Emetophobia: How to help my daughter’s phobia of vomiting?

Parent Question:
My daughter has a phobia of being sick. It is totally consuming her and our lives. She is such a loving girl, but this is all we talk about as she needs constant reassurance she won’t vomit. Please help.

A fear of getting sick or vomiting, also known as emetophobia, is much more common phobia than people might think and can be disabling to the sufferer. As you are discovering, such fears can become a constant concern throughout the day and can affect not just the child, but the whole family who are trying to help.

As parents it is easy to get caught into constantly reassuring the child they are not going to vomit and/or becoming hypervigilant that the child is not exposed to triggers or situations that might activate the phobia. This can be exhausting to everyone.

Exposure therapy
Like most phobias, one of the most successful treatments is cognitive behavioural therapy (CBT) and graded exposure in particular. In graded exposure, your daughter is taught to face her fear in small gradual steps and to learn to reduce her anxiety at each step.

Rather than relying on you for constant reassurance, the goal is to help your daughter learn strategies to “reassure herself” when she faces situations that trigger her phobia.

To do this you might identify with your daughter all the different triggers for her phobia (eg eating certain types of food, sitting down to dinner, watching people eat, thinking of dinner coming up etc). Then you ask her to assign a “fear rating” to each of these triggers and start with tackling the least-fearful one first.

For example, if watching people eat is a low fear trigger you might show her a picture of a person eating and then help her manage the fear as she feels it. She might do this by distraction or relaxation or challenging the thinking or dialogue in her mind ( switching from “I’m going to vomit” to “I can cope” etc).

Be supportive
The key to exposure therapy working is to get your daughter on board to give it a go. People who have specific phobias often think they are a bit crazy or stupid for having these fears, and this self-criticism makes the fears worse rather than better.

Be very empathic when you talk to your daughter and explain to her that lots of people have these phobias but that they can be beaten with hard work and persistence. Introduce the steps of an exposure therapy as a fun game that she can use to gain control.

Once again, it is most important to start with the smallest of steps so your daughter can experience early success which you can build upon together.

Further help
Parents can help their children work through specific CBT techniques and there are many good self-help guides online. Alternatively, you may prefer to get the support of a CBT therapist. You may be able to access a therapist via your local primary care psychology service (referral usually via your GP) and there are many private directories, such as psihq.ie, cbti.ie, iacp.ie, counsellingdirectory.ie and mymind.org/cbt.

John Sharry is founder of the Parents Plus Charity and an adjunct professor at the School of Psychology, University College Dublin. This parenting Q&A was originally published in the Irish Times in November 2021. John writes in the Irish Times Newspaper on Tuesdays. His website is www.solutiontalk.ie.