Vomit Phobia – Fear of Vomiting (Emetophobia)

Posted by in Agoraphobia, Health Anxiety, Obsessive-compulsive disorder (OCD), Panic, Phobias, School Refusal, Social Anxiety Flu season will be quickly upon us and with it comes an unfortunate increase in the likelihood of experiencing fevers, coughs, runny noses, vomiting, and the like. Although no one enjoys being sick, this time of year poses particular challenges for individuals suffering from “vomit phobia”, or emetophobia, the fear of throwing up. The fear of vomiting can affect individuals of all ages. It sometimes emerges in childhood and, if untreated, may follow a relatively chronic course. However, it can also develop well into adulthood, sometimes taking root after a negative health experience (e.g., after getting food poisoning or after experiencing an episode of severe or uncontrolled vomiting). Vomit Phobia in Children and Teens Consequences associated with the fear of throwing up can be extreme. In children, vomit phobia can lead to school refusal and avoidance. Academic performance may suffer, and children may miss out on certain developmentally important social milestones. If a child or teenager is afraid of getting nauseous or throwing up, he or she may avoid birthday parties, sleepovers, dating, and eating out at restaurants. Missing out on these activities can affect relationships and impact social development, which may lead to chronic social impairments. Even when longstanding social problems do not develop, children with vomit phobia still experience a great deal of unhappiness, fear, anxiety, and distress. Fear of Vomiting in Adults Adults with the fear of vomiting may also be significantly impaired by their symptoms. They may have more absences from work and may avoid work-related travel, which can affect opportunities for advancement. They will often dread meetings, during which they may feel trapped and uncomfortable, and may avoid certain job responsibilities like public-speaking or presenting.  This can leave otherwise bright and capable individuals stagnating in jobs that are beneath their true capabilities. Vomit phobia also affects travel for leisure and dining out, and can wreak havoc on romantic relationships. Women with the fear of vomiting may experience extreme distress at the thought of becoming pregnant and experiencing morning sickness. Women with the fear of morning sickness may delay starting families, and some may choose to never have children at all due to the fear of recurrent vomiting during pregnancy. Clearly, this can have profound and lasting effects on one’s life. What is Emetophobia? Emetophobia is defined as an excessive or irrational fear about the act, or possibility, of vomiting. However, this relatively straightforward definition...
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IOCDF Conference, IOP for OCD Program, & Group Therapy for Panic…

Posted by in General, Obsessive-compulsive disorder (OCD), Panic Just a few quick announcements: 1) The 2012 meeting of the International Obsessive-Compulsive Foundation (IOCDF) is just a week away. The IOCDF conference marks the perfect convergence of all things OCD-related. In attendance are some of the best clinicians and researchers in the field.  Many of these individuals will be presenting talks related to OCD diagnosis and treatment. Hundreds of individuals with OCD will also be at the conference, some of whom will be leading workshops and sharing stories of recovery. This year’s roster of presentations looks to be exceptional. If you haven’t registered yet, there’s still time. This year’s meeting will be held in the Windy City: Chicago, Illinois. I’ll be attending–hope to see you there! Also…I may try to be more active on Twitter during the conference.  Feel free to follow me here. 2) I have revamped the description of my Intensive Outpatient Program (IOP) for OCD and have posted an updated summary page on my practice website. This program is not for everyone…but is appropriate for: Local OR out-of-town patients (with any level of OCD symptoms) who wish to complete treatment in the shortest amount of time possible. Individuals who have stubborn symptoms of OCD that have not responded well to traditional outpatient therapy. Individuals with severe symptoms who are seeking an alternative to residential treatment or to psychiatric hospitalization (inpatient treatment). We offer specific programs for adults, kids, and teens.  Click the above link to access the program description. 3) In other news, I’d like to announce that I’ll soon be starting a 6-week, CBT-based group therapy treatment program for panic disorder. This group is designed as an introduction to cognitive behavioral therapy for panic. Although you won’t be panic-free in 6 weeks, you’ll have some of the basic skills and knowledge you’ll need to kickstart your recovery.  Moreover, because this intervention is a  therapy group, you’ll get to work alongside others with similar symptoms. Till next time… Questions? Comments? Will you be at the 2012 IOCDF Conference in Chicago? Sound off...
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Agoraphobia – Symptom Attacks, Triggers, Panic, & Avoidance Behaviors

