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.

I have a 10yo DD with diagnosed emetophobia. PM me if you like. I am not in the UK though.

It’s an insidious and tricky to treat thing. It’s not associated with phobias like spiders or heights, it’s a lot more in the family of OCD and ED.

While you find the right diagnostic health (do not be fobbed off by your GP) there are a few things worth putting in place.

Find a metaphor she gets, like calling her intrusive thoughts ‘Worry Bullies’. Insist that you (& everyone) find them yukky and annoying and refuse to speak to them.

Example: ‘Mum, what day did you buy this sausage’ ‘Darling you know I like answering your questions, but I don’t answer Worry Bullies. I think they were asking that question, not you, right? Let’s shut the door on the Bullies, and not let them in, even if they keep ringing the doorbell, hey? Now eat up, and we’ll go for a walk.’

It helps them distinguish between ‘me’ and ‘my thoughts’ over time. Also carefully police her online life- we’ve been told to keep DD far away from food challenges, food hacks, the sort of thing rife on kids YouTube. Food should be just treated as boring fuel. Eaten in company wherever possible.

Emetophobia is like an octopus. Starts with vomit, but moves like lightening to other areas. Watch for Worry Bullies around topics like alcohol, pregnancy, germs. All things that they know can induce vomiting. My DD even started talking about being a lesbian, which her therapist tracked back to ‘lesbians can’t get pregnant, so won’t get morning sickness’. I mean, she may end up being a lesbian (and a pregnant one!) but for the moment I’ll trust the therapist that it’s related to her anxiety disorder.

We’ve improved it with lots of care and hard work. We’ve been told it’s super important to put in a big effort with girls before puberty hits. There’s a strong overlap of ED developing in these tween years, which is very hard to dislodge. I look around our Psych’s waiting room with such fear. Waif-like pale blue skinned teen girls with stoic hollow-eyed parents.

I don’t mean to scare you, I think we’re lucky to have the chance to find professional help for this stuff. Just don’t underplay it, and get the whole family on board. I’ve had to distance from a grandma who just can’t stop ‘tut tutting’ about her ‘silliness’ and complimenting her ‘fine slim figure’. Grrrrrr

The Thrive programme linked below doesn't have any links to evidence based psychology, be wary.

Does she understand about what vomit is for and how it can be protective etc? Your daughter may be too far into the phobia to pull back, but obviously most people don’t like being sick but I’ve spoken to my son (who gets travel sick sometimes) about messages to the brain, why we vomit when we’re ill, what else can cause it, how feeling sick can be a protective measure (in caveman times) and also going through the “worst” that will happen - he’ll be sick, feel awful and then get better.
If it had gone further than this I would definitely have sought CBT though. Also, I would discourage her from reading too much about it as she might end up focussing on it. It’s such a debilitating phobia if left to get out of control so you have my sympathies. Can you pinpoint where it’s come from?

@ittakes2

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.

I agree with this.

Also @Nitpickpicnic is good

OP, I have this after nearly dying at 3 years old, was very traumatic and imprinted on my life.

I confess I just live with it, have tried therapy, CBT, anxiety work and exposure.

The only thing that has helped has been meeting my husband, he is literally a bin and will eat anything Seeing him eat sausages, bbq food, meat on/over date, etc has almost been like monkey-see monkey-do for me. When I met him I was a size 6 as my eating range was limited to 'safe' foods. Now I'm a more healthy 12/14 as I enjoy food properly for the first time.

But please whatever you do, be gentle with her. She did NOT choose this.

@Averyhungrycaterpillar

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.

Wow that’s fantastic @Averyhungrycaterpillar well done for conquering it.

Another sufferer here since childhood. I’ve tried all sorts of therapies but unfortunately I am worse than ever. Add menopausal anxiety into the mix and it’s not good.

OP I hope you can get some help for your daughter, you sound like a lovely caring mum. I never felt I could talk to my mum about it but I didn’t realise till much later it was a phobia.

Also I haven’t tried it myself but there is something cslled the Thrive programme, look up the book on Amazon.

OP you could also look up David Samson, he’s supposed to be a specialist in this. But not cheap - he’s in Harley Street in London.

Seeking GP support doesn't have to mean a CAMHS referral. You're not equipped to support an anxiety or eating disorder.

I'm wondering if we have done the right thing about reassuring her about use-by dates, perhaps that is feeding her fear?

Honestly, I think it was the opposite of what she needed. It effectively tells her that she is right to be anxious and afraid and that she needs to continue this behaviour to keep herself 'safe'. Thereby keeping her stuck in the cycle.

A more useful action would be to educate her about what sell by dates mean, what use by dates mean - the difference, how they are calculated, why they have to be printed, and most importantly how to make your own safe assessments about food safety.

So, not eating something that is legitimately unsafe (uncooked chicken for instance) based on accurate knowledge of how to assess that is reasonable.

Avoiding eating based on panic and as a way to make the panic go away - not good. That will only cause ever deepening anxiety. That's when she needs support to eat anyway so she can slowly retrain her brain about the boundaries of what is 'safe'.

The brain is risk averse. It very quickly learns new threats - which is why getting your approach right to avoid teaching her brain to be afraid of sell by dates for instance is so important.

It is much slower to relearn that something is safe. So it will take more effort and consistency to help her overcome this anxiety and to be able to feel calm around food than it took for her to get to this level of anxiety.

