I get dozens of emails from families who are concerned about their emetophobic children. (I include teenagers when I say "children.") I can certainly understand their worry. Their child does not eat, does not want to go out, washes hands incessantly, etc. I am also impressed by the concern that parents have by reaching out for help. Unfortunately my practice is full right now and my wait-list, depending on your time zone, can be up to a year long. So here are some tips for those worried parents.

1. Anxious children are responding to family stress. This doesn't mean that you're abusing your child or she's being sexually molested by someone, although if that were true, it could certainly lead to a phobia. In my work with families I have found that the stressor is often something as simple as moving away from friends or family, or mother being preoccupied with caring for an aging parent. Children around the age of 9 seem to be particularly at risk for responding to this type of stress by developing a phobia.
2. Anxious parents make for anxious children. This is no way to suggest that it is the family's fault that the child has developed a phobia. But children "act out" family stress one way or another. It's probably easier to treat a phobia than a drug addiction, so perhaps there's a way to be thankful. And while I can certainly understand a parent worrying about a child with a phobia, don't forget that your worry is one more thing the child has to deal with. Try to remain calm, hopeful and optimistic while still taking it seriously and seeking help.
   
3. Seek family counselling. Instead of assuming the child is the one with "the problem" set the microscope to examine a wider area. What's happening at home? What is the family stressor? If you as parents can get some family counselling and you can talk through the current situation with someone it will probably go a long way in helping your child.
4. Don't allow avoidance. Avoiding what a child is afraid of will lead to a full-blown phobia or make an already existing phobia worse. Be kind, gentle and supportive but calmly let your child know that s/he must still go to school, to grandma's, etc.
   
5. If your child isn't eating seek medical help. Let your child know first, again, calmly and firmly, that if they don't eat they will end up in hospital where they won't be able to come home until they start eating. This isn't a threat, it's just a fact and they need to know that they must do something to help themselves.
6. Reassure your child that vomiting isn't dangerous or harmful. It can't hurt them in any way, so they don't need to fear it. This is more helpful than constantly reassuring them that they won't vomit. Kids can "sense" that you're b.s.-ing them on this one (how do you know if/when they will vomit?) so they will keep asking you over and over until you're about to throttle them. 

Even though my practice is full, I'm still willing to talk with your local therapist about how to approach treating your family/child. So if you find someone you really like to work with they can check out my resource website for therapists at www.emetophobiaresource.org. It's completely free

Emetophobia Awareness Day is officially May 1st, 2012. I say "official" rather tongue-in-cheek. It's only official because I thought it up and said so! But the point is, we emetophobes need to come out of the closet for the good of all.

Emetophobia is so common yet most doctors, therapists and researchers have never heard of it. It's been featured on the TV show "My Strange Phobia" as though the woman featured was some kind of fluke of nature. As a result people suffer in isolation, are looked down upon by their partners and families and cannot find any help or hope from the medical community. This is wrong. Part of it is our fault.

For some reason emetophobic people (myself included, in the past) are horribly ashamed and embarrassed to admit that they are afraid of vomiting. Sometimes we try it, tentatively. "I'm deathly afraid of vomiting" we say. To which they reply "Well nobody likes it." As if we would then go, "Oh ok" and we'd get our lives back. But the problem is, these sorts of belittling comments silence us. This can go on no longer.

What I've noticed by listening to literally thousands of emetophobics online and after spending the past two years treating exclusively emetophobics is that we are not specific enough when we talk about our phobia. Some people use the word "phobia" loosely, meaning they squeal and jump up on a chair when they see a spider. This is not a phobia, it's just a fear. A true phobia of spiders would mean your life is completely ruined and you are debilitated by the fear. You can never sleep at night in case there's a spider in the house. You spend every waking hour vacuuming and cleaning and spraying with Raid. You can't work, socialize or even go out of your house because other places are not as "safe" from spiders. That's a phobia.

So we need to not only come out of the closet, but we need to say more. Explain more. I find in consulting with other therapists that most of them have no idea how scared an emetophobic is of vomiting. Some therapists have tried ludicrous ways of treatment such as suggesting that the emetophobic vomit in order to "see how it can't hurt you." Imagine having a fear of spiders and being forced to be covered with them for an afternoon. Now imagine having a phobia and doing the same thing. This is not "treatment" it's cruelty.

We have to speak out, and we have to be more explicit. We can't back down when our families or our doctor or therapist tries to brush the phobia off as not very significant and believes it can be overcome by just "getting over it."

Stay tuned to this blog (or subscribe) for ideas, press releases, tips and more as we get closer to May 1st. Meanwhile, think about what media outlets you might have access to or what PR/marketing folks you could approach for some help.

Living with emetophobia is not really about the fear of vomiting. In one sense, vomiting has nothing to do with your fear or phobia. I tell all my clients: your problem isn't vomiting. Your problem is anxiety.

