Fear Of Vomiting Research Articles

Specific fear of vomiting (SPOV) in early parenthood: assessment and treatment considerations with two illustrative cases

Abstract Specific phobia of vomiting (SPOV) can be a severe and debilitating anxiety disorder and affects women in the childbearing years. The perinatal period and early parenthood is a time of increased risk for the onset or exacerbation of anxiety problems, which can have an impact on both the woman and the developing child. There are particular issues pertinent to the physical experience of pregnancy and tasks of early caregiving that women with SPOV may find difficult or distressing to confront, but these are not well documented. Cognitive behavioural therapy (CBT) focused on exposure to vomit cues and processing distressing early memories of vomiting is an effective treatment for SPOV. This paper describes the successful CBT treatment of two young mothers with SPOV, outlining the challenges faced by parents at this time and the need to take this into account in treatment, using illustrative case material. Key learning aims (1) To understand how specific phobia of vomiting (SPOV) affects women in early parenthood. (2) To know how to target and update traumatic early memories of vomiting with imagery rescripting. (3) To know how to design and carry out effective behavioural experiments for perinatal SPOV. (4) To understand how to take mother, baby, and the mother–infant relationship into account in SPOV treatment.

S1380 Avoidant/Restrictive Food Intake Disorder Characteristics and Prevalence in Adult Celiac Disease Patients

Introduction: Celiac disease (CD) affects 1% of the United States population. Currently, the only treatment for CD is a strict gluten-free diet, but some patients (pts) can develop dysfunctional eating habits including avoidant/restrictive food intake disorder (ARFID). In this study, the objective was to identify the prevalence of ARFID in adult CD pts and assess metabolic complications, disease control, diet adherence and association with symptom and quality-of-life metrics. Methods: This was a retrospective study of 137 biopsy proven adult CD pts who completed an ARFID survey between 2018-2020 within the CD clinic. Demographics, clinical results, standardized diet assessment, and results of Celiac Disease Symptom Diary (CDSD) score and Impact of a Gluten Free Diet Questionnaire (IGFD) were reviewed. Results: Seventy-eight pts (57%) met clinical or subclinical ARFID criteria. Pt demographics are described in Table 1. There was no difference in age, gender, body mass index, micronutrient deficiencies or bone disease in pts with or without ARFID. There was no difference in surveillance duodenal biopsy activity or adherence to a gluten-free diet in pts with or without ARFID. There was slightly higher tissue transglutaminase IgG positivity in ARFID pts, but not in other serologies (2% vs.15%, p=0.007). The top reasons for restrictive eating were fear of gastrointestinal (GI) discomfort including irritable bowel syndrome (IBS) (48%), picky eating (14%), poor appetite (11%), fear of GI discomfort excluding IBS (11%), fear of choking (5%), fear of weight gain (5%), orthorexia (5%), and fear of vomiting (3%). Food and social burden on IGFD questionnaire were most predictive of ARFID (p=0.008 and 0.002, respectively). Conclusion: ARFID is common and has a high impact in CD pts. Although some eating behavior is certainly due to CD, there was no distinct difference in disease control between pts with or without ARFID, suggesting these maladaptive behaviors are not necessary for disease control. There was no increase in metabolic or bone disease complications over 2 years. Better understanding of social and food impacts on pts that score high on the ARFID survey may prevent further deficiencies and impaired, long-term detrimental eating behaviors. The use of a validated tool to screen for ARFID can help identify pts who struggle with this disorder and can guide the physician and a CD trained dietitian in dietary and behavioral management.Table 1.: Characteristics of Adult Celiac Disease Patients With and Without Avoidant/Restrictive Food Intake Disorder (ARFID)

3171 Amoxicillin-Clavulanate Related Mixed Cholestatic-Hepatocellular Injury

INTRODUCTION: Recognition of Drug-induced Liver Injury (DILI) may be challenging as it is often diagnosis of exclusion, unavailability of diagnostic test and variability in presentation. Many antibiotics can cause DILI but Amoxicillin-Clavulanate has rare adverse reaction causing mixed cholestatic-hepatocellular injury. Since amoxicillin alone does not induce liver injury, combination of amoxicillin and clavulanic acid could be responsible for this adverse reaction. It can be due to metabolic idiosyncrasy or hypersensitivity mechanism. CASE DESCRIPTION/METHODS: 64-year-old female with no pertinent PMH presented to ER with abdominal pain and jaundice. She had abdominal pