At wits end - 8 year old DD severe emetophobia and won’t sleep.

[Ricecrispiesatsix]

Just that really. Our 8 year old daughter has SEVERE emetophobia (phobia of vomit) and recently it’s spiralling out of control. Her older sister has been off school with a tummy ache this week, and as well as that a kid in her class has been vomiting. So her anxiety is through the roof.

Every night she cries herself to sleep until 11pm because she’s so scared of being sick. Sometimes one of us will sit with her to try and calm her, sometimes we leave her and pop in every 5-10 minutes, it doesn’t seem to make a difference. We can sit with her until she’s asleep, but when we try and leave she always wakes up and starts crying even more. She won’t sleep in our room in case her sister is sick in the night and comes in (this hasn’t happened in years btw and feels very unlikely).

Tonight I was supposed to be at a party but I had such a horrendous evening when DH was out earlier this week that I couldn’t do it to him. The only way is to tag team it but even then we’re struggling not to lose our tempers with her because we’re absolutely knackered.

I know it’s not her fault but it’s so so hard. The more tired she gets, the more she struggles to sleep and it’s all cumulative.

We paid for her to have psychotherapy last year and it helped for a while but we can’t afford it indefinitely. She’s on the waiting list for CAMHS. In the past when things have triggered her phobia she’s stopped eating evening meals (and she’s already on the first centile for her weight) and obsessively washed her hands until they bleed. Sleep has always been a huge issue for her. The more tired she gets, the more sick she feels and then the more difficult she finds it to sleep.

I can hear her sobbing right now. DH is with her and he’s doing a great job but she cannot be reasoned with.

OP do you know about PANDAS? Symptoms can be similar to what you describe. (It’s a weird reaction to an infection, usually strep, which causes OCD and other things).

Please check out panspandasuk.org

Has she been assessed for autism? I think there is a massive link, I know there is for me. It's a sensory issue coupled with a loss of control, plus emetophobia is the only phobia that is a form of OCD (as told to me by my psychologist friend)

My understanding of PANDAS is that it’s a big change in behaviour - she’s always been like this! Well she’s always been very demanding, and she’s had the phobia since a traumatic incident when she was about 3. Then lockdown exacerbated it. It’s usually manageable until something like a family member being a bit unwell triggers it.

She hasn’t actually but we have wondered about it. She’s very pedantic and literal. She’s academically very bright but struggles with empathy.

I know she is young but could your GP prescribe something to help her calm herself and sleep . Is there a kids version of Rescue Remedy or something natural.

Emetophobia is a very common phobia in children and adults (often women). It is sometimes, although not always, triggered by an unpleasant experience of vomiting, and is best treated with (gradual) exposure therapy and/or a CBT approach from
a therapist who has experience dealing with emetophobia in children. I really sympathise with your DD as I also suffered from this phobia, which developed at the same age and caused issues with sleep, hygiene, and - when especially bad - eating. I eventually sought help as an adult and wish I had had intervention much earlier. The good news is that it is a treatable problem when one has calm, consistent and specialist support.

Good idea. I have a GP appointment booked for her so will ask. Also I’ve heard good things about melatonin…

I looked on the Speakmans website and they had some good things on this.

I had this as a child and it was incredibly debilitating.

Melatonin gummies are available I think.

Emetophobe here and it's definitely not PANDAs. My phobia also started around age 8, and I had the same severity of symptoms around my late teens/early 20s. Fortunately it improved a lot in my 30s and doesn't have a significant impact on my day to day life at all. A few things to consider:

1. A single traumatic event being the cause of emetophobia has been largely debunked. In virtually every single case, the person has ASD, ADHD or both. Neurodivergent thinking patterns seem to trigger and prolong the phobia.

2. Look into Rob Kelly's Thrive program. It gets to the root cause of the phobia and if you can afford it again, be sure to work with a Thrive therapist and not a random one. CBT and traditional methods of therapy are largely useless. The program claims to "cure" the phobia which isn't always the case, but it can help immensely towards living a life with much fewer symptoms.

3. Stress levels and overall feeling "unsafe" seem to contribute directly to emetophobic symptoms. As it overlaps heavily with ND, the pressure to mask in daily life is also a huge factor. The easiest initial step is to reduce pressure in all areas of life wherever possible. It may involve encouraging her to pursue special interests, paying for hobbies, finding ways to unmask, giving her enough time and space to decompress between everyday transitions etc.

