Emetaphobia ruining our lives - 8 year old won't eat

[Lubielou79]

My daughter is suffering with a fear of vomit - emetaphobia

It started after she had an awful vomiting bug last January. It has progressed to the extent that she is often refusing food for fear of being sick.

She was already small and underweight before this but is so skinny now. At 8.5 years she's 16kg and 118cm. She has low BMI and I've been told to increase it but it's impossible.

She's had terrible tantrums and complained last week she couldn't see. I managed to get her to have something sweet and she came round and vision improved. She said it was large floaty things blocking her vision.

We've had a urgent camhs referral done but the wait is 52 weeks. I tried a different route into psychology via our endocrinologyist (already being seen at children's for poor height and weight).. the letter came back that psychology department is over subscribed and they can't give a date

We have dietics next month so I'm keeping a food diary, maybe they can force something?

I'm also paying privately for her to see a psychologist once a fortnight but the eating situation is getting worse.

I'm wondering if anyone else is in the same situation or has any advice. I feel really helpless

Thanks so much

This could be the key OP

She was fine afterwards but at Easter someone was sick in the classroom and this is when it started

Is it a fear of being embarrassed

In that the way she felt when that child was sick in front of her

I guess all the other DC made comments and noises during and after the vomiting

I'd explore that side of things

Hi there,

Oh your poor DC, I really feel for her. She must be feeling so awful.

im a clinical psychologist and I work in CAMHS. Depending on your catchment area this could potentially be prioritised. I would try calling the CAMHS on call system and explaining that your daughter’s BMI is dropping and she is unable to eat, causing fainting episodes- even better if your GP can do this liaison on your behalf. I’m assuming she is on the waiting list at the moment.

where I work (in London) this would be a good enough reason to expedite the referral and be seen immediately. Although my service is well funded with a lot of staff and we have more of an ‘open door’ approach as much as we can, with a low bar for risk. Not all services are the same, but maybe where you live it would be reason enough to be bumped up. Eating issues tend to be taken extremely seriously in my experience, particularly when BMI is dropping.

There is a very specific recommended treatmebt for emetophobia , which is CBT but there is a specially developed programme of CBT, not just generic CBT. This is the NICE recommended treatment for emetophobia. It combines trauma work with CBT.

How long have you been seeing a private psyc and have you discussed things not changing with them? I’m surprised they haven’t spoken with you more about this (and left you feeling more reassured about plans). Make sure they are a qualified psychologist (HCPC registered with a protected title and also Dr- not just ‘Psychologist’ or ‘Child psychologist’, which anyone can call themselves), then maybe approach and discuss to plan with them if you haven’t already and you feel confident they have the right level of expertise? This is part of their role and it should be happening already.

i would be wondering about what is keeping this going, the role you and your family have in supporting and breaking cycles, and given how engrained this sounds I would probably be thinking about therapy more than every other week (weekly), unless you’re all working super hard every day between sessions I don’t think things will be able to change quickly enough with that level of support. If you’re working on a hierarchy for instance, if you find that the next step in the ladder is too much then you need to wait 2 weeks to trouble shoot and re-plan, it just won’t work that way.

anyway, I hope you get the right support as soon as possible OP!

My daughter was referred to CAHMS and they rejected her.

No one even mentioned referring my 9 year old. This is after visible weight loss, school absence and a massive change in behaviour. :(

also to echo another poster my daughter is also on the ASD pathway too!

My eldest (8yo) has emetephobia and this time last year it was causing lots of issues. He's skinny anyway but he began restricting foods and only eating safe stuff, obsessed with checking use by dates, lots of tantrums and anxiety about whether he looked pale (in case it meant he might be ill) worry about whether he touched a surface out and about and if it could have germs that cause him to be sick. Months of waking up at night asking if I thought he might be sick...

