If you asked me what I'd eaten today, I might well reply, "nothing." I'm not on a diet, but I suppose it would be fair to say that I'm starving myself.
Self-imposed starvation is most commonly attributed to anorexia nervosa; I haven’t been diagnosed with anorexia and am not preoccupied by my weight, which is actually of a pretty healthy size. But I am obsessed with food, or rather, the dangers it presents. I have emetophobia, an intense fear of vomiting. This phobia has ruled my thoughts and my life for the best part of a decade.
Millions of people are thought to suffer from emetophobia, yet very little is known about the condition: vomiting just isn’t a sexy area of research.
Dr David Veale, a consultant psychiatrist in cognitive behaviour therapy at the South London and Maudsley NHS Trust and the Priory Hospital in north London, is one of the UK’s only experts on emetophobia. “Sometimes I ask patients, ‘If I gave you the choice of either vomiting now or taking this pill that makes you die painlessly, what would you choose?’ They frequently choose to die rather than vomit. This is an indication of the perceived awfulness of vomiting,” Dr Veale says.
For female sufferers, the phobia can be so debilitating that they may delay pregnancy or forgo having children altogether due to their anxiety surrounding morning sickness or their ability to care for a sick child.
A lot of emetophobes are particularly terrified of vomiting in public – many cite a fear of losing control and of others finding them repulsive. Sufferers are also usually afraid of witnessing other people vomit, often because they fear they may catch something. Many interpret feelings of nausea as inevitable precursors to endless vomiting, insanity and death. It sounds irrational, granted, but phobias, by their very nature, are irrational.
Emetophobia differs from other phobias, though, in that it leaves sufferers terrified of their own bodies; you can’t escape it – you are afraid of yourself.
Like most phobias, the fear of vomiting can often be traced back to early childhood. Typically, there will have been a traumatic experience in which vomit was involved, which will have triggered a child’s subconscious into attaching negative feelings and emotions to being sick, explains Amber Ford of Anxiety UK, which supports people living with anxiety disorders. “As the child grows up, instead of their rational, conscious mind overriding this response, the difficulty in accessing the subconscious can mean that such adverse reactions can persist,” she says.
I can count on one hand the number of times I vomited between the ages of four and 21. Whenever a poorly friend reported that they’d spent a night on their knees worshipping at the porcelain altar, it would occur to me that this was a process completely alien to me.
Then, one morning in 2007, after too much alcohol or a dodgy dinner, I found myself getting up close and personal with my toilet’s U-bend. Throwing up wasn’t so bad when it happened, I decided.
A week later, the waves of nausea hit me again, but this time it was unimaginably worse. My temperature had been flitting about for most of the day and then came the heart palpitations. Eventually, I keeled over in my hallway, struggling to breathe; I was certain I was dying.
I didn’t vomit that night, but I later found out that I had experienced my first panic attack. Many more such attacks followed, and a breakdown ensued. It’s astonishing how quickly your life can unravel. I didn’t complete my third year at university – my jam-packed schedule of crying, shaking and rocking back and forth in the foetal position didn’t really allow for additional pursuits such as studying or turning up for exams.
I did manage to alight upon a new hobby, however: washing my hands. Emetophobia routinely leads to a fear of germs and a compulsion to clean and wash. I began scrubbing my hands vigorously at every opportunity, wincing as I plunged them into scalding hot water, the pain a small price to pay for being able to chalk up another victory in my newly declared War on Germs.
Previously innocuous objects activated a never-ending catalogue of code-red situations. When the threat of contamination lurks on every door handle, it can be hard to switch off; I didn’t sleep much. My body felt awash with adrenaline and I experienced constant nausea.
Perhaps unsurprisingly, I stopped eating. What doesn’t go down, can’t come up, I reasoned. I lost a lot of weight, fast, but I didn’t notice until my jeans kept falling down in public. A heavily restricted diet is a near-universal trait among emetophobes. Sufferers can become very underweight and are often misdiagnosed with anorexia.
The relentless onslaught of intrusive thoughts and ritualistic behaviour experienced by emetophobes means the fear of being sick is often camouflaged by the OCD that sufferers commonly present with. There is a significant overlap between the two conditions. The emetophobe and the obsessive-compulsive may both adhere to stringent sets of rules when it comes to cleaning and eating, and compulsively seek reassurance from others to calm their anxiety. Doctors readily diagnose the OCD, but often fail to identify the underlying problem – the emetophobia – usually because they have never heard of it.
Learning to relinquish control is key in overcoming emetophobia, according to Dr Veale. The benefits of cognitive behaviour therapy (CBT) in treating other phobias are well documented, he says, and CBT can be tailored to treat emetophobia. His method of treatment involves challenging rituals or “safety-seeking behaviours” and gradually shifting the patient’s focus from the avoidance of vomiting to learning to accept that they may vomit one day and preparing themselves accordingly.
Dr Veale emphasises that there is no “miracle cure” for emetophobia, but believes that with the correct treatment, the degree of distress and preoccupation with vomiting can significantly decrease over time.
My recovery has been a long process; it is still ongoing. But I have come a long way. Following my breakdown, a doctor referred me to a private therapist, who gave me hope that I might be able to regain some semblance of a life and, armed with my two closest allies, Dettol and Carex, gradually I began to do so.
I returned to university and completed my degree. My marks wouldn’t stand out as shockingly brilliant or shockingly poor, but I was so proud. My illness had taken so much of me, I seemed to disappear into it completely, but I refused to let it swallow me up.
I slowly identified a list of “safe” foods I could allow myself to eat. This started out as oatcakes and bottled water. Now the list is more extensive and, to look at me, I wouldn’t appear to have a problem with food.
More often than not, I have a good day now, meaning that I eat at least one meal and a few snacks, but there are bad days, like today, when I fast. I continue to see a therapist, though, and have learned to ways to manage my anxiety.
And there are silver linings. I’ve realised that my experiences have made me a kinder person. They have taught me compassion, and made me instinctively accepting and supportive of others living with their own mental illnesses.
I know how fragile the human mind can be; we may feel robust, but life can take unusual twists and turns. I also know that a life can be rebuilt with stronger foundations than before. My illness has taught me empathy, humility, courage, determination. Recently I have begun entertaining the possibility that the future might be OK – good, even.
If you asked me what I had eaten today, I might well reply, “nothing.” But I hope that, every day, I’d be a little less likely to.
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