When food becomes a source of anxiety, most people think of eating disorders (EDs). However,
that’s not always the case! Sometimes, issues with food restriction are driven by something
else: the fear of vomiting. This condition, known as emetophobia, can lead to avoiding foods or
situations that the person believes might make them sick. It can involve fear that you will vomit,
fear of seeing/hearing others vomiting, or a fear of vomiting only in public.

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What is Emetophobia Like?

 

No one enjoys vomiting, but people with emetophobia are terrified of it. Even seeing the word
“vomit” can trigger their anxiety. The fear goes beyond not wanting to feel the discomfort of
throwing up. Often, the core fear (the main fear underneath it all), is much more catastrophic. It
might be:

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• The feeling of nausea will never go away / “I will always feel like this, and I can’t cope​ with that”

• Feeling of losing control of one’s own body

• Not being able to breath / choking / dying from suffocation

• Being judged by others or seen as disgusting

• Fear of a time in the past when they vomited and it was traumatic for them

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The specific anxiety triggers will be different for each person, but some common emetophobia
triggers are:

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• Eating foods commonly associated with food poisoning (such as seafood)

• Going to places where there are “sick” people (hospitals, daycare)

• Physical feelings that are associated with sickness (nausea, feeling “weak”)

• New foods or going to new restaurants

• Becoming pregnant (even if wanting to have kids)

• Food close to expiration date

• Places where there is heavy alcohol consumption (for fear that someone might vomit)

• Gory movies that could induce nausea

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People with emetophobia will often structure their life around avoiding their triggers. They may
struggle to have a social life due to not being able to try new restaurants or eat food prepared by
others. Some never leave the house without anti-nausea medication and water. They may eat
only at specific times or lack proper nutrition due to how limited their number of “safe” foods are.
It can be an extremely impairing disorder.

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Emetophobia vs. Eating Disorder

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Both emetophobia and EDs like anorexia nervosa can involve restrictive eating. In both
disorders, folks may have “safe” foods that they eat more often, or exclusively. Often, the foods
are bland and predictable. However, the reasons that the foods feel “safe” are different.
 

In emetophobia, “safe” foods are ones that the individual feels aren’t going to make them sick.
They are often more bland because those foods tend to be easier to digest. They may avoid a
lot of spices, greasy foods, etc., not because of the calorie count, but because of the fear it
might upset their stomach.
 

In most EDs, foods tend to feel “safe” because they are lower in calories or otherwise perceived
to be less likely to cause weight gain. It comes back to the person’s body image or appearance,
and the core fear underneath that (for example, that others will see them as “lazy”).

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But What About ARFID?

For those with avoidant/restrictive food intake disorder (ARFID), an eating disorder that is also
not related to body image, there may also be fear of vomiting or other feared outcomes of eating
certain foods. For others with ARFID, the primary concern is about the texture, taste, color, or
smell of certain foods.

The difference between emetophobia and ARFID is that, with ARFID, the individual is usually
only concerned about food. With emetophobia, fears are not limited to foods but expand to other
potential causes of vomiting or being around people vomiting. Therefore, although vomiting can
be a primary concern in ARFID, there would not be additional triggers beyond food and eating.
 

The Fear Behind The Food

These differences illustrate one of the best ways to tell if someone has an ED or emetophobia:
identifying the fear driving the food restriction. In EDs (with the exception of ARFID), foods are
avoided because of a fear of gaining weight, and what that might mean to them. Often, the
meaning is related to problematic and inaccurate societal beliefs about weight/fat. The individual
may fear that gaining weight or becoming fat would mean they are lazy, that others will never be
attracted to them, that they have poor self-control, or that they will be/are worthless. For people
with EDs, eating may feel like failure.
 

With emetophobia, issues of body image are not part of the disorder, and triggers are not limited
to food and eating. Folks can have both emetophobia and an ED at the same time, and
identifying what is contributing to food fears isn’t always simple. An assessment by a
professional is needed to provide an accurate diagnosis.

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Why Does the Difference Matter?

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Knowing whether someone is experiencing emetophobia or an eating disorder matters because
treatment can be different depending on what is underlying the eating concerns. Both can be
effectively treated using exposure therapy, which involves intentionally exposing oneself to
triggers and learning to tolerate anxiety and discomfort over time. However, there are some
nuances to treatment that are different between the two in order for treatment to be most
effective.

Emetophobia is a challenging condition that can feel overwhelming to deal with. With proper
treatment and a therapist who understands the different reasons why certain foods can be
triggering, folks can and do recover. Therapy can help, and there is always hope.

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- Guest blog by Johanna Wood, PhD, LP, clinical psychologist and owner of Leap Counseling
and Consultation, a solo private practice specializing in treatment of adults with OCD and
anxiety disorders.

Check out more of her work at leap-counseling.com