4. Distraction works very well against emetophobia, especially positive "escapism" type activities such as pursuing her special interest, going shopping, playing video games, reading or engaging in a fun, safe activity that is within her comfort zone. Actively encourage all of these things, even if it means paying for a game console, allowing extra screen time, paying for apps or in-game currencies. I cannot emphasise enough how important it is for emetophobic girls (who are almost always neurodivergent) to have a place to escape from their minds. Being punished or forced to spend time alone with their thoughts is usually what makes the phobia worse. Bedtime is very hard because you are alone with your mind. It often helps to engage in some level of maladaptive daydreaming where you imagine you're in a different world or living a different story until you fall asleep (books or games help with this).

5. A simple example would be to allow her to play a video game in the evening if she's too terrified to sleep. Look into cosy games which are not overstimulating. Or let her watch Youtube videos of (calm) things that may interest her. It sounds counter-productive to all parenting rules but emetophobia is your brain going haywire and you need to bring it back to a safe space with positive distractions.

6. Emetophobia is often caused by not feeling in control of your life combined with low self esteem or shame. Anything that works against these two things is good. I mentioned video games in particular because it gives people a sense of control. Similarly, try to give her more control in real life by letting her make more decisions, even minor ones. Also encourage anything that may help build self-esteem like a hobby, sport, etc.

7. Don't make a big deal about food. Let her have safe foods (usually carbs, bananas or packaged UPF snacks) until all the other areas have been addressed. Food is almost never the cause or prolonging factor of emetophobia and it usually makes things worse if emetophobia is treated like an eating disorder. By forcing someone to eat more, it increases the anxiety and shame which makes symptoms worse.

8. Focus all your energy on reducing stress, reducing her need for masking and actively providing positive distractions. As these things improve, it will become easier for her to eat more things and feel less controlled by the emetophobic thoughts. Emetophobic girls tend be very thin (into adulthood too) but it's almost never life-threatening in the same way as anorexia. Just be sure to provide safe foods, especially any calorie dense options she likes (eg most emets are fine with butter or chocolate).

could you get some kind of placebo medicine that you could give her to settle her stomach “so she’s not sick”? eg. peptobismol or whatever it’s called or somwthing shes not had before that could be used to reassure her shes fine. even though itll do nothing much at all. but she will think it does.

for during school hours what about some essential oils that are antibacterial and antiviral sprinkled on her clothes or dripped on a hanky she could sniff could genuinely help fight illness. with a lavender and chamomile type essential oil sprinkled around her pillow for better sleep. neom do a nice nighttime one. not sure how well it works right enough.

with regard to handwashing i’d tell her that germs get into the bloodstream through open cuts so she needs to wash her hands carefully but not so much they go red or bleed as thats actually MORE likely to let germs in. i’d give her a hand-gel to use after washing her hands to nhs guidelines standards if that’s any better.

We've been having sessions with mental health team through school. Took several weeks to get referral sorted through the SEND lead at school. We've been working through "Helping Your Child with Fears and Worries" by Cathy Creswell. Worth a read for tips on managing anxiety in children.

Yes this did help me as well! Even though in the long term, therapists try to discourage "safety behaviours" (carrying a bottle of water, digestive medicine, certain gums or mints), it does help in acute situations and particularly for children whose minds are easier to convince.

Anything that is calming or good for your tummy helps. Eg drinking fennel tea at bedtime, sucking on a peppermint sweet or Tictac, smelling calming essential oils or balms etc. Sometimes having a safety object also helps like a stuffed animal designed to help their mind, worry dolls etc.

Would personally not recommend using scare tactics as a way to combat behaviour, eg telling her more germs get into her hands by washing. Firstly, that's simply not true on any scientific level so it's basically lying to a child about something that is very crucial to her MH. She will definitely remember that forever and know you lied to her. Nobody will become more of an expert on hygiene than emetophobes! At some point in adulthood, they will know exactly how viruses are transmitted along with incubation times of different illnesses, so they will absolutely recall which things they were told were actually untrue. Just like the eating habits, hand washing will improve once her stress levels and self esteem improve.

