Emetophobia and Social Anxiety Disorder

[Seashell84]

Hi,

I hope you don’t mind me posting this here as although this does affect work, this is only a small part of it. It is also going to take a bit of explaining so I’m sorry about that.

I’m a 30 year old female and I have Emetophobia, both for myself being ill and also with other people being ill. I’ve been like this for as long as I can remember but have only discovered that it is a real phobia and that it actually has a name earlier this year.

It includes all the usual things people with this phobia avoid – travel/staying away from home, social situations involving alcohol, children/family, illness in both people and animals, medications in case of side effects, visiting hospitals/doctors surgeries, sell by dates on food, not touching raw meat, refusing to eat certain food, being overly aware of cars parked at the side of the road and of pavements, not being able to watch TV if someone is sick (even if it’s the fake stuff) as well as numerous other things.

It also means that you are constantly scanning people to see if they look unwell and will panic if someone says they feel ill, which is getting tiring. The same thing can happen even if someone just coughs.

Oddly enough though, I’m not excessive with cleanliness (at least in my own space), don’t show OCD tendencies in relation to food preparation (although I do with checking taps and doors!) and you certainly wouldn’t associate me with being anorexic.

In reading about Emetophobia I also found out about Social Anxiety Disorder. I can quite easily agree with all of the things listed on the NHS website for this disorder except the drugs and alcohol thing because of my emetophobia!

Unfortunately, I think that these two things are working together at the moment. I work from home so don’t get out much, but am scared to go out and do things because of these issues (plus I couldn’t afford to do something like go out to a pub every week which is what people my age seem to want to do). There is definitely an increasing sense of isolation and it’s getting to the stage in my life where I don’t want to be on my own forever but don’t make new friends easily and don’t know how to overcome it.

I don’t know any of the doctor’s at my GP practice as the one GP I’ve seen recently (the first time seeing a doctor since 1997) has now left and I would feel uncomfortable discussing this face to face with someone I haven’t met before, especially as I don’t know if I would be taken seriously or not.

I feel I’m missing out on so much, but that I’ve done this to myself by being ruled by my phobia. Do you have any recommendations for how to overcome this, or where to go from here as I don’t think this can’t go on for much longer without it escalating further?

Sorry for the essay, and thank you for your help.

[Janine Ward]

Hi,

Sounds like you have had some tough times with your anxieties. There is a service across the whole of the uk that can help with most anxiety disorders including social anxiety, OCD and emetaphobia. Visit http://www.iapt.nhs.uk for a list of local services which can be access often through self referral which means you do not need to see a GP at your local practice.

The recommended treatment for most anxiety disorders is cognitive behavioural therapy sometimes with medication but in most mild to moderate cases not. This looks at how we think and behave in situations and how this can reinforce certain feelings we have. For example a person may see someone who is ill and think 'oh dear I better wash my hands as I might get ill', they wash their hands and they feel relived and do not avoid or do anything more to cope with ill people, others may think 'I better wash my hands' wash them, then find themselves thinking but what if I haven't got rid of the germs, what if they are in the air and other such thoughts. This is likely to lead them to behaviours such as washing frequently, avoiding anyone that is ill and carrying antibacterial spray, covering up their face around I'll people and so on. CBT looks to start acknowledging why we do these things and how to start bringing the behaviours back down to a manageable level.

I hope this helps but CBT is evidenced to be the most effective for these disorders so hopefully with the right course of treatment you can start to overcome some of these anxieties!
Good luck and all the best.

[Adam Eason]

Hello Seashell84,

I hope you don’t mind me posting this here as although this does affect work, this is only a small part of it. It is also going to take a bit of explaining so I’m sorry about that.

There is no need at all for any kind of apology. These clinics are designed for you to be able to ask questions - that is why we are here. Your explanation helps us to offer up the most pertinent responses too

I’m a 30 year old female and I have Emetophobia, both for myself being ill and also with other people being ill. I’ve been like this for as long as I can remember but have only discovered that it is a real phobia and that it actually has a name earlier this year.

Let me also assure you that this is fairly common. I have worked with numerous people to help them overcome this fear and there have also been some high profile media stories citing people who have suffered with this phobia. Including a story that was picked up on by many tabloid newspapers about a young lady with emetophobia who cancelled her own wedding due to the fear. (If you'd like a link or reference, do let me know and I'll happily provide one)

It includes all the usual things people with this phobia avoid – travel/staying away from home, social situations involving alcohol, children/family, illness in both people and animals, medications in case of side effects, visiting hospitals/doctors surgeries, sell by dates on food, not touching raw meat, refusing to eat certain food, being overly aware of cars parked at the side of the road and of pavements, not being able to watch TV if someone is sick (even if it’s the fake stuff) as well as numerous other things.

This is very typical behaviour by anyone who has such a phobia.

The problem with such avoidance strategies is that you perpetuate your phobic response and make it stronger the more you continue to avoid such things/places/items etc. Therapists and text books refer to it as 'negative reinforcement' - essentially, every time you avoid something, or 'escape' a situation where you are presented with the stimulus of your fears, you feel better. Thus, you get emotionally rewarded (I realise that sounds perverse) for avoiding and in turn, this reinforces your desire to avoid in the future. It perpetuates the issue.

Learning coping skills to be able to deal with the situations and circumstances that you used to avoid is something I'd suggest. There are numerous books to help you with that, but your GP should be able to help you locate resources and ideally an accredited and experienced professional should you require it.

In reading about Emetophobia I also found out about Social Anxiety Disorder. I can quite easily agree with all of the things listed on the NHS website for this disorder except the drugs and alcohol thing because of my emetophobia!

