DD(10) has told me she has emetophobia. How should I support her?

[cheeseismydownfall]

DH and I gradually noticed over a year ago that DD(10) was checking sell/use-by dates on food and asking about how long food had been in the freezer, if it had been cooked properly etc. We slowly realised that she was claiming not to be hungry if she had any doubts about how fresh something was (she has never had a big appetite and it isn't uncommon for her to occasionally eat very little at meals, so it took a while to spot the connection). Around this time we checked her search history on her tablet and found she had been searching "fear of being sick" - this was probably about six months ago.

We didn't want to make a big deal of it, so we have been keeping a quiet eye on things and reassuring her about use-by dates when asked (we would normally play pretty fast and loose with dates on food, relying on our own judgement, but have been more careful for her sake). All very manageable and it hasn't impacted her life in any way e.g. she has no issues eating at school, at friends' houses etc. We never discussed with her the worry about being sick - she doesn't know we knew about that.

However we've just been away for the weekend camping and we noticed that she wouldn't eat barbequed sausages etc and was worried about the water coming out of the rather rustic looking tap. Then this morning she got upset, said she was feeling sick and finally "confessed" that she has a phobia of vomiting. I asked if she thought it was emetophobia and she nodded hard - she clearly knew what the term meant.

She isn't an especially anxious child in any other respect (although she is scared of spiders and bees/wasps) and she hasn't actually been sick herself for years - I can't even remember the last time - so I'm not sure what has caused it. She has mentioned once of twice when children have been sick at school with an almost gory relish, so I think it only relates to her being sick herself, not other people.

So, I'm now wondering what, if anything, we should do to help her. I'm wondering if we have done the right thing about reassuring her about use-by dates, perhaps that is feeding her fear? We are very low key and relaxed though and definitely not an anxious family in general. I've seen threads on here about how challenging emetophobia can be for adults and so I'd really like to do whatever I can do try and address it before it gets worse. It would be wonderful to have some insight from people who share this phobia about what would have helped them as children.

She can't diagnose herself with any phobia OP. Nor can you. I suggest you take her to the GP. They will discuss things with you both and tell you about some routes towards sorting this out and getting a proper diagnoses.

I'd be more concerned with an emerging eating disorder.

Don't jump to pathologising a natural dislike of vomiting, it might legitamise a more dangerous problem.

There are some very good therapies for phobias, and the earlier they are treated the better.
I know woman who didn't have kids due to their emetophobia.
Please take her to the GP for a referral for CBT, or find a private therapist (not counselling as that doesn't work well for phobias- she will need someone who is properly trained in exposure therapy).
Good luck with getting her the appropriate help

@lughnasadh

I'd be more concerned with an emerging eating disorder.

Don't jump to pathologising a natural dislike of vomiting, it might legitamise a more dangerous problem.

But it's not normal to avoid eating things due to a fear of being sick. That is classic phobia behaviour. The treatment of vomit phobia takes into account the normal disgust response (or should do if the clinician is properly trained).

I do all the things you describe your daughter doing and a lot more. I really don’t want to get food poisoning and vomit. I really don’t want my kids to get ill and vomit. I loathe vomit. I am extremely vigilant about food safety. I don’t think I have emetaphobia. I agree with posters above re ED signs.

@FortunesFave

She can't diagnose herself with any phobia OP. Nor can you. I suggest you take her to the GP. They will discuss things with you both and tell you about some routes towards sorting this out and getting a proper diagnoses.

Perfect response.

I asked if she thought it was emetophobia and she nodded hard - she clearly knew what the term meant.

I'm surprised you asked her this, and even more so that she knew the term?

Sorry!

Around this time we checked her search history on her tablet and found she had been searching "fear of being sick" -

I see this part of your post now. So that's probably how she knows the term.

I only found out that a term existed for a fear of being sick. The internet means that information is much more accessible than it ever used to be.

I've been like that all my life. I will do absolutely anything to prevent myself from being sick or being around anyone else who is sick. I don't have an eating disorder. I drink very little alcohol in case it makes me feel/be sick and I avoid being around drunk people.

I'm afraid I have no advice. It's just something I live with.