Better to tell her it's more important to take care of her body because she's worthy of that. Get a good hand cream and apply it on her hands. Try to minimise the impact without shaming or punishing her for it. Try to encourage her to see the healing on her hands as a sign her fears are improving so that way, she'll be motivated to feel better.

you misquoted me. i didnt lie to imply more germs get into your hands by washing.

I was telling the truth - that more germs can get into open cuts (caused in this case by excessive handwashing). Which is true. you don’t handle anything dodgy with cuts on your fingers. it’s common sense not scaremongering. keep your skin in good condition by washing the right amount and youll be fine.

good idea re handcream. the lidl loccitane dupe lavender one is good. again it’s hopefully got essential oils in it.

ERP therapy the gold standard treatment for emetophobia. She sounds very scared and you sound exhausted. It is possible to overcome this with therapy and hard work.

I had severe emetophobia as a child. My suggestion would be to offer a placebo anti-emetic. Tell her it will stop her from being or feeling sick. You could make this melatonin, or phenergen which will help her to sleep, should you be able to get hold of any. But otherwise it could be fake medicine like a vitamin. My next step would be to find hypnotherapy.

I think some viruses can increase anxiety.

i was phobic but got over it having kids as they were sicky.
I do think it can be linked to ND. And in your case sounds like ocd too.
I think its partly for me seeing a few piles around when i was young and being a bit sickly

I have been exactly like your DD. I'm over it now but I went through phases like that and it was hell (and probably hell for my parents)

I had therapy numerous times where they tried to see what in my past had caused this and couldn't understand that I was just terrified of vomit or the sensation of nausea or vomiting, to the point I would rather die (but I wasn't suicidal). I later learned that the sense of impending doom that gave rise to the phobia is a neurological reaction to certain states of illness, so i was right all along, I just felt terrified and there was no underlying reason.

In the end, over the course of my life what eventually helped was a very calm doctor who was with me when I had a stomach bug and remained totally calm. Even though I was in a panic. That didn't cure the phobia but it seemed to make me think that there was another way to deal with nausea and vomiting. I knew that already but having it modelled to me was a stronger thing. He also gave me an injection to stop the nausea and vomiting and gave me buccastem tablets to take the next day. I could see how these worked, which meant I was starting to sense there was a way to control the thing I feared.

Then I had this really kind nurse who told me that I should carry around Buccastem in my bag. Not safe for a child!! I just want you to know that this was the turning point for me. She knew I wouldn't take them unless definitely ill and that wouldn't be very often obviously. With a child this is not safe or appropriate, but I'm wondering if this could be discussed with a doctor to see if there are any safe methods of her gaining some control over nausea and vomiting, the thing she fears.

Some might say that it's not nausea, vomiting or seeing people sick that needs to be controlled, it's her anxiety. I'm just saying this way around didn't work for me. I had to feel better, which meant first being exposed to the thing I feared (getting a stomach bug and being sick) and then EXPERIENCING that it was ok because the medicene given controlled the thing I feared.

In other words I had to experience the thing I feared and then realise I could cope with it.

I got another bug some years later but I had my buccastem and it was enough to make me feel better and stop vomiting.

Since then I was sick after getting a nasty skin infection, took the buccastem, which helped but it didn't stop me vomiting. It still mitigated it. I realised I was no longer terrified of it.

I hope some of this will help you and your husband understand things with your daughter. My case might not be the same but I've been in a very similar situation so can explain from that point of view. I also know that a CBT trained therapist would likely be very helpful (and if not, find another one).

You're welcome to private message me if you want. The crux of it is that she fears something and she fears she would not survive it or cope (including if she witnessed it in someone else). The solution is to experience it and experiencing coping (not just practically, but emotionally). How you get that probably requires a chat with your GP and / or a CBT therapist.

interesting, heard of this for ocd, how does it work for emetophobia?

Just wondering if what I put above was a form of erp without realising it?

You have heard wrong mostly, and it is very unlikely to be prescribed for general sleep issues, especially in children. It is unlikely to have any impact for general sleep issues in fact. This is more of a US thing with the obsession, fuelled by marketing.

There are very specific scenarios it can be prescribed for sleep or sleep adjacent issues though, not suggesting you don't ask. Just pointing out what you have heard, is almost certainly nonsense and will be even if it turns out it will help in this case.

Defo considering she was always difficult and demanding consider an autism assessment.

My dd is 20. Has suffered with emet since 8.

She was diagnosed autistic at 17

I wish we had known earlier.

