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

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.

Finally all my schoolwork is completed, resume updated, forms filled out, supervised hours all done, references and transcripts arranged for and criminal records check sent in and back. The whole package has been sent off to the registering body for consideration this October, and God-willing and the creeks don't rise I'll be a registered clinical counsellor before 2012. It takes such a long time! But I have a friend who's about to be licensed as a psychologist in California and she needed to complete 1000 hours of supervision first so I can't complain.

This summer I've been taking it easy with a fair bit of time off to relax and enjoy my garden, Vancouver and the little fishing village I live in called Steveston. I also bought a used bicycle and have taken up riding for exercise. Other than a nasty spill on Thursday and a skinned knee, it's proved to be very beneficial.

One of the things I've been working on in my time off is an update and minor re-organization of the Resources page. Instead of just 8 categories of gradual exposure I now have 10 plus four more in the "miscellaneous" sections. After working with over 30 clients the past year I noticed what was in the wrong order and what was missing. I now have a level called "sentences" which comes in after "words" and before "drawings." I also added a level of pictures of people around toilets - something that many emetophobes have a problem with. In the miscellaneous section is a page about animals, hospitals, a simple picture of a water fountain and a "is it soup" quiz that demonstrates how we assign the property "disgusting" to some things which look exactly like other things that we don't deem disgusting at all.

I haven't finished the "sentences" section yet, and I also hope to add another level soon called "in vivo" which means "in reality" - things that people can gradually begin to do in real life such as not washing hands so much, not disinfecting everything, not throwing out food, etc.

I really hope that the new resource page helps a lot of therapists in treating emetophobia and also understanding it so that as many people as possible can overcome this phobia!  Stay tuned for my fall newsletter!