Emetophobia

What It Is, Causes, Signs and Symptoms, Diagnosis, and More

Author: Emily Miao, PharmD

Editor: Alyssa Haag

Editor: Józia McGowan, DO

Editor: Kelsey LaFayette, DNP

Illustrator: Jessica Reynolds, MS

Modified: Mar 04, 2025

What is emetophobia?

Emetophobia, a specific type of phobia, is an overwhelming fear of vomiting or seeing other people vomit, which interferes with the individual’s daily life and social activities. People with emetophobia may experience anxiety, panic attacks, and distress when triggers are present. They may avoid foods that may spoil easily and objects or situations due to the fear of vomiting or exposure to someone else who may vomit in these situations. Individuals may also cope with their fears through compulsive behaviors such as excessively washing hands or food items to prevent situations where vomiting may be a possibility (e.g., food poisoning). Emetophobia is a rare condition occurring in approximately 0.1% of the population.

An infographic detailing the background, risk factors, symptoms, diagnosis, and treatment of emetophobia; including an individual vomiting into a toilet.

What causes emetophobia?

The exact underlying causes of emetophobia are poorly understood, but it is thought to be multifactorial, involving a combination of genetic, environmental, and social factors. There may be genetic factors that predispose the individual to develop mental health conditions (e.g., obsessive-compulsive disorder) or specific phobias, like emetophobia. For example, individuals with a known family history of a specific phobia have an increased risk of developing a phobia compared to individuals without a family history. Most individuals develop emetophobia following a traumatic experience related to vomiting such as choking or an illness (e.g., stomach flu). Finally, individuals who identify with cultures where vomiting and illness are stigmatized or seen as a sign of weakness may be more prone to developing a fear of vomiting.

What are the signs and symptoms of emetophobia?

Signs and symptoms of emetophobia may vary between individuals, but the hallmark feature is an intense, debilitating fear of vomiting or seeing another person vomit. Symptoms may include nausea, panic attacks, anxiety, tachycardia (e.g., increased heart rate), dizziness, and diaphoresis (e.g., excessive sweating) when triggers (e.g., items with expiration dates coming up soon) are present. Signs may include avoiding new foods and beverages, restaurants or trigger foods that have caused vomiting in the past, the use of words to describe vomiting (e.g., “barf”), and places where ill people may be (e.g., hospitals, nursing homes). Genetic females may also avoid becoming pregnant due to the fear of morning sickness associated with pregnancy. Individuals may also limit their food intake, throw away food that is close to the expiration date, and overcook food as a way to destroy traces of bacteria. Over time, these behaviors may lead to complications including dehydration, malnutrition, social isolation, and other mental health disorders (e.g., depression, other phobias).

How is emetophobia diagnosed?

Diagnosis of emetophobia begins with a thorough review of symptoms and medical history. A physical exam can help assess signs of dehydration (e.g., poor capillary refill) and malnutrition. The Diagnostic and Statistical Manual of Mental Disorders 5th Edition (DSM-5) criteria for diagnosis of a specific phobia include the following:

(a) Marked fear or anxiety about a specific object or situation (e.g., vomiting)
(b) The fear or anxiety is out of proportion to the actual danger posed by the specific object or situation (e.g., vomiting or seeing another person vomit)
(c) The fear or anxiety causes significant distress that results in impairments of activities of daily living and other important areas of functioning
(d) The disturbance has lasted 6 months or more
(e) The disturbance is not better explained by another medical condition

Since emetophobia is a diagnosis of exclusion, other mental health disorders should be ruled out. For example, avoidant restrictive food intake disorder (ARFID) may present similarly to emetophobia. ARFID is characterized by severe restriction of food intake that is not based on distortion of body image, nor an expressed desire to lose weight. Both disorders may present with weight loss and malnutrition, but the majority of ARFID cases do not specifically include the fear of vomiting.

How is emetophobia treated?

Treatment of emetophobia consists of a combination of psychotherapy, pharmacotherapy, and supportive care measures to address disease-related complications. Psychotherapy options include cognitive behavioral therapy (CBT) and exposure and response prevention (ERP). CBT is a structured, goal-oriented type of talk therapy that helps affected individuals address and manage problematic patterns of thinking. CBT usually requires multiple sessions with a psychotherapist or psychiatrist, who helps the affected individual gain a deeper understanding of the underlying problem and recognize problematic thoughts and behaviors related to identified triggers. ERP is another form of talk therapy in which the individual is gradually exposed to the trigger. During ERP, a therapist creates a safe environment and gradually exposes the individuals to feared objects and situations. Similar to CBT, ERP requires multiple sessions where individuals learn to cope and manage their fear responses.

Pharmacotherapy options include selective serotonin reuptake inhibitors (SSRIs) such as fluoxetine and citalopram, which can be used in conjunction with psychotherapy for individuals with more severe symptoms. Finally, supportive care measures such as fluid hydration and nutrition support may be provided to address nutritional deficiencies, if present. A multidisciplinary team of psychiatrists, nutritionists, and mental health counselors may be helpful to manage and treat emetophobia.

What are the most important facts to know about emetophobia?

Emetophobia, a specific type of phobia, is an overwhelming fear of vomiting or seeing other people vomit which interferes with the individual’s daily life and social activities. For example, individuals may develop aversions to a particular food item and avoid travel or new social situations. The exact underlying causes of emetophobia are poorly understood, but it is thought to be multifactorial, involving a combination of genetic, environmental, and social factors. The diagnosis of emetophobia is confirmed when the DSM-5 criteria are met and symptoms are present for 6 months or more. Treatment of emetophobia consists of a combination of psychotherapy, pharmacotherapy, and supportive care measures to address disease-related complications.

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596

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