Around this time we checked her search history on her tablet....

How often do you do this? Does she have unsupervised access to search for - or stumble across - anything that's out there?

Hi OP this sounds very similar to me. The best thing I have done is receive CBT but make sure that the practitioner has experience with emetophobia as it’s a tricky one to treat. A GP should be able to refer you, especially if it’s impacting eating/weight.

Do look out for signs of an eating disorder as the phobia can lead to restrictive eating patterns, so don’t rule an ED out. However from my personal experience ED treatment wasn’t appropriate and it wasn’t until I did CBT that things improved. The sooner it’s tackled the easier it is to treat as the safety behaviours are less ingrained.

I'm emetophobic, in my case it was after a traumatic event.
I wish I had had CBT as a child - had it as an adult and it didn't make that much difference. (Although now I'm able to watch people being sick on tv).
So yes, please look into CBT while also acknowledging that use by dates and washing hands etc is sensible precautions.

But it's not normal to avoid eating things due to a fear of being sick. That is classic phobia behaviour

Not if it's a very reasonable response to the people who feed you 'normally playing pretty fast and loose with dates on food'. It's then a worry that you will be made ill by other's food hygiene lapses, not the being sick itself.

It's not exactly a fun way to spend an evening/couple of days/two whole sodding weeks feeling like I was dying and another terrified of shitting myself every time I stood up with a very public experience to account for that fear at the start of that week , but I don't actually give a damn about being sick in itself, as in 'OMG! I might vomit!' just as well with my history--.

But I do absolutely give shits about whether the food I'm given is safe in the first place, which really wasn't the case as a child.

Thank you for taking the time to reply, I really appreciate your comments.

I take on board the point about not being able to make a diagnosis ourselves. Perhaps this isn't a 'full blown' phobia, and I certainly don't want to rush to medicalise anything. But as a PP said, choosing to go hungry because you are worried that a perfectly average meal will make you sick is not normal. In an ideal world, yes, a GP would be the first person you'd turn to - but there are threads after threads on here about children and teenagers with absolutely desperate mental health issues who are simply unable to access the support that they need on the NHS. (I have first hand experience of this - my elder son has a severe tic disorder and after two years on the CAMHS waiting list he was discharged without even being seen). I will of course seek formal advice but given the state of children's mental health services I am also keen to explore other avenues and hear from people with first-hand experience.

Re. the ED suggestion - this is a really valid point, and in fact was our first worry when we initially noticed her saying that she wasn't hungry at times when we thought she must be. But she shows absolutely no signs whatsoever of being worried about her weight (or her appearance in general) and eats like a horse when it is a favourite meal. I can see how one issue might grown into a more general ED as she gets older though so it is definitely something I will keep an eye on.

Re. internet access (I just knew someone would raise this) - she and her brothers (along with tens of thousands of other children) have spent months doing live online lessons over the past year while DH and I have been working full time. I cannot supervise her at all times. We have the standard protections like safe searching enabled, we check their history from time to time, and we talk to them a lot about good and bad content online. But yes, there are times when she has unsupervised internet access. I worry about it, but I honestly do not see what more we can do.

Re. our food hygiene - none of us have ever been sick as a result of food poisoning. Perhaps 'fast and loose' was the wrong term - what I mean is that I use my own judgement and will happily eat out-of-date yogurt or cut a bit of mould off some cheese. I do not feed the children reheated rice that has been left standing around for hours or chicken that has turned green.

AliceThroughTheLookingGlass and niceupthedance, thank you for your replies, I really appreciate advice from people who have lived through this themselves. Do you think CBT could be effective for a 10 year old? I guess my worry is striking the balance between tackling this before the behaviours become ingrained, as you say, but not wanting to make things worse by focussing on something that may perhaps resolve of its own accord.

Hello OP, I have been an emetophobe since I was 8 - similar to PP after a traumatic event. Unfortunately DM didn’t seek any treatment early and I developed an ED in my teens and had lots of missed opportunities due to the phobia. I really recommend CBT, and hypnotherapy really helped me when I wouldn’t leave the house due to being so scared of being sick in public. I still have the odd wobbly day, but generally wouldn’t say I have the phobia anymore. Best wishes to your DD, it’s an awful thing to go through at any age.

