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Felix Lawson
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Emetophobia and disordered eating in Adolescents
A revised presentation by Felix/Katie Lawson
What will I cover?
1. Why did I choose this topic?
5. Potential problems
8. Anecdotal evidence
2. What is emetophobia?
6. Eating disorders- a brief summary
9. What Ive learnt so far
3. The science behind the phobia
10. How can society help?
7. Corellation
4. What the research says
11. Thank you- any Qs?
Why did I choose this topic?
What made me choose this subject/ question? a brief summary.
My decision
I collected the ideas that I liked the most and put them in a list. I then kept reforming the list until I had a final 5. I ranked the final 5 out of 10- my criteria being along the lines of what I would be able to stick with and what I would enjoy doing the most. I then took the top 2 and flipped a coin to decide as I am indecisive.
Original Ideas
- Fashion though the decades
- How does having autism put you at a disadvantage in a mostly neurotypical society?
- How does autism affect young people's romantic relationships?
- How does emetophobia effect the social lives of adolescent women?
- Emetophobia and disordered eating in adolescents
VS
What is emetophobia?
A definition of the phobia and key defining symptoms.
Definition
Emetophobia, also known as SPOV (specific phobia of vomiting), is an extreme fear of vomit, seeing vomit, watching people vomit, hearing the noises of people vomiting and gagging, or even feeling sick. It can effect people in lots of different ways and, as there are with lots of phobias and mental illnesses, it can be experienced mildly or very severely.
symptoms of emetophobia
- Intense fear and anxiety about being sick, or seeing someone else vomit.
- Extreme anxiety and fear about the following situations;
symptoms of emetophobia
- A person may try avoidant/ protective behaviours to reduce the risk of vomiting;
The science behind it...
What is the science behind emetophobia?
There is little research on the exact cause of Emetophobia.Some believe that the fear develops on it's own, or after a traumatic experience that involves vomiting. Another theory is that genes or other biological or psychological factors could trigger this phobia . Additionally, anxiety can cause nausea.
How does it develop- Idea 1
Developing on its own
1. No signs of emetophobia present2. Slowly, signs of emetophobia become present in the person's life (eg; they start to feel more anxious about sickness) 3. Signs of phobia begin to show themselves more (more anxiety in situations surrounding sickness and vomiting) 4. If untreated, the phobia may begin to increase in severity and perhaps feed into other disorders such as OCD 5. There are numerous visible signs of emetophobia if left untreated, if treatment such as CBT (Cognitive Behavioural Therapy) has been used by the person then the symptoms may become more manageable.
How does it develop- Idea 2
Developing via a traumatic event
1. Life pre-traumatic event (no signs of emetophobia)2. Traumatic event (fear of vomiting is triggered) 3. Signs of phobia begin to show themselves (more anxiety in situations surrounding sickness and vomiting) 4. If untreated, the phobia may begin to increase in severity and perhaps feed into other disorders such as OCD 5. There are numerous visible signs of emetophobia if left untreated, if treatment such as CBT (Cognitive Behavioural Therapy) has been used by the person then the symptoms may become more manageable.
How does it develop- Idea 3
Developing via genetics or psychological/ biological factors
1. Signs of emetophobia are less prominent2. Over time, the symptoms begin to bceome more noticeable and/or severe 3. Signs of emetophobia are fairly prominent 4. If untreated, the phobia may begin to increase in severity and perhaps feed into other disorders such as OCD 5. There are numerous visible signs of emetophobia if left untreated, if treatment such as CBT (Cognitive Behavioural Therapy) has been used by the person then the symptoms may become more manageable.
Overall, a common thing in all of these timelines is the severity and intensity of emetophobia increasing if left untreated.
What does the research say?
Emetophobia can be treated- what does this mean?
This presents a case study of the successful use of combined treatment for emetophobia in an adolescent female. Therapy included education, CBT, and exposure therapy in tandem with Sertraline (50mg). Following this, symptoms of emetophobia were significantly reduced, panic attacks had remitted, and the continued use of medication was no longer indicated .
Fix R.L , Proctor K.B , Gray W.N , 2016 Treating Emetophobia and Panic Symptoms in an Adolescent Female: A Case Study Accessed on 23/05/2022https://journals.sagepub.com/doi/abs/10.1177/1534650116642576
Potential problems
What issues could be faced with treatment of this phobia?