I'd avoid any form of self-diagnosis. When symptoms and issues are categorised and listed on websites, it is easy for us to spot things that we sympathise with and thus label ourselves as having the same issue. If I visited the NSH website or WebMD, for example and examined the symptoms for ADHD, just about every single person I know could be diagnosed with that condition. It is in our nature to highlight similarities sometimes, especially if you are exploring a phobia and looking for answers.

I don’t know any of the doctor’s at my GP practice as the one GP I’ve seen recently (the first time seeing a doctor since 1997) has now left and I would feel uncomfortable discussing this face to face with someone I haven’t met before, especially as I don’t know if I would be taken seriously or not.

It is your GP's job to treat you seriously and with respect. I'd like to think that you;d be treated accordingly and I strongly advise you to go and have an appointment in order for you to seek out the best direction forward. There are numerous avenues for you to explore and be assured that there are many possible solutions to help you overcome this issue and to start living your life in the manner you wish.

Do also consider having a read of some of my other posts in this clinic (links follow), they may offer you some additional assistance, however, ask away if you have any further questions or send me a message and I can do my best to point you in the direction of further resources.

viewtopic.php?f=690&t=6860&p=19582#p19582

And here

viewtopic.php?f=688&t=6887

And here

viewtopic.php?f=688&t=6859

Most importantly, I hope you find the right way forward for you and that a solution is not too long transpiring.

[Seashell84]

Hi,

Thank you both for your responses, they are very helpful.

It has really got to the point now where I’m aware that I’m avoiding a lot of situations because of this phobia or getting myself worked up about it, but didn’t know what to do about it. There are even a few people who think it’s funny, but I don’t think they realise the extent to which this has become a problem and how much it affects leading a ‘normal’ life, or the fact that it’s everyday as you can’t get away from other people or yourself!

Would treatment for this be likely to include exposure therapy?

Yes, I can see why you would avoid self-diagnosis off the internet and have tried it before (turned out I had Labyrinthitis not what I thought I had )! However, I’ve tried the Social Phobia Inventory (SPIN) questionnaire on two separate occasions and scored over 50 both times. In your experience, does this tend to be an accurate measure of social phobia?

Also, as an example, having to make a phone call feels like it makes my heart rate double and I have to have written down what I’m going to say otherwise I freeze. I will try by best to avoid anything where the focus is on me especially if it is in a group situation and even someone asking me a simple question will make me blush and feel hot which is embarrassing. Even at school my reports were always along the lines of works well but never speaks. I could go on with quite a few other things, but does this sound like social anxiety could be a possibility?

It would be so nice not to have to live with these, or certainly not to the same extent anyway, and I now feel like I have a bit of direction in order to take the first step.

Thank you again for your help.

[Adam Eason]

Hello again,

It has really got to the point now where I’m aware that I’m avoiding a lot of situations because of this phobia or getting myself worked up about it, but didn’t know what to do about it.

Then it sounds like now is a great time to take some measured action.

Would treatment for this be likely to include exposure therapy?

It may well do, and evidence does indicate that exposure interventions are very well suited for the kind of issue you cite here. The process is described and discussed in another thread by Wendy Green here at this clinic, so do have a good read of that.

Please note though, you'll only ever be asked or expected to undergo real-life behavioural exposure once you are fully equipped and have a range of coping skills to deal with those situations. Usually, this means you'll engage in some imaginal rehearsal of the exposure, it may involve systematic desensitisation (imagined exposure to the target situations whilst maintaining a profound level of relaxation), cognitive restructuring (whereby you learn how to communicate effectively with yourself when facing the target situations) as well as even conducting some role-playing of the situation. You'll be equipped with coping skills and strategies for being able to face the old fears in real-life until the symptoms (anxiety, desire to escape etc) abate. Then with repetition, this becomes easier and easier and you learn to behave, think and feel the appropriate responses in those situations.

I’ve tried the Social Phobia Inventory (SPIN) questionnaire on two separate occasions and scored over 50 both times. In your experience, does this tend to be an accurate measure of social phobia?

It is used to help highlight and explore the issue, not just for diagnosis. It also helps establish patterns and informs on how to best deal with social anxiety issues. Please bear in mind, that having sought out such a measuring tool, you are actively looking for anxiety responses and so it can tend to get slanted in a high score fashion.

Sometimes, an anxiety disorder of any kind can begin to generalise into other aspects of life. For example, someone with a fear of dogs, may find that the anxiety of walking in parks in case of meeting a dog, may begin to generalise into becoming a fear of going into any public spaces. Such anxiety can be learned so well that we become predisposed to being inappropriately or unduly anxious in a wide number of aspects of life.

I'd be inclined to suggest again that however well informed you can become by using such measuring tools, discussing it with a medical professional in the first instance and then perhaps exploring further with the aid of someone else is very likely to help you get in control of it.

Individuals can sometimes fall into a trap of making the issue worse by labelling it at all - it can become part of your identity and how you perceive yourself - "the one with social anxiety" and that might make individuals believe they are passive recipients of the disorder, which is not useful. be assured, with the right application, professional support and investment of time and energy, you can make a degree of healthy change happen.

Even at school my reports were always along the lines of works well but never speaks. I could go on with quite a few other things, but does this sound like social anxiety could be a possibility?

Just because things have been a certain way in the past, this does not mean this is an accurate indicator of how things need to be now and in the future. Excessive rumination about reasons, contributing factors and so on, can simply amplify your anxiety. I am not suggesting you ignore these contributing factors, but learning skills and ways of dealing with the fears and looking to overcome them would serve you better initially in my opinion and professional experience.

I now feel like I have a bit of direction in order to take the first step.

That is marvellous to read. Good luck going forward.

[Seashell84]

OK, no more self diagnosis off the internet, promise! Thank you again