It's just that things to do with vomit trigger the anxiety or panic attack. So getting over emetophobia is more simple than you think. Because it doesn't matter who is vomiting, who has norovirus, whether you feel nauseous or sick, how often you've washed your hands or anything else "out there in the world." None of those things matter. All that matters is your ability to control your anxiety. Because right now, your anxiety probably controls you.

Therapists measure anxiety on an 11-point scale called an "SUD" scale which stands for Subjective Units of Distress (or Disturbance). There are 11 points because zero is one of the numbers: 0-10. Zero represents no distress (anxiety) at all. 10 is the worst possible panic you could ever imagine.

As I am working through gradual exposure with clients I am constantly asking them for an SUD number. (It probably annoys the hell out of them!) But the numbers are important because they're your numbers. Hence the term "subjective." 7 is 7/10 for you. Perhaps that's when you start to feel your heart racing, but for someone else it's when they have sweaty palms and tingling feet. Everyone's numbers are different, but the numbers help us to get an idea of whether your anxiety is rising, lowering or staying the same.

But the numbers also serve another important purpose. They let you know how scared you are. Often phobics think of themselves as either "freaked out" or calm, but there are a lot of numbers in between those two and learning to recognize each one of them is key to overcoming your anxiety.

Let's say that you are feeling 1/10 for a baseline. A little stressed perhaps, but no noticeable symptoms. If your anxiety rises to 3 or 4/10 you can probably lower it again just by taking a deep, cleansing breath and then concentrating on slowing your breathing right down and dropping your shoulders to a more relaxed position.

If your anxiety rises above 6/10 being able to control it is more difficult. Up at 8 or 9 you're not even able to think straight. But often it is those numbers between 4 and 7 that give phobics the most trouble. It's there that you can feel a lot of body symptoms such as increased heart rate and breathing, tingly hands or feet, dizziness, nausea, etc. So if you notice your anxiety that high, it's time to try to relax. Breathe slowly. More slowly! Don't hold your breath at the top or bottom of the air - keep it moving. Relax shoulders, stomach, face and jaw. Then take a numerical reading again. Are you at 3 or 4 now? Great. Because it's much easier to lower it from there. More concentrated breaths, more relaxed muscles.

Just the act of "taking a number" can help calm you down. Whatever the number is, you can lower it! Just practice, practice, practice. If you need some help click on the "Resources" section and then "Relaxation Recordings." Good luck! Before you know it your fear of vomiting (or fear of norovirus) will be much better.

One of the reasons I have information on this site about norovirus is so that people with emetophobia can find it, and find the help they need to overcome their fear of vomiting. And this time of year I get more emails asking for help than all the other seasons combined. All because it's winter (at least in the northern hemisphere) and norovirus seems to be running rampant through the schools and nursing homes.

So why the title of this post? Because researching norovirus is not going to help you with your emetophobia. In fact, it may only make it worse. If you are emetophobic you probably think your biggest problem is avoiding or preventing vomiting. But that's not true. In fact, vomiting isn't any problem at all. It's not dangerous. It's not harmful. It can't hurt you in any way. Your biggest problem is anxiety or the fact that you fear something that can't hurt you.

Focusing on norovirus and ways to avoid or prevent vomiting is what will make your phobia even worse. It will trick you into believing that vomiting is some sort of big scary monster to be avoided at all costs. But norovirus isn't Ebola or AIDS - it's a harmless virus that makes you feel quite lousy for 24 hours and then you're fine.

I understand how scared emetophobics are of norovirus - I used to be that scared. Luckily for me, I was emetophobic before there was an internet. I really think that if I had researched all this stuff and gone online talking to other emetophobics my life would have been completely destroyed.

Spend your energy researching ways to get over anxiety disorders. There's lots of that on the internet! There are relaxation recordings, tips for panic attacks, and of course lists of therapists in your area that deal with anxiety disorders and phobias. If they've never heard of emetophobia just get them to email or call me!

It's winter here in the northern hemisphere and it seems whenever there's a slow news day one of the stations that has to now fill 24 hours a day will report on a norovirus outbreak. Norovirus is now the technical name for any "Norwalk-like" viral gastroenteritis. It's also known as the "stomach flu" (even though it's not related to the flu) and in the UK it's called "winter vomiting virus."

In reality, you can catch a norovirus any time of the year because when it's summer here it's winter in Australia and somebody can hop on a plane and spread it just about anywhere when they arrive. But since it's spread primarily from hand-to-mouth it can tend to hang around more when people spend a lot of time inside. That's why you hear about noroviruses in nursing homes, schools and cruise ships. These are places that a lot of people gather inside - all touching surfaces that can be contaminated.

Out in the general population if you don't have kids and don't go to schools and nursing homes without washing your hands after you've been there then it's almost impossible to catch a norovirus. If you do have kids and you're in the room nearby them when they vomit then you're at risk. But if you're not, then all you have to do is wash your hands before putting your fingers in your mouth and you'll be fine.