Potential problems
Autism
Exposure therapy
The conditions in exposure therapy do not always reflect reality . So someone with, for example, PTSD may be able to handle simulated conditions in a therapist's office but may not be able to cope with the situation if it presents itself in reality. Gupta S, 2021, What is exposure therapy? https://www.verywellmind.com/exposure-therapy-definition-techniques-and-efficacy-5190514#toc-effectiveness (accessed on 23/05/2022)
Autistic children tend to rate CBT as less effective at treating their anxiety than their parents and clinicians do, according to a meta-analysis of 19 randomised clinical trials. (see next slide for data) Mccarty N, 2021, Cognitive behavioural therapy may be only mildly effective for anxious, autistic children. https://www.spectrumnews.org/news/cognitive-behavioral-therapy-may-be-only-mildly-effective-for-anxious-autistic-children/#:~:text=Autistic%20children%20tend%20to%20rate,of%2019%20randomized%20clinical%20trials. (accessed on 23/05/2022)
Eating disorders- a brief summary
What is an eating disoder? Which ones are the most common with emetophobia?
Disordered eating- an overview
An eating disorder is a mental health condition where you use the control of food to cope with feelings and other situation. https://www.nhs.uk/mental-health/feelings-symptoms-behaviours/behaviours/eating-disorders/overview/ (accessed 23/05/2022)
EMetophobia and disordered eating
Some individuals with Emetophobia may develop an abnormal relationship with food as a result of their phobia.Some emetophobics may also struggle with a fear of food or excessive worrying whether or not certain foods will make them sick. This can lead to the restriction of certain foods or whole food groups which can result in malnutrition and extreme weight loss. https://www.eatingdisorderhope.com/blog/emetophobia-and-eating-disorders-is-there-a-connection (accessed 27/05/2022)
Eating disorders associated with emetophobia
Anorexia Nervosa
ARFID
Anorexia Nervosa is a serious mental illness where people are of low weight due to limiting how much they eat or drink. They may develop "rules" around what they feel they can and cannot eat. As with all eating disorders, it can affect anyone of any age, gender, ethnicity, or background. Not all cases of anorexia cause extreme weight loss, some cases may be at a weight that is considered "normal" for their age, gender, etc...
ARFID, also known as Avoidant Restrictive Food Intake Disorder, is a condition characterised by the person avoiding certain foods or types of food , restricting the amount eaten, or both.This could be due to many different reasons such as; sensory-based avoidance or restriction of intake, concern about the consequences of eating, low interest in eating, etc...
Eating disorders associated with emetophobia
OSFED
Orthorexia
Anorexia, Bulimia, and binge eating disorder are diagnosed using a list of expected behavioural, psychological, and physical symptoms. Sometimes a person's symptoms don't exactly fit the expected symptoms for any of these three specific E.D.s. In that case they might be diagnosed with an "other specified feeding or eating disorder" (OSFED). OSFED accounts for the highest percentage of eating disorders and it is every bit as serious as any other eating disorder.
Orthorexia was defined in 1997 by Dr. Steven Bratman, MD. It is not currently recogised in a clinical setting as a seperate eating disorder.Orthorexia refers to an unhealthy obsession with eating "pure" food. Food considered "pure" or "impure" can vary from person to person. This doesn't mean that anyone who subscribes to a healthy eating plan or diet has Orthorexia. As with other E.D.s, thebehaviour involved is used as a coping mechanism.
For more information on eating disoders go tohttps://www.beateatingdisorders.org.uk/
This is the source of my information of the last two slides(accessed 27/05/2022)
Correlation with Emetophobia
What do these eating disorders have in common with emetophobia?
Eating disorders *
- most eatig disorders can lead to malnurishment and revolve around food anxiety and guiltiness.- can contribute to other disorders eg: anxiety, depression, OCD, etc... - creates a domino effect that can ruin every aspect of the person's life.
Emetophobia *
- can lead to malnurishment if the person has particular anxiety around food.- can contribute to other disorders eg: anxiety, e.d., OCD, etc... - creates a domino effect that can ruin every aspect of the person's life.
These are just some examples of the correlation between these two disorders *
Anecdotal evidence
Other people's experiences with both of these disorders...
