Field of Science

A question for psych/neuro/gastro friends: walking, anxiety, and emesis.

I may or may not have mentioned before on this blog that I have a specific phobia of vomiting. If I haven't, now you know. I don't like to talk about it in my online life because it is a major source of stress in my offline life (it is the root of the agoraphobia that I know I have mentioned), but I bring it up today because I have some unanswered questions that I'd like to put out into the blogosphere.

For those of you who are not familiar, I will try to outline the nature of emetophobia, at least the way I experience it. It stems ultimately from a fear of losing control of one's body. Vomiting is unavoidable, violent, and sometimes unpredictable. It isn't fun for anyone (well, almost anyone), but for an emetophobe it becomes a life or death situation. That loss of control is not just unpleasant, it is entirely unbearable and intolerable, and the mere thought of losing control in such a manner is enough to arouse panic and hysteria. As a result, an emetophobe becomes hyperalert to internal and external cues that vomiting is about to happen. Internal cues like nausea, or external cues like someone else actually vomiting, saying they don't feel well, saying they had vomited recently, etc. It differs from person to person, and some people are only afraid of themselves vomiting whereas others are afraid of themselves and others vomiting. To speak for myself, the only reason why I'm afraid of someone else vomiting is because I'm afraid I'll catch whatever they have and, as a result, vomit myself.

As a result of this state of being hyperalert, there are undoubtedly a lot of false positives. Emetophobes are notorious for not being able to decipher their own gastrointestinal cues. Non-pathological sensations like having gas or feeling full are misinterpreted as nausea. Nausea (real or perceived) causes anxiety, and one of the symptoms of anxiety is, yeah, more nausea. It becomes a terrible positive feedback loop that can be really hard to escape once the ball is rolling.

I have several coping mechanisms that I use when I feel the anxiety beast starting to swell inside me. They fall into several categories: preparative, preventative, and distractive. Preparative behaviors are things that will ease the process if I actually do throw up, such as taking off loose clothing, tying back my hair, and making sure I have access to a toilet. Preventative measures are things like taking antiemetics, benzodiazepines, sipping water, sucking on peppermints, etc. The distractions, however, seem to be the most effective.

My distraction techniques usually have two horns: giving my body a menial task to accomplish and giving the rest of my brain something to focus on. Generally this involves walking around my apartment and either having a conversation with my boyfriend (if he's around and willing to oblige) or putting something light and fluffy on the TV. I'm fond of sitcoms and baking shows (like Cupcake Wars) for this situation. The TV/conversation part is easy to understand: I'm providing an easy distraction for my brain to focus on instead of thinking about the nausea and anxiety. If I don't focus on it, most of the time it will go away on its own. The walking part is less easy for me to understand.

I know that having a menial activity to focus on is part of the distraction process. If I'm focused on walking around and balancing, even if only a tiny part of my brain is involved, that's one less bit of my brain that can be thinking about my stomach. But, that's not the only thing. The walking actually jostles my body, and adds "noise" to the internal cues that I'm misinterpreting as nausea. The walking seems to literally settle my stomach by covering up the stimulus with other sensations. But finally, I can't fully rule out a physiological connection. Could there be a chemical reason why walking settles the stomach or reduces anxiety? I've heard of "walking through the pain", but can you walk through the fear as well? I don't know enough psychology or neuroscience (I imagine the brain-gut axis is very important in this response, but I don't know how) to know the answer to that, so I'm hoping that someone out there will. Can physical movements calm the sympathetic response?

As a side note, I have often wondered if there was a physiological reason why emetophobes claim to vomit less often than normal people. I know that the sympathetic response causes gastrointestinal motility to slow down. If fear slows down peristalsis, could it also slow down reverse peristalsis?

[Image credit: Lauren Brooke. I had to search for a good image with my hand over my face, peeking through my fingers. Shockingly I was spared from having to see any images of actual people actually vomiting. Score one for me.]

ResearchBlogging.orgBOSCHEN, M. (2007). Reconceptualizing emetophobia: A cognitive–behavioral formulation and research agenda Journal of Anxiety Disorders, 21 (3), 407-419 DOI: 10.1016/j.janxdis.2006.06.007

Davidson, A., Boyle, C., & Lauchlan, F. (2008). Scared to lose control? General and health locus of control in females with a phobia of vomiting Journal of Clinical Psychology, 64 (1), 30-39 DOI: 10.1002/jclp.20431

Lipsitz, J., Fyer, A., Paterniti, A., & Klein, D. (2001). Emetophobia: Preliminary results of an internet survey Depression and Anxiety, 14 (2), 149-152 DOI: 10.1002/da.1058

Veale, D., & Lambrou, C. (2006). The Psychopathology of Vomit Phobia Behavioural and Cognitive Psychotherapy, 34 (02) DOI: 10.1017/S1352465805002754


  1. I would say you can "walk through the fear," but that is going through the experience itself and coming out on the other side, and most importantly, realizing, you are relatively unharmed. Fear/anxiety/stress can all make insignificant problems seem larger than life, and to the person who is going through those problems, they are. The person who is suffering from problems must realize that they have survived past experiences, and as unpleasant as those experiences may have been, the person will survive if the problems come up again. That is walking through fear.

  2. Interesting! I absolutely hate the idea of vomiting, and will try to avoid it at all costs. I can't stand when I see it on TV or others talk about it. Not sure if it's to the extent you're talking about, but it's nice (in a way) that others feel similarly!

  3. I have the same thing. I haven't vomited in about 8 years, and that was such a relief at the time, but I'm still irrationally afraid of it to the point that it seems equivalent to dying. It's interesting because my wife will easily make herself throw up to relieve a really uncomfortable stomach. It's helpful to me when the internal alarm bells (and flashes) are going off just to clinically imagine the displacement of a small amount of stuff. Just some minor spitting up. The lack of actual horror in this mental picture actually takes the edge off.

  4. I don't like to talk about the last time I vomited because I'm afraid I'll jinx myself-- that's how deep the fear runs! It's really crappy. It sorta comes and goes with me, though. It was really bad from age 7-13 or so, then not quite as bad in high school and most of college. It started getting really bad again around the time I graduated from undergrad. I'm hoping it'll disappear again for a while sometime really soon.

  5. Cool post, you are the first person I've heard of with Emetophobia. You're on to something when you talk about walking around to distract your brain. I've heard of this before, and I have no explanation (sorry). I deal with chronic pain from a disease I have and walking helps, even though it causes more physical pain, I notice that it distracts my brain from recognizing the pain. Is walking a cure for many diseases?!

    Just a thought, since today is 4/20, have you tried weed as an antiemetic?

  6. I think the movement in walking might promote gastric emptying of the stomach into the small intestine, but I could be wrong.

    Isn't vomitting very uncommon? Other than one episode of drinking, I have vomitted only twice. I would guess most emetophobes overestimate how much other vomit.

  7. That's an interesting idea, Chris. I hadn't considered it. And yes, I would imagine most emetophobes do overestimate that. It's sorta the nature of paranoia, I think. :)


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