We saw a counsellor but what really helped surprisingly was me and him going through a workbook from
Amazon called "What to do when you worry too much". Someone on MN suggested it and I admit I wasnt expecting it to help at all, given the therapy we were paying for hadn't helped but it really did. It helped him realise that the phobia of sick was actually just how his overriding anxiety was presenting itself. We stopped talking about specific phobia of sick, and instead the book helped us talk about our worries more generally and get to some of the roots of the issue. It's practical in terms of explaining to kids through the activities that the worry and anxiety doesn't help at all.

Your poor DD. Lots of great advice here - hope she can start to feel better. Not sure if this would work but would she have the protein type milkshake drinks?

Not sure if this is helpful but my daughter did have this fear and I ordered a book specifically for children along the lines of CBT (I think). I cannot remember the title but there were two things that I and my daughter found very helpful

1. Think of two tomato plants.

One, you give a lot of care and attention, water it regularly, make sure it has a lot of light and nutrients etc. The other one you acknowledge but you put it in a dark corner. Sometimes you water it, sometimes you forget it, don't give it extra care. After a while the neglected plant withers and the other one thrives. It's the same with fears. Put them in a corner. Don't give them extra attention. (I know it's easier said than done but it was remarkably useful and reassuring)

1. Allocate 15/20 minutes a day to talk about your fears. No more.

When you have fears at random times during the day, imagine a very heavy box with an even heavier lid. Put all your fears in that box, throughout the day. Do not talk about them. Then at the allocated time, open this imaginary box, speak about the fears, describe them. But after that time close the lid again. And stop talking about them.

I'm not sure if I described this properly, but it made a big difference to our lives.

All the very best

I also want to add there's a strong theory that emetophobia isn't necessarily caused by isolated experiences that involve vomiting so there's less need to focus on the "trauma" in order to cure the phobia. It's more a pervasive thinking pattern, tendency to ruminate, social anxiety, high disgust propensity, sensory issues, prorioception issues (hyperawareness of bodily symptoms), all of which frequently overlap with neurodivergence.

People tend to look back and try to make connections about what caused emetophobia and usually land on a incident that involved being sick. However virtually 100% of school age children will have had a stomach bug or witnessed someone else vomit within any 12 month period. The vast majority of those don't go on to develop emetophobia.

I find it's more realistic to accept that some children are born with an innate propensity to develop emetophobia. Due to the inevitable exposure to vomit situations throughout childhood, the phobia will arise sooner or later. Exposure also plays a negligible role. I mentioned to one of my therapists that I felt being an only child may have contributed to the fear because I didn't have many opportunities to be exposed to others being sick. She said it was the exactly opposite, many of her clients with siblings hated growing up in big families because they were constantly terrified that someone else might get carsick or catch a bug.

Realistically, the phobia is also never cured or truly goes away. I think it's comparable to eating disorders or alcoholism. The thoughts will always be there in varying levels of intensity. However there's a huge difference between being completely housebound and malnourished, or having a reasonably normal life whilst dealing with a few intrusive thoughts now and then. Relapses are also common during stressful periods, although emetophobic behaviours are not that dangerous per se (compared to drugs or alcohol) so recovered emetophobes can get their life back on track reasonably quickly.

52 weeks is disgusting isn't it. Can you afford any private therapy in the mean time?

Sorry i see you're already doing this

In the immediate term I agree with people saying let her eat what she's comfortable with. I'd also suggest eating little and often, as she may dislike the sensation of feeling full (I have emetophobia and while it's broadly under control, I don't like feeling too full).

I'd also suggest letting her eat alone. Put out a few things on the table for lunch, including things you know she will eat. Then go and do something else - she might feel like she wants to try something but wants to be able to nibble at it and stop without feeling like she's under observation. That's not a criticism of you, I just imagine she's very aware that you are (understandably!) anxious to see her eating.

How is she with drinks? Just from a calorie and nutrition viewpoint, would she drink juice or smoothie, even if she wouldn't eat the fruit?

Hi there, I’m a 40-something emetophobe who has had it since I was late primary school age. No idea why it came on, but I’ve been dealing with it for around 30 years.

