If you asked me what I’d eaten today, I might well reply, “nothing.” I’m not on a diet, and I don’t have anorexia, but I suppose it would be fair to say that I’m starving myself.
But I am obsessed with food, or rather, the dangers it presents. I have emetophobia, an intense fear of vomiting, which has ruled my thoughts and my life for the best part of a decade.
I’m not the only one. Dr David Veale, a consultant psychiatrist in Cognitive Behavioural Therapy at the South London and Maudsley NHS Trust, and at the Priory Hospital in Southgate, north London, is one of the UK’s only experts on emetophobia, which is thought to affect millions. “Sometimes, I ask patients, ‘If I gave you the choice of either vomiting now or taking this pill that makes you die painlessly, what would you choose?’ They frequently choose to die rather than vomit. This is an indication of the perceived awfulness of vomiting,” said Dr Veale.
For female sufferers, the phobia can be so debilitating that they may delay pregnancy or forgo having children altogether due to their anxiety surrounding pregnancy sickness.
A lot of emetophobes are particularly terrified of vomiting in public. Many cite a fear of losing control and of others finding them repulsive. Sufferers are also usually afraid of witnessing other people vomit. Many interpret feelings of nausea as inevitable precursors to endless vomiting, insanity and death.
As with most phobias, the fear of vomiting can often be traced back to early childhood. Typically, there will have been a traumatic experience in which vomit was involved, which will have triggered a child’s subconscious into attaching negative feelings and emotions to being sick, explained Amber Ford of Anxiety UK, which supports people living with anxiety disorders. “As the child grows up, instead of their rational, conscious mind overriding this response, the difficulty in accessing the subconscious can mean that such adverse reactions can persist,” she said.
I can count on one hand the number of times I vomited between the ages of four and 21. Whenever a poorly friend reported that they’d spent a night on their knees worshipping at the porcelain altar, it would occur to me that this was a process completely alien to me.
Then, one morning in 2007, after too much alcohol or a dodgy dinner, I found myself getting up close and personal with my toilet’s U-bend. Throwing up wasn’t so bad when it happened, I decided. But a week later, the waves of nausea hit me again. That’s when the heart palpitations started. Eventually, I keeled over in my hallway, struggling to breathe; I was certain I was dying.
I later found out that I had experienced my first panic attack. Many more such attacks followed, and a breakdown ensued. It’s astonishing how quickly your life can unravel. I didn’t complete my third year at university – my jam-packed schedule of crying, shaking and rocking back and forth in the foetal position didn’t really allow for additional pursuits such as studying or turning up for exams.
I did manage to alight upon a new hobby, however: washing my hands. Emetophobia routinely leads to a fear of germs and a compulsion to clean and wash. Previously innocuous objects activated a never-ending catalogue of code-red situations. When the threat of contamination lurks on every door handle, it can be hard to switch off; I didn’t sleep much. My body felt awash with adrenaline and I experienced constant nausea. Perhaps unsurprisingly, I stopped eating. What doesn’t go down can’t come up, I reasoned. I lost a lot of weight, fast. A heavily restricted diet is a near-universal trait among emetophobes. Sufferers can become very underweight and are often misdiagnosed with anorexia.
The relentless onslaught of intrusive thoughts and ritualistic behaviour experienced by emetophobes means the fear of being sick is often camouflaged by the OCD that sufferers commonly present with. There is a significant overlap between the two conditions. The emetophobe and the obsessive-compulsive may both adhere to stringent sets of rules when it comes to cleaning and eating. Doctors readily diagnose the OCD, but often fail to identify the underlying problem of the emetophobia.
Learning to relinquish control is key in overcoming emetophobia, according to Dr Veale. The benefits of cognitive behavioural therapy (CBT) in treating other phobias are well documented, he says, and CBT can be tailored to treat emetophobia.
My recovery has been a long process; it is still ongoing. Following my breakdown, a doctor referred me to a private therapist, who gave me hope that I might be able to regain some semblance of a life. I returned to university and completed my degree. My marks wouldn’t stand out as shockingly brilliant or shockingly poor, but I was so proud. My illness had taken so much of me, but I refused to let it swallow me up.
And there are silver linings. My illness has taught me empathy, humility, courage, determination. Recently, I have begun entertaining the possibility that the future might be okay.
If you asked me what I’d eaten today, I might well reply, “nothing”. But I hope that, every day, I’d be a little less likely to. – The Independent