Phenomenology, Clinical Correlates, and Impairment in Emetophobia

Emetophobia, or a specific phobia of vomiting, is an underresearched disorder characterized by extensive avoidance and safety-seeking behaviors. Extant literature has primarily focused on online support groups and qualitative investigations, thereby limiting the generalizability of results. As such, this study sought to examine the clinical correlates, phenomenology, and impairment related to emetophobia in 436 undergraduate students. About 5% of the sample exhibited significant emetophobia symptoms (n 5 21), with all participants in this subsample reporting an age of onset prior to adulthood. In addition, participants' most distressing aspects of emetophobia were reported to be the somatic sensations of vomiting and the social impact of the disorder. For the entire sample (N 5 436), emetophobia symptoms were associated with heightened anxiety, somatization, and depressive symptoms. In addition, functional impairment was observed across home/family, school/work, and social domains of life, even after controlling for the effects of anxiety and depressive symptoms. Detailed results and implications of the findings are discussed, and suggestions for future studies are presented.Keywords: emetophobia; vomit; phobia; phenomenology; impairmentEmetophobia is an underresearched psychiatric condition characterized by an extreme fear of vomiting. Classified as a type of specific phobia (American Psychiatric Association, 2013), the illness typically begins at a young age (Holler, van Overveld, Jutglar, & Trinka, 2013; Lipsitz, Fyer, Paterniti, & Klein, 2001; Price, Veale, & Brewin, 2012) and runs a chronic and disabling course, with impairment occurring across work, social, family, and interpersonal domains of life (Holler et al., 2013; Lipsitz et al., 2001; Veale & Lambrou, 2006). Several etiological factors may contribute to the development of emetophobia, such as instances of conditioning (through vivid experiences of vomiting or witnessing others vomit) as well as medical history (e.g., prior hospitalizations), family psychiatric history, and general biological preparedness (Lipsitz et al., 2001). However, a sizable number of individuals with emetophobia do not experience any or all of the aforementioned etiological factors, indicating that it may be a conglomerate of different factors, and further research on other aspects is warranted. There are no randomized controlled trials for the treatment of emetophobia to date, with existing literature limited to case studies predominantly focused on cognitive behavioral techniques (Ahlen, Edberg, Di Schiena, & Bergstrom, 2015; Faye, Gawande, Tadke, Kirpekar, & Bhave, 2013; Graziano, Callueng, & Geffken, 2010; Hunter & Antony, 2009; Kahana & Feeny, 2005; Kobori, 2011; Maack, Deacon, & Zhao, 2013; Williams, Field, Riegel, & Paul, 2011). This is particularly problematic, given the disabling nature of the disorder and the anecdotal reports of treatment refractoriness and refusal (Lipsitz et al., 2001; Veale & Lambrou, 2006).Prevalence studies on emetophobia are largely lacking, but existing rates range from 2% to 8.8% in the European community (Becker et al., 2007; van Hout & Bouman, 2012), with a relatively higher occurrence in females relative to males (van Hout & Bouman, 2012; Veale & Lambrou, 2006). Behaviorally, individuals with emetophobia commonly engage in maladaptive avoidance and safety-seeking behaviors that serve to maintain the anxiety symptomology (Holler et al., 2013; Lipsitz et al., 2001; Price et al., 2012; van Hout & Bouman, 2012; Veale & Lambrou, 2006). Indeed, individuals with emetophobia commonly avoid stimuli that may trigger their fears of vomiting, such as certain foods (e.g., meat, seafood), locations (e.g., bars, restaurants), and medications (Boschen, 2007; Faye et al., 2013; Graziano et al., 2010; Holler et al., 2013; Lipsitz et al., 2001; Price et al., 2012; van Hout & Bouman, 2012; Veale, 2009; Veale, Costa, Murphy, & Ellison, 2012). …