Anecdotal Evidence
1. Source: the independent
5. Source: instagram
2. Source: the mirror
6. Source: reddit
3. Source: the daily mail
7. Source: personal experience
4. Source: facebook
"Self-imposed starvation is most commonly attributed to anorexia nervosa; I haven’t been diagnosed with anorexia and am not preoccupied by my weight, which is actually of a pretty healthy size. But I am obsessed with food, or rather, the dangers it presents. I have emetophobia, an intense fear of vomiting. This phobia has ruled my thoughts and my life for the best part of a decade.""Emetophobia differs from other phobias, though, in that it leaves sufferers terrified of their own bodies; you can’t escape it – you are afraid of yourself." "A heavily restricted diet is a near-universal trait among emetophobes. Sufferers can become very underweight and are often misdiagnosed with anorexia."
https://www.independent.co.uk/life-style/health-and-families/features/how-i-beat-my-fear-of-vomiting-eating-frightens-me-10003913.html (accessed 07/06/2022)
"A bizarre phobia of being sick led worried teachers to believe a schoolgirl had developed anorexia. Young Phoebe Dormand, from Harrogate, Yorkshire, was even scared of drinking WATER after developing emetophobia when she was 12. She was worried that anything she ate might make her ill and vomit - and her weight plummeted to just over seven stone. Phoebe - whose mum Pam Dormand also battled the crippling anxiety disorder as a teen - survived by eating just Babybel cheese.""She said: "My school started monitoring what I was eating because they thought I was anorexic, but they didn't really look into why I wasn't eating. " I do think my illness triggered a form of eating disorder, but I wasn't doing it to be slim." "I was trying to get control." "
https://www.mirror.co.uk/news/uk-news/phobia-being-sick-made-schoolgirl-9190208 (accessed 07/06/2022)
" Doctors feared 30-year-old Georgina had an eating disorder, when in fact she was suffering from a condition known as Emetophobia - the fear of being sick." "Georgina, a content designer, said: 'At my lowest point I weighed just five stone, I looked like a skeleton and I was so frail. ''I was skipping most meal times and avoided going out so people couldn't judge me on how I looked. ''I longed to become a parent but I knew my sickness phobia was controlling my life and causing my body to become extremely unhealthy.' ""She added: 'I continuously starved my own body, living on a diet of digestive biscuits and toast in the fear that over eating or rich food would cause me to be sick. 'This led to numerous health problems including my periods stopping. ''I was admitted into hospital for dehydration and it was feared I had an eating disorder. "
https://www.dailymail.co.uk/femail/article-3450860/Five-stone-woman-ate-digestive-biscuits-petrified-sick.html (accessed 07/06/2022)
I do not have Facebook, however, at my request my mum posted about my EPQ question and asked for responses relating to people's experiences with emetophobia and eating disorders. These are some of the responses I got;"I have twin daughters who are autistic and have emetophobia which has led to an eating disorder called ARFID. I'd never heard of ARFID until my daughters were diagnosed . I feel emetophobia is really misunderstood/ underestimated, no one took my concerns around my daughter's struggles with it seriously until everything escalated to the point of one of my girls having to be hospitalised due to serious health problems from her ED. Then once she was hospitalised it was hard for some of the staff to understand the intensity of her emetophobia. More awareness is definitely needed." "My experience with food is very one off. Developed emet aged about 4 after eating a bath pearl causing..."
Facebook group- Emetophobia Support (private) (accessed 27/04/2022)
"... instant sickness. Then after that I just hated feeling out of control. After getting a sickness bug aged 7 I controlled what I ate. If you're from the UK there was a Dr named Gillian McKeith who did a you are what you eat programme. I became obsessive with how much I'd eat and what I turned vegetarian to avoid food poisoning risk from meats my mum would ladle everything in oil - this was a trigger as while on holiday and ordering some tomatoes and mozarella mum chirped in with don't have olive oil on it you'll be sick. I think excessively exercised aged 9 I'd ride my bike miles to burn off stored fat as again my mum would link dirty to fat lazy people. I didn't want to be dirty as that could also lead to illnesses. While changing age 9 my mum noticed I was thin so said if I didn't eat she would takeme to the drs and they'll do blood tests ( needles were a big phobia growing up- control)I was diagnosed OCD aged 7 during this and sypersensitivity as clothing would hurt. 20 years on we now understand more..."
