her phobia. Your daughter needs to gradually retreat as she needs to develop her own emotional regulatory skills. I encourage self-sedation, so instead of always giving answers, I ask my daughter to generate her own solution. You can help her develop a set of self-relief strategies (satisfied statement notes, fidget tools, playlists). This helps to change her focus from seeking external comfort to trusting her own ability to handle discomfort. There are also great apps she can use.clearfear.stem4.org.uk) and calm harm (calmharm.stem4.org.uk).
The goal is to help my daughter to tolerate discomfort and manage her anxiety. As she is sick, she gradually challenges her avoidance by slowly encouraging certain foods she is avoiding. This is called exposure therapy, and over time small exposures can help rewire fear responses. I worked with people who have watched videos of people vomiting while practicing anxiety management techniques such as deep breathing, mindfulness, and 5-4-3-2-1 (see nhsinform.scot).
Emetophobia is a broader problem, a symptom of perfectionism, and is not uncommon in young people who develop the need to navigate and control the world of uncertainty. By dealing with emethophobia, daughters understand themselves better and recognize that expectations of control increase psychological vulnerability and tolerating pain is a core and fundamental life skill.
You already exist and do a lot by being collaborative. The best thing you can offer is your belief in love, structure, and her ability to cope, even when she doesn’t initially believe in herself. I hope both well.