This is why professional input matters. Not to medicate or label - medication wouldn't help with this, it's coming from her thought patterns - but so that the way you manage it is helpful rather than inadvertently harmful.

The CCI website has a number of free online modules that are often used by the NHS when delivering cognitive behavioural therapy.

I would recommend reading the ones on anxiety (and maybe look through the resources to see if the ones on panic or other areas might be useful too).

It will help you understand what is going on in her brain to cause this behaviour and keep it going, and it will help you to ensure that you stop feeding and perpetuating it but can start helping her bring it back under control.

The basic principle though is not to validate the anxiety by joining in with her behaviours around dates and avoidance but prove she can survive the anxiety-provoking situations instead and help her think about it differently.

Avoid avoidance basically! The CCI site also has good information on how to do 'exposure' therapy type activities in a safe and successful way without overloading or causing more harm.

www.cci.health.wa.gov.au/Resources/Looking-After-Yourself/Anxiety

I agree with @tornadosequins but as someone with emetophobia it is very difficult so definitely get some support.
I don’t know when or why mine started, I have no memory of ever actually being sick although I know from being told that I used to get travel sick. I have a very restricted diet and don’t like to try new things, and nausea during my pregnancy with DD basically caused me to have a nervous breakdown and I was signed off work for two months. It’s absolutely worth getting help as it can become very severe.

To be clear, my 10yo DD didn’t have any ‘event’ or vomit-related trauma that we can track her emetophobia back to. She probably, looking back, had less ‘spitting up’ and illness than most from baby years onward. And she has otherwise always been a good and wide eater.

But her brain still decided that vomiting was a thing that was to be avoided (in herself and others) on pain of death. And anything that might cause nausea needed to be avoided too. Breaking those brain connections is tough, but possible, I’m told.

Be careful to seperate generalised ‘anxiety’ or ‘phobia’ information from emetophobia. And search out professionals and treatments that are specifically for kids, and moreover, preteen girls. Sorry to some previous posters, but anything less specific is a waste of time (in my view) and time is of the essence.

We went through every kind of well-meaning (and some not) medical & mental health professional. Once we found a paediatric psych with specific clinical/research experience in exactly emetophobia (and OCD/ED) we finally started getting somewhere. Don’t waste your time, it’s a pretty specific thing.

I thought I'd come back to this thread with an update.

I really appreciated the knowledgeable posters who told me in no uncertain terms to take it seriously. I feel bad for not replying at the time - it was quite hard to hear.

Anyhow, I took your advice and DD has her first appointment with a clinical phycologist tomorrow who specialises in childhood anxiety and eating disorders. Thankfully we have private medical insurance because the GP who did the referral said that basically there was no hope of any support from CAHMS, which is a whole different thread. Thank you for giving me the push to get her seen.

Its very hard - on the surface she is such a happy, easy going girl, but I can see there is a well of anxiety below the surface. I really hope we can help her.

Best of luck to your DD, I hope the appointment today helped @cheeseismydownfall.

I recommend this book for you, here I've read it as it's written by my psychiatrist (who is a leading specialist in emetophobia) and it's very good.

Aren't a lot of kids at age afraid of vomiting? After all, it's an awful experience.

The food thing (checking dates, not eating food she thinks is underdone) is unusual. I'd not make a big deal of it for the time being unless it worsens as it might pass. Get DD involved with cooking her own food.

My emet was in full flow when I was 10 (50 years ago). I really wish I'd had a Mum like you, although I don't think it has even been recognised as a condition back then.

meredith, thank you for the recommendation - I'll get hold of that when it is published.

silvercat, I'm sorry to hear you struggle with emetaphopbia.

We've now had now had two full sessions with the phycologist - a mix of the two of us together, some time just with me, and some time just with her. It has been a challenging but thought provoking process, that has revealed that actually there is probably more going on than we may have realised - it may be 'just' anxiety or it may be that actually there is something specific at play and the phycologist said that diagnostic tests (for ASD) may be something that she will want to explore a little way down the line once she has a clearer idea of what is going on in DD's head - she doesn't want to rush it.

But I'm relieved that she is getting some help and DD herself has said that she is glad that it is happening and thinks it will be helpful. I guess we just have to see where it takes us now.

So pleased she feels positive about it. I really hope she can get the right support. You sound like such a great mum for listening and wanting to help.

Hello and sorry for stirring up an old post. But I've stumbled over your advice and I'm really keen to have the details of who your daughter saw and who is helping her please. Also how is she and you?
My son has started with emet and it's heartbreaking - I'm desperate to know how to help him
Any advice you could give and I'd be very grateful
Thank you in hopeful advance

@pinkrabbits39 CBT and exposure response prevention has the best outcome (mental health professional here) great book by Professor David Veale on overcoming emetophobia on Amazon for you to help support your son. It’s a relatively common phobia and often more prevalent in neuro-divergent folks from a sensory perspective

I have been emetophobic since I was in the infants school. Please just believe her and support her. I don't have an eating disorder, I'm not mad but I would rather die than be sick. I doubt a clinician will be able to 'sort her out' but your support and not asking her to do things which make her uncomfortable will be invaluable.

At ten if I had been told to eat a sausage I was concerned about because it was the 'worry bullies' talking I would have felt ridiculed and that my genuine to me worries were being absolutely taken the piss out of.

Book ordered, thank you for your advice