CBT was certainly helpful for me from the perspective that it forced me to do things out of my comfort zone. So at my worst I wouldn’t eat out and needed to be in full control of food preparation. It’s been many years since I had CBT but I remember making a list of my fears/safety behaviours and working through them from the easiest to overcome to the harder ones. I can now happily let my husband cook and occasionally eat out (although with lockdown this is an aspect I need to work on again).

The main thing is it will only work if your DD wants to tackle the fear as CBT is hard work and you need to fully commit to get the most out of it. At 10 she may be too young, but this is where professional guidance would be useful. You can certainly approach it from the point of view of exposing her to things she is wary of at the moment but definitely don’t turn it into a battle as this is where it could swing into a control/ED situation. Also is there anything she could be anxious about? My safety behaviours tend to ramp up if I’m particularly stressed about something.

I have lived through this. It can be diagnosed as OCD or as a social phobia so it's important to get the right treatment as early as possible, and to not enable her behaviour.

CBT!!! I have this, it’s fucking awful and caused ARFID to the point where my diet is so restricted it’s untrue, I am petrified of overeating, and that my kids might be sick. Please OP get her checked out, it is a horrible phobia and ironically enough it’s most common in people who are never sick x

If there is one thing I could change in my life it would be to go back to when my daughter was your daughter's age and get her to have therapy for minor issues. Puberty is a game changer - the child's brain is changing so minor issues become huge, massive, life affecting issues and then on top you are dealing with a hormonal child who wants more say in whether they do or do not want to do certain things including have therapy.
Your daughter's issues are really not minor - they are major and need addressing ASAP. Read some of the teen mental health threads of some famillies sadly dealing with some tragic situations with their teens. You have an opportunity to nip this in the bud if you can - I am sorry but it will get worse as her brain starts to change with puberty because her decision making process will sit in the impulse part of her brain for over a decade.
Can I also please suggest you don't think of this as medical - she just needs to learn some skills / tools to deal with some anxieties. Can I recommend you also look for a clinical pyschologist. There is a whole range of people who will suggest different things but a clinical pyschologist who can do a range of approaches including CBT are the most effective and you don't want any false starts and needing to change therapists. I say this from personal experience. I hope things go well for you both.

Sorry just read an earlier post from you - my son had effective CBT at 8. the therapist said 8 is the age a child starts to realise they are part of a bigger world and it can be frightening for them and it triggers anxieties.

Try the book

What to Do When You Worry Too Much

Blurb...this is an interactive self-help book designed to guide 6-12 year olds and their parents through the cognitive-behavioral techniques most often used in the treatment of generalized anxiety. Engaging, encouraging, and easy to follow, this book educates, motivates, and empowers children to work towards change. It includes a note to parents by psychologist and author Dawn Huebner, PhD

(Was recommended by chikd psychologist hase good stuff

I recommend https://www.emetophobia.co.uk/emeto-cure/. I had this phobia all my life but this course is really good and I really don't struggle with it now.

I have this. The thought of being sick makes me sweat, shake, panic, hyperventilate. It's really bad.
Imo the best thing you can do is support that her feelings are valid while also keeping things like use by dates as casual as you can. More like "oh yes that's in date" rather than "shall we check the date on that and smell it together".

Morning sickness did my phobia a lot of good but I don't think pregnancy is a suitable approach here

I'm emetophobic, mine started when my mum had really bad morning sickness when she was expecting my brother, I was 5 going on 6 but I can remember it clearly. Ever since I have had a horrific fear of both being sick & anyone else being sick, I shake, sweat & could beat Linford Christie over 100 metres if anyone is sick, the first time I was sick when I was expecting ds I was on my own, didn't make it to the toilet & had to ring my mum to come & clear it up. Normally if I feel sick I can fight it, even though I know I would feel better if I was sick. I have trained ds ever since he was small to sort himself out if he is sick, it is something I just can't do, poo & blood don't bother me at all, my mum had a massive haemorrhage at home after an operation & it didn't bother me, I cleared it up no problem. Like your dd I actively avoid anything likely to make me ill