ERP for OCD and emetophobia are similar but there are some differences too. Therapists like myself do a thorough assessment first and work with their client to devise treatment goals. Then therapy is individualised for that client.

So sorry ye are going through this op. My son who is 13 has emetophobia. He is doing really well now but had a really tough time age 8-10. He was diagnosed with ocd and very mild autism.
it just came out of nowhere but through therapy we found out the one and only time he has ever vomited his auntie was minding him, she started roaring at husband to get towels and he basically got a bad fright so this triggered it they think. He had also drank out of another child’s bottle that day so associated that with germs and it all kicked off. Absolute torture for months, we couldn’t touch his food, he lost 2 stone, hands were bleeding from all the washing. Gp referred to CAMHS but once he was diagnosed with autism they would not look at him.
we got private cbt and did a workbook with him everyday about emetophobia sorry I can’t find name now but loads online it was very helpful.
school helped us as much as they could also. He is very happy boy now and doesn’t worry as much but if he hears or sees anyone getting sick he would get upset. He has only ever vomited that one time. Thank god we all seem to avoid the vomiting bug.
i hope your daughter is ok. I would get cbt as soon as possible and maybe a physcolgist review.

Thank you for all the replies. Lots of ideas to consider which is great. The more I think about it the more I think she probably is ND - another thing that sprang to mind is that she’s always had little phrases, words and questions she gets obsessed with and repeats again and again.

She definitely needs therapy - it’s just prohibitively expensive to have it privately.

It’s been helpful to have the perspectives of fellow emetophobes, helps us to understand what she’s going through a bit more.

Our eldest daughter is fine now but without really thinking about it said “I feel sick” at dinner time tonight and that was it - DD8 ran upstairs and wouldn’t sit at the same table as her. It’s all very frustrating.

Our eldest daughter is fine now but without really thinking about it said “I feel sick” at dinner time tonight and that was it - DD8 ran upstairs and wouldn’t sit at the same table as her. It’s all very frustrating.

That's totally to be expected, having someone say they feel sick out of the blue is one of the biggest emetophobia triggers. That would even make me freak out and I consider myself mostly recovered. The important part is to focus on getting her everyday life back into order, especially in such a way that doesn't impact the rest of the family. Being able to eat and sleep normally is a foremost priority.

These are triggers that everyone in the family need to avoid saying or doing whenever possible. It's not enabling the phobia, but giving the person headspace to avoid their thoughts. Even fully recovered emetophobes find it very unpleasant to hear things like this:

1. Anyone announcing out of the blue that they feel sick, especially in an enclosed space like a car or dinner table. If someone does feel mildly sick (ie. not to the point of throwing up within the next 5 minutes), please just refrain from talking about it.

2. No graphic stories from recent times involving vomit and sickness. Loads of people seem to enjoy saying how "they were up all night throwing up" because of some virus or food poisoning. If they feel totally fine at the present moment, just don't mention any vomit stories from the past.

3. Theatrical exaggeration about how they tend to get car sick, motion sick or how someone's kids would puke all over the place in certain places. Again, it's really not relevant to conversation and nobody benefits from knowing about that, least of all an emetophobe.

4. Loudly questioning if food tastes off or if anyone else feels funny after eating a certain meal that the emetophobe was also part of. Again, even if this were the case, it doesn't help anyone to discuss it in detail. Or having made everyone a meal and making everyone aware that one ingredient was expired.

5. If someone does feel sick or is sick, fully expect the emetophobe to want to distance themselves as far as possible and don't shame her for it. It's not offensive or heartless, it's just part of specific behaviour of a MH issue. There are loads of mums who love their children but need their partners to clean up vomit. It's really not a huge deal in the bigger picture.

In future, if the other daughter feels sick, you can proactively allow your DD to sleep in another room. She will be hugely grateful for your understanding and that in itself is enough to reduce stress levels and, ironically, improve the phobia.

Emetophobia is a condition that on the mildest level, only results in minor lifestyle quirks. Since most people don't spend every week vomiting, it's not a huge deal to accommodate the emetophobe on the 1-2 times a year someone in the house has a stomach bug. Let them stay in a different room, let them use different eating utensils and let them stick to their safe diet for a few days. It will eventually blow over. Actively fighting this or shaming the emetophobe for their behaviour in a flight or fight moment is not productive.