Posted by in Agoraphobia, Panic Let’s dispel a common misconception about agoraphobia. Agoraphobia is not a fear of the outdoors. Many people mistakenly believe this myth, due to the word’s Latin roots.  Because agoraphobia can be broken down into the roots agora (“marketplace”) and phobia (“fear of”), many people assume that agoraphobia is a “fear of the marketplace” or a fear of being in wide open spaces. What is agoraphobia? However, this literal interpretation is different than what psychologists mean when they use the term agoraphobia. Clinical psychologists, therapists, and psychiatrists conceptualize agoraphobia as a fear of experiencing physical symptom attacks in certain types of situations (Zuercher-White & Pollard, 2003). Symptom attacks include full-blown panic attacks, limited symptom panic attacks (sweating, dizziness, disorientation, difficulty breathing. heart pounding, nausea), diarrhea, other gastrointestinal (GI) issues, vomiting, headaches, and feelings of dissociation, depersonalization, or derealization. Agoraphobia-related Situations The fear of having a physical symptom attack is often strongest in certain types of situations (Zuercher-White & Pollard, 2003), including those in which: Your symptoms might be embarrassing or are likely to be noticed by others. Escape is difficult or impossible. Help is not readily available. Restrooms are inaccessible (or not private). You have little personal control over the environment. Agoraphobia-related Avoidance Behaviors Fear of symptom attacks then contributes to avoidance behaviors and significant changes in one’s daily routine (Zuercher-White & Pollard, 2003). These changes might include: Shopping at odd times (e.g., going to the store after midnight to avoid crowds or getting stuck in a checkout lane). Avoiding concerts, fairs, and other loud, chaotic gatherings. Avoiding lines at stores and theme parks. Avoiding driving (especially on highways and freeways that are prone to traffic/accidents and/or have limited exit ramps). (Note: Sometimes individuals think they have a “fear of driving” but the underlying condition is actually panic or agoraphobia.) Avoiding small social gatherings where others might notice one’s physical symptoms. Avoiding spontaneous, unplanned activities that might seem unpredictable and uncontrollable. Avoiding interactions with authority figures or people whose impressions are important (e.g., bosses, superiors). Avoiding certain foods to prevent GI problems (e.g., not eating spicy foods, Mexican foods, dairy). Avoiding caffeine (coffee, soda) or alcohol because of potential physical symptoms. Avoiding airplanes/flights, trains, roller coasters, subways, buses, boats, taxi cabs, and most forms of public transportation. Avoiding eating unfamiliar foods or in unfamiliar restaurants. Over-planning activities (i.e., planning escape routes, planning excuses to make if one has to leave an activity...
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Panic Attack Causes: Fight-or-Flight & the Sympathetic Nervous System

Posted by in Panic Panic attacks feel awful. However, despite the unpleasantness of panic attacks, we’re actually lucky to have the neural circuitry that drives them. Although it might not feel like it, panic is caused by one of your body’s most important self-protective mechanisms. What causes panic attacks? When we are safe, our bodies are designed to conserve resources in order to promote long-term survival. If all is going well, there is simply no need to squander a precious commodity like energy. However, whenever we are in danger and there is the potential for death or serious harm, our bodies will utilize whatever resources are necessary to guarantee that we live to see another day. Think about a time you unexpectedly encountered a physical threat in your environment. Maybe you were peacefully gardening when you happened upon a snake. Maybe you were out for a stroll when an unfamiliar dog ran up to you with its teeth bared. Maybe you were happily picnicking in Jurassic Park when you suddenly came face-to-face with a velociraptor. What are your options? You essentially have two: Fight – You can go head-to-head with the threat in order to neutralize it. Flight – You can escape the situation by evading the predator. Regardless of which option you choose, the success of your “fight-or-flight” strategy depends on being able to mobilize yourself swiftly. The ability to instantaneously shift into high alert mode in order to deal with an imminent threat is supported by something called the sympathetic nervous system. This system helps promote short-term survival by activating your brain and the other biological systems (e.g., various glands like the adrenal gland) that are necessary for responding to threats. Secretion of chemicals like adrenaline and noradrenaline temporarily give you an energy boost, sharpen your senses, quicken your reaction times, and boost your strength (Barlowe & Craske, 2006). Why do people have panic attacks? Physiologically, what are the symptoms of sympathetic nervous system activation? As your body is gearing up to take action, you are likely to notice rapid heartbeat, rapid breathing, tunnel vision, trembling, sweating, frequent urination, digestive issues (e.g., diarrhea), and pupil dilation. Together, all of these symptoms are designed to work in concert to help you defeat or evade the predator (Barlowe & Craske, 2006). For example, changes in circulation and respiration increase the availability of vital nutrients for your brain and muscles. Sweating makes your body slippery,...
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One Panic Treatment Basic that Even Your Therapist Might not Know

