Is Emetophobia an OCD Subtype?
In my humble opinion… yes!
When many clients with emetophobia start therapy with me, they are often surprised to hear that their diagnosis is not a “Specific Phobia,” but actually Obsessive-Compulsive Disorder (OCD). It’s got phobia right there in the name — why am I now dealing with a whole other problem?!
OCD is essentially a vicious cycle of obsessive thoughts/images/urges organized around a core fear and compulsive behaviors acted upon to (temporarily) alleviate discomfort associated with these obsessions. Temporarily is the key word here; the discomfort will always end up returning when compulsions are being performed! There are many well-known “subtypes” of OCD — for example, contamination OCD, sexual orientation OCD, and harm OCD. However, OCD can be centered around just about anything… including having OCD!
How does emetophobia fit into this? Let’s start with the core fear (spoiler: it’s not just a fear of vomiting). Most people with emetophobia fall into one of a few categories: fearing themselves getting sick, fearing others getting sick, or a mix of both. Sounds simple enough. However, if we dive deeper, each person with emetophobia will have a different reason as to why they fear vomit. Some might say they are concerned about embarrassing themselves in public settings. Others are worried that the nauseated feeling/illness will “last forever.” Still others will report that they will never be able to tolerate or escape the sense of contamination present after someone else has vomited near them. Boiling all of these down, there is a common theme of “never ending distress” of some sort, whether that involves feeling ashamed, feeling discomfort, or feeling trapped.
Keeping in mind this core fear, let’s return back to the idea of obsessions. Obsessive thoughts in emetophobia may look like the following. Take notice of some of the underlying core fears present in each of these thoughts:
“What if this bathroom door handle has norovirus particles on it? Last time I had norovirus was absolutely miserable.”
“Was the chicken my son ate really fully cooked? I feel like I saw some pink… now I’m going to be up all night worrying.”
“That person over there looks pale… are they about to get sick? Maybe I need to get away from them.”
“My stomach feels weird, and I’m about to do a work presentation. What if I threw up in front of everyone?”
Next come compulsions, which can be endless in emetophobia. Taking these examples previously given, these may look like the following:
“What if this bathroom door handle has norovirus particles on it?” —> Compulsive handwashing (ritualistic, repetitive, excessive), scanning the bathroom to see if anyone “looks sick” or is facing the toilet in the stalls, deciding to forego eating for the rest of the day “just in case”
“Was the chicken my son ate really fully cooked?” —> Changing the meal last minute, excessive use of meat thermometers, staying up “listening” for signs of son getting sick, asking son if he’s feeling nauseated or checking his temperature
“That person over there looks pale… are they about to get sick?” —> Running away/conversely, staying nearby to “check” whether the person is actually sick, changing clothes upon returning home to avoid perceived contamination, Googling “norovirus outbreaks in my area,” “food recalls 2024,” or searching through Yelp reviews for “food poisoning”
“My stomach feels weird, and I’m about to do a work presentation. What if I threw up in front of everyone?” —> Taking excessive OTC or prescription anti-nausea medications, scanning the room for trash cans or exits “just in case,” hyperfocusing on stomach sensations throughout the presentation, avoiding the presentation altogether
These compulsions will very likely reduce the anxiety/distress the person is experiencing in that moment. But that relief won’t last! Why? Because the compulsions are perpetuating the idea that the person cannot tolerate the discomfort of the unknown (in this case, the possibility of oneself or others getting sick). When people with emetophobia are stuck in the obsessive-compulsive cycle, they will find that their lives become more and more centered around vomiting, despite it being the last thing they want to focus on! This is true of every OCD subtype’s theme, but really speaks to why emetophobia so closely falls in line with the symptoms of OCD.
Finally, I might add that most of the clients with emetophobia I’ve worked with over the years have not had emetophobia as their only OCD theme (whether in the present moment or in the past). Completing assessments such as the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) will often indicate additional obsessional themes that need to be treated in tandem with emetophobia. This checks out, as most people with OCD do not present with just one subtype throughout their lifetime, and many have multiple themes going on at the same time!
I hope this brings some clarity to why I (and most everyone in the OCD field) conceptualize emetophobia as an OCD subtype! Feel free to reach out if you have any questions or thoughts!