Facebook group- Emetophobia Support (private) (accessed 27/04/2022)
"... I then over ate from age 10 I became very big, I started to hide foods from the cupboards to eat in secret. I then stayed home until age 13 when I discovered boys I'd be out all of the time so to curb the fear of sick I didn't eat while out and always had to carry a bottle of water on me to wash my hands with and drink (same now). It calmed when I had my first baby age 17 as I hadn't been sick since I was 6/7. Aged 18 I caught a sickness bug it took me weeks to get over the trauma I starved myself for weeks incase I got diarrhoea. I went from 13 stone to 8.5 stone in less than 6 months. I lost my son aged 19 I was in ICU with sepsis. The pneumonia and side effects do death drugs caused awful nausea so as I tried to be normal and go off the rails drinking the nausea kept it at bay. I stopped eating again in fear of sick. Over the years I developed IBS and intolerances - dairy and gluten plus some vegs. I now avoid eating out or at others houses incase I get dairied and it makes me violently diarrhoea and vomit so on holidays for a week I live off crackers I've brought... "
Facebook group- Emetophobia Support (private) (accessed 27/04/2022)
"... in fear of sick. Fast forwarding to having more children 2019 aged 25 I felt settled and back in control as was only an issue if I had diarrhoea or was travelling. Although I did control it with agoraphobia tendencies I'd avoid being out in public incase. My third baby was 2021. In hospital I got diarrhoea (stress) I restricted food in hopes it would stop. The anxiety of being alone and out of control led to a blood pressure spike this made me get nausea and the MRI fluids caused more diarrhoea. Was so miserable, scared and alone dur to covid. Due to agoraphobia, PND (post natal depression) and emetophobia I lost 5 stone in baby weight in 3 months. Baby is now 1 she's brought home 2 sickness bugs in 3 months. It's hard, I'm on day 5 of not eating. Normally day to day. I won't eat food that's defrosted on the side. I rarely if ever eat meat can't remember the last time. I obsess over ingredients in case additives can cause sickness or diarrhoea. I eat alone at work and isolate myself from people too..."
Facebook group- Emetophobia Support (private) (accessed 27/04/2022)
"... I have no friends but worry if I get one they'll to go to eat and I can't. I control all the cooking. I bleach all work boards/ knives too. I smell all foods before I'll eat them even if they're in date. I obsess over gut health in the hopes it'll help my immune system. I won't touch my kids' leftovers or use the same cups/ cutlery etc... I wont eat if I'm going to be travelling in the next 2hrs."
Facebook group- Emetophobia Support (private) (accessed 27/04/2022)
I do not have Facebook, however, at my request my mum posted about my EPQ question and asked for responses relating to people's experiences with emetophobia and eating disorders. These are some of the responses I got; "My daughter has emetophobia, is ADHD, and clearly has some sort of eating disorder." "Same here, Autistic, Emetophobia, ARFID" "My daughter is 12 and recently diagnosed with ARFID triggered by Emetophobia."
Facebook group- ARFID support for parents and carers in the UK/ Ireland (accessed 27/04/2022)
......instagram stuff
........ (accessed 00/00/2022)
" Growing up it was a lot more difficult from refusing to get into cars and constant severe anxiety to crying hysterically in public places. Over time it got worse moving towards avoiding public places, avoiding people, physically losing consciousness, the whole ordeal. I wasn’t always afraid of myself getting sick due to stomach issues causing nausea all day everyday. A few years ago the anxiety creeped over into my side as well and I developed an eating disorder from being so scared to eat and so scared to get sick (for reference this caused me to go from 210-115 in the matter of 8 months). I’ve been around this ring a few times now where the anxiety leaves my half and then comes back when I least expect it and I feel like I’m stuck in this really unhealthy pattern."
https://www.reddit.com/r/emetophobia/comments/m91ar3/emetophobia_turned_me_anorexic/ (accessed 07/06/2022)
"I wish, so wish! That emetophobia was classified as an eating disorder. There are times when I can go days without eating, at the worst of my phobia I lost 40lbs in 2 months from pure starvation. If I feel a twinge in my stomach I can go days without eating." "I refuse to eat leftovers and at most resturants, my diet is like five staple foods and I'm malnourished, anemic and Vitamin D deficiencent." "If I eat something and dont feel well afterwards I will punish myself by not eating or weird forms of self harm, like today I had chili for dinner, I now have acid reflux and I'm just kicking myself for it, and it's a totally normal dinner! This is eating disorder behavior."
https://www.reddit.com/r/emetophobia/comments/eaefbj/emetophobia_an_eating_disorder/ (accessed 07/06/2022)
"I just binged on garlic bread and I’m freaking out in case the ridiculous amount of garlic I ate will make me sick. I panic a lot after eating too much sugar as well. And I can’t purge because of my emetophobia so I’m scared I’ll gain loads of weight."