Posted by in Panic If you have panic disorder or suffer from panic attacks, chances are you might be inadvertently doing one simple thing that is making your panic attacks and anxiety worse. You might have even learned this strategy from your therapist.  Although beneficial in many different contexts, when used inappropriately, this technique has the potential to dramatically increase symptoms of anxiety and panic. The technique in question? Deep breathing. What is deep breathing? Deep breathing, or diaphragmatic breathing, is a core coping skill taught by many excellent therapists of diverse theoretical orientations. It is a technique that has a long and revered history in the field of psychology due to its anxiety-reducing (anxiolytic) effects. Used alone or when combined with other strategies, such as visual imagery or progressive muscle relaxation (PMR), deep breathing can be a potent aid to relaxation. It is applicable to a wide range of stressors, requires no equipment aside from what you carry around with you in your head, and can be brought to bear quickly and discretely at work, school, or any other place you might need it. As such, deep breathing is a powerful technique to have in your coping toolkit. In addition to being useful for managing anxiety, proficiency in regulating your diaphragm also increases your vocal control, which helps you sound more confident when speaking. It is this vocal control that gives public speakers and opera singers alike the ability to better regulate vocal tone, exert vocal power when needed, and (in the case of the opera singer) sustain notes over long intervals.  Prior to being formally trained in diaphragmatic breathing (deep breathing), most people have only a limited sensory awareness of how to properly control the diaphragm muscle and regulate their breath. When asked to breathe deeply, most untrained individuals intuitively raise their shoulders in an effort to draw in more air. This strategy actually results in shallow, inefficient breaths because it doesn’t allow the diaphragm to lower properly and create room for lung expansion. For deep breaths, your belly should expand downward and outward (rather than upward and inward).  This is the type of breathing you naturally use when you’re sleeping or lying on your back.  For additional guidance on deep breathing, ask your therapist (or vocal coach!) to teach you the basics; remember, however, that lots of practice is necessary to gain greater breath control. As always, I am available for consultation...
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Although it might feel like you’re dying, you’re not. That’s just what the panic wants you to think.

Posted by in Panic Disclaimer: Because panic attacks can mimic the symptoms of several serious medical conditions, it’s important that you talk with your doctor before beginning any panic treatment program.  Never begin panic treatment without first obtaining medical clearance from your physician. Panic attacks feel horrible. If you are one of the 5% of Americans suffering from recurrent panic attacks due to panic disorder, you are likely well-acquainted with the nasty constellation of physical sensations that occur during a full-blown panic attack.  Panic attack symptoms are frightening and often include accelerated heart rate, sweating, trembling, choking or smothering sensations, chest pain, nausea or GI problems, dizziness, lightheadedness, feelings of unreality or detachment from one’s body, numbness or tingling sensations, chills, and hot flashes (Barlowe & Craske, 2006).  Physical symptoms frequently co-occur with intense worries and fears, such as fear of dying, losing control, or going crazy. One of the primary reasons that panic is so scary is because it often masquerades as something other than itself.  Just ask the closest ER doc, who might tell you that up to 20% of ER visits are panic-related (Julien, 2001).  In many cases, individuals who have panic attacks don’t understand what’s happening to their bodies and misinterpret panic symptoms as symptoms of a heart attack or another serious medical condition.  As a psychologist in Palm Beach, Florida, I work closely with physicians throughout the greater Palm Beach, Fort Lauderdale, and Miami areas to help individuals recover from panic attacks, panic disorder, and generalized anxiety. Individuals with panic often live in fear about when the next attack might occur.  Because these attacks can be unpredictable and may occur “out of the blue,” they often leave the panic sufferer feeling frightened and out-of-control.  As a consequence, many individuals with panic try to anticipate and avoid any situations in which panic  might arise. Although this reaction to panic is understandable, unfortunately, it perpetuates the panic cycle. Panic is maintained and strengthened through safety behaviors and avoidance.  As such, breaking free from panic involves two primary steps: 1) learning to think differently about your symptoms, and 2) adopting behaviors that are incompatible with panic.  These are the two bedrocks of cognitive behavioral therapy (CBT) for panic. Just as is the case for other anxiety disorders, the secret to overcoming panic is based on behavioral exposure exercises.  To overcome your panic, your approach must be multifaceted: 1. Counter your body’s natural impulse to escape.  We are genetically,...
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