So what about cruise ships? Emetophobics are notoriously terrified of them because on slow news days reporters tell stories about norovirus on a ship. Here's the thing: cruise ships have 3,000+ people on them. That's more people than the entire population of my small town growing up. Every winter somebody got an illness in my town. And every winter somebody gets an illness on a cruise ship too. But that doesn't mean everyone on the ship catches it. My sister works as a theatre production manager aboard Royal Caribbean's Brilliance of the Seas. According to her the cruiseline is super-paranoid about noroviruses. So much so that every crew member, no matter what their job, is called out to bleach the hell out of every surface if ever someone on the ship gets sick. And they're confined to their rooms for 72 hours.

So cruise away! Cruises offer great fun, great food, and a wonderful and inexpensive way to see the world.

I had to apologize to three of my emetophobia clients this past week for a photo I posted on my Resource Page of some vomit (no people in the picture). I had found a photo which I thought would be good to put between another photo of vomit and the final photo on Level 8 of two people in a parking garage. Long story short: I posted the phot in HUGE format without realizing it! I had printed it out for my binder in the thumbnail version, and didn't realize the clients were looking at this ginormous zoomed-in view! Anyway, the clients all did extremely well in looking at it and I was very proud of them. But I have indeed made that photo smaller now!

The photo, as well as many others I show clients to have them gradually desensitize to vomit, brings up an interesting topic which is the title of this week's blog. How much of our inability to cope with vomit is anxiety and how much is disgust?

With anxiety, therapists use a standard "SUD" scale of 0-10 which stands for "Subjective Units of Distress." We ask clients (constantly, to the point we're annoying) to "give us a number." But the emotion of disgust is one of those interesting emotions that, at least at higher levels, is tied to anxiety. It's why some people faint if they see somebody with horrible injuries: the anxiety goes too high and all the blood drains from their head. The way I like to describe it is this: "When disgust goes too high, it pulls anxiety up with it."

What does this mean for emetophobics? Well, is the glass half-full or half-empty for you? If you're the half-empty kind of person it means that you will have to learn how to cope with some pretty disgusting stuff in order to get better. Sorry. If you're the half-full sort of person you can look at it this way: the perk of desensitizing your anxiety to vomit is that you also desensitize to disgusting things! So like...you could become a nurse in the end or one of those TV CSI people who examines bones and severed heads and such. (Can you tell which sort of person I am? haha)

If you think you're the kind of person who gets disgusted easily or gets squeamish then it will be an important part of your recovery to desensitize to disgusting things in general. The more you can handle looking at awful things, the less your phobia will be triggered in your everyday life.

For over ten years now I've been a member and moderator of an emetophobia discussion forum. I've probably read posts and corresponded with literally thousands of emetophobes. One thing I've found that the majority have in common is the need for reassurance from others that they won't vomit. On the forum, phobics describe their stomach symptoms and, often in a panic, ask the community for reassurance that they won't vomit. Inevitably the community responds with reassurance that they won't be sick and that they're just anxious.

Children with emetophobia (or any other phobia for that matter) often ask their parent(s) for reassurance that they won't vomit, or won't see a spider, etc. I've talked with some pretty exhausted parents who day in and day out are peppered with questions from their anxious child.

Getting reassurance from someone else brings temporary relief to one's anxiety. But it is temporary, and in the long-run will make your phobia worse. What every emetophobic can benefit from is the knowledge that seeking reassurance is a symptom of anxiety disorders. It's part of the problem, not any sort of solution - temporary or not. It's one way in which emetophobia is related to Obsessive-Compulsive Disorder ("OCD"). The obsessive thought is "what if I'm sick? what if I'm sick?..." or "is it norovirus? is it norovirus?"

In seeking reassurance you may calm down a bit if someone tells you that you're not going to be sick and it's just gas, or just some discomfort, or you're just full, etc. etc. The problem comes in when a) you don't really believe them - because after all, they're not you, and how could they know what your stomach is going to do? and b) them reassuring you that you won't be sick is like them saying that if you were to vomit you would somehow be in some kind of danger or harm's way, when in reality vomiting is not dangerous or harmful at all.

So if you're emetophobic, try to think clearly when you are tempted to ask for reassurance. Practice breathing more slowly and evenly, and relaxing all your muscles from head to toe. Say to yourself, "vomiting is not dangerous or harmful in any way, so I don't need to be afraid of it." If you're the emetophobic's loved one do not give them reassurance. It's tempting to do so because it may calm them down, but it will make their phobia worse in the long run because it's a way of avoiding what they're afraid of. Instead, help your loved one out by helping them to get professional help for their phobia. If you can't afford that, check out the "Resources" page on this website's menu and then click "Self-Help." Meanwhile, calmly say to them something like this: "I don't know if you're sick or not, but I do know that even if you are, you will be ok. Vomiting isn't harmful, it just feels like it is. I will be right here with you, no matter what.