https://www.reddit.com/r/EDAnonymous/comments/rt4gwm/eating_disorders_and_emetophobia_are_a_horrible/ (accessed 07/06/2022)
"I've always had extreme anxiety and been afraid of v* and recently because of the pandemic i've been having it even worse and i haven't been able to eat much or drink much without spitting out most my food or water and the dehydration and hunger gives me extreme n* so it makes me not be able to barely eat so it's a cruel cycle that's been going on for about a month""i've been occasionally spitting out my food while eating for years because i didn't want to over eat and v*, but i've never been this bad. my stomach hurts everyday, i've lost over 15 pounds, i've been in bed all day everyday, and i don't even get up to use the bathroom much because of the lack of food and water i've been consuming. and the reason i can't eat is because i'm scared i'll eat the food and v* it back up and also because i've been g*gging because i've been coughing so much because my throat is so dry. "
https://www.reddit.com/r/emetophobia/comments/gaawb4/i_have_a_emetophobia_induced_eating_disorder/ (accessed 07/06/2022)
One of the reasons I wanted to do this as an EPQ was because I have experienced living with a range of mental illnesses and disorders (as well as a physical disability).My emetophobia trigger was when I was little (I'm not sure what age) and I was on my first (and last) Brownies camp. It was up in the cheviots and one of the leaders made burgers and chips for tea, she didn't cook the burgers properly. Thankfully, I'm a super picky eater due to my autism (and possible ARFID) so I only had chips. However everyone who had a burger got food poisoning and was up being sick. I was absolutely terrified and for the entire night was either sat in the hallway rocking backwards and forwards crying or I was washing my hands until they hurt like hell. I got one of the leaders to call my mum, who was at work and immediately drove up to collect me after I rang her in tears, the leader who cooked the food then called her a too soft parent and said that if I was her child she would just leave me here...
Personal anecdotes/ my story
(that leader also violated important health and safety rules as she did not send home the people who had food poisoning which meant that all of the vomiting continued all the way until their parents came to take everyone home). After that there were other various incidents which gave me trauma surrounding vomit but nothing was quite as bad as in the summer of 2020. I caught norovirus and was sick for the first time since I was either a baby or a toddler. After I vomited (only once) I thought "I'm so proud of myself, that wasn't so bad!" and for about a week or so after I thought I had finally overcome my phobia. I was very, very wrong. The night of the bug I had eaten curry and various other foods. It has been 2 years and the smell of the exact curry I had still gives me a panic attack. I watched the film Labrynth on the night of the bug and over a year later I got the courage to rewatch it and had multiple panic attacks (but I did it!). That case of norovirus has also caused many other issues...
Personal anecdotes/ my story
... since about a week after the incident I started to have multiple panic attacks hourly, every hour, every day, every night. I only managed to get sleep after I passed out from exhaustion. I have been on two different medications for my emetophobia since the norovirus; propanalol (a commonly prescribed anxiety medication) which I ended up stopping because it gave me nightmares and cyclizine (an antiemetic) which I have been on for a while now. During the time inbetween being initially prescribed propanalol and a few months into being prescribed cyclizine I started to get addicted to antacids. I have seen CAMHS and the school councillor for my emetophobia and other issues but (as usual for the UK's mental health services- I didn't get the help I needed). Since the norovirus I have suffered from disordered eating and I'm still in recovery (although I'm getting better). Some days I don't eat anything unless I'm forced to, some days I overeat to cope. I have very complicated relationships with friends and others due...
Personal anecdotes/ my story
... to my emetophobia, autism, anxiety, disordered eating, ocd and other issues. I have had acquaintances make jokes that when they feel ill theyre going to track me down and throw up on me, I have had friends tell me to suck it up because I'm "overreacting" and "it's not that bad". I have also had a teacher tell me that I can't be depressed because I was "acting happy yesterday" despite the fact that human emotions are forever changing, you dont stay one emotion throughout the entire week it's basic logic (and the teacher was a science teacher so they should know that). Every time I am outside the house I am thinking of where I could go to hide if someone was sick and even when I'm inside the house I am thinking about "what would I do if I threw up right now". I also get very challenging intrusive thoughts about my phobia. In all honestly, my life has been changed forever by emetophobia and the other things it has caused in my life.
Personal anecdotes/ my story
What have I learnt so far?
A summary of what I have learned through my research so far...
How can society help?
What accomodations could we make as a society in order to help those suffering from emetophobia and eating disorders?
thanks!Any questions?