In the beginning I used to sleep sitting up with a bucket in my room (I was never ill). It took about 2 years to take the bucket out of my room. It took a few more years to lie down to sleep. I can’t really remember discussing it lots with my parents but they just accepted my foibles (my term) and if it reassured me, we did it.

I can’t comment on what’s best to get her to eat, but as others have said, safe foods are your friend. For me this is low-risk, carby foods such as potatoes eg jacket potatoes, chips, cereal, toast, and tell her it’s not possible to be ill through these foods. One things emetophobes like is certainty ie control. If she can see they’re ripe / not mouldy, you can tell her there is no way they will be the cause of food poisoning. Let her prepare them with you.

When out and about, it’s important to us to know exactly where the toilet is, especially when on public transport like trains, and in restaurants. Sit somewhere where the toilet is in view. Sometimes we can be irrational, like not wanting to sit in the back of a 3-door car because there’s no access to opening a window or door - that still gets me sometimes on long car journeys.

It sounds really hard OP, but give lots of encouragement and try and give that certainty about foods. Stay away from higher risk foods for now, and in time she will come back to them.

Over time I have got better with age. As I’ve got older, I’ve realised the constantly feeling sick was actually the anxiety of thinking about it making me feel hot and sweaty and nervous. Now I can recognise these anxious moments and dismiss any worries about whether it’s gonna happen.

But it doesn’t go away forever, in a lot of cases. I have intrusive worrying thoughts about it maybe once a day. I decided to have a baby despite my deep concern for morning sickness, but I got through it (using a lot of my usual coping techniques). Now I have paranoia over my daughter being ill but ultimately I just get on with it, because there’s no other choice. I’m proud of how far I’ve come, and your daughter will get better, I promise.

I am completely overwhelmed by the amount of useful advice and support. Thank you everyone who has commented.

I have been sat with my notebook and pen going through all the advice and making a list.

Thank you to the professional who recommended trying to bump her up the list with Cahms, I will get onto this next week.

I also very much appreciate all the advice on safe foods from people who have first hand experience of this. It's a really helpful perspective

This is such good advice, I definitely am very anxious.

Thank you for the advice, I will have a look to see if I can call and speak to the GP again.

We've had about four sessions with the psychologist, she has all the correct qualifications. Things have been somewhat disrupted by summer holidays so it feels like we're just getting started. We have another appointment next week so I will raise whether we should meet more often.

Can I ask why you're wanting her to eat meat? Why not just focus on carbs?

In the immediate term I agree with people saying let her eat what she's comfortable with. I'd also suggest eating little and often, as she may dislike the sensation of feeling full (I have emetophobia and while it's broadly under control, I don't like feeling too full).

Agree with this! Feeling full was a big anxiety trigger because it meant a longer time period you have to go through before you can be sure you won't be sick. Hunger is a safe sign that you won't be sick so it's very comforting.

You may also have to accept different definitions for meal sizes or portions. During the peak of my phobia, a single slice of toast, one banana or one chocolate bar was a meal. I also hated too much variety because that increases the chances that one of those many different foods might make you sick. Salad was off limits for the longest time. So meals that are only made from 1-3 ingredients are safer than fancier dishes or multiple courses. Carbs are much preferred over meat or fish. Cooked meals or UPF shelf-stable snacks are better than raw ones.

In terms of nutrition, you may be surprised at how little is needed for a somewhat balanced diet. As along as you convince her to eat one thing from each food group, it won't matter if that's all she eats on repeat. I found fruits quite manageable because when fresh and unpeeled, it's almost impossible that an apple or banana would make you sick. I also ate canned sweetcorn, baked beans, jacket potatoes and peeled oranges. I also read somewhere that fresh pineapple contains enzymes that help you digest food (true) so I happily ate that although not as often due to the cost.

In the long run, you can aim for her to eat a small variety of fruit & veg, and that will be good enough. Unlike ARFID, emetophobia is not related to textures and sensory issues but purely how likely a food is to make you sick. So emetophobes can end up with a reasonably varied diet as long as know all those foods are fresh and safe.

ARFID is also worth exploring in your research

Before all this started she was already being seen by children's hospital for low weight and slow growth. Those investigations are still ongoing and she has a blood test to check for potential genetic causes next week. Growth hormone has been checked but was OK.

At a check a few weeks ago they said that compared to last Sep she has grown 3cm but failed to gain any weight at all (she's still 16kg same as last year). She's very small compared to her peers.

A couple of weeks ago they said her low BMI is cause for concern and could cause issues with delayed puberty / future fertility problems etc.

I think the January sickness bug and then several periods of fasting for 2/3 days at a time combined with picky eating are just holding her back.

In my head if I can get her eating protein like meat it may help with the weight she's supposed to be gaining. She already doesn't eat any dairy and has to have a calcium supplement so she won't get protein from milk and yoghurt.

Would she take an anti sickness pill? At least she would know for sure she will not be sick. Also high protein shakes might help

I wondered about giving some kind of placebo pill but honestly I don't know what I'm doing with this. I wondered whether that somehow re-enforces that she should worry.

I'd love it if she would drink a protein shake but she refuses all milk and yoghurt, has for years. I would say she already had ARFID and was a picky eater before all this.

At the last appointment with endocrynology at children's hospital they said they would refer for ARFID but I've not had anything on that at all. I will follow up.

Out of interest, is her emetophobia very food-focused, or does it show up in other areas? For example, concern around hand washing, touching things when out that might be "contaminated" (like door handlers, railings, things that get touched a lot by a lot of people), reluctance to go out if she's not near a toilet, nervous on long car journeys?

My dd had/has food issues due to ASD. She is a lot better now as a young adult and often sorts her own food out.

I managed it by having no rules around food. I let her eat what she wanted, when she wanted. I figured anything was better than nothing. Eg. Breakfast in the past has been lasagne because nothing else would do.
I tried to be really cool and relaxed about it all, in reality, I was anything but.

I have no experience with a fear of vomiting, my only suggestion would be to ask the gp or someone to prescribe her meal replacement shakes for now to keep up her calories and try and get up her weight.

We've been prescribed these before but she flat out refuses them. She doesn't like milk shakes or yogurts. I'd love it if she would cooperate on this, would make things so much easier

I recently bought all the different flavours of huel plus other protein drinks from supermarket but each one was a no

I'm also paying privately for her to see a psychologist once a fortnight but the eating situation is getting worse.

I also noticed you mentioned how the eating situation tends to get worse after each session that involves exposure. From my experience, very very few therapists know how to effectively tackle emetophobia, considering its very complex nature and overlap with neurodivergence. Exposure therapy has generally been found ineffective for people with ASD/ADHD, and can make conditions like CPTSD worse.

I would strongly recommend taking the money and looking into the Thrive program which someone else has mentioned in the thread as well. There are licensed Thrive therapists that only require 6 sessions but each one is specifically targeted for the phobia. Some are also specialised in young children and teens. Exposure therapy doesn't play any role at all in the Thrive Program because emetophobia is essentially caused by a pervasive pattern of faulty thinking rather than an actual fear of vomit.

I did all kinds of exposure therapy over the years including looking at pictures of vomit in increasingly graphic depictions, listening to audio, watching videos, putting my hands on toilet seats etc. The effect was negligible at best. (Thrive helped me about 80% and exposure/CBT about 10%). The only exposure "therapy" that helped was having a baby and dealing with real life situations like spitting up, gag reflex, nursery viruses etc. But that was obviously entirely different compared to controlled exposure in a medical setting.

Regarding the comment about anti-emetics, you could encourage her to try something against anxiety through placebo effect. Having a small crutch might make the difference of feeling able to cope with a meal or the anxiety that comes after a meal. Mints, Tictacs or gum are popular (non medical) anti emetic devices. You can tell her the mintiness or menthol is used to calm queasiness, which is also true. Sniffing lavender or lemon essential oils are also common tricks for getting rid of nausea. Again, safety behaviours like this aren't widely encouraged as an end-goal for emetophobia recovery but they are relatively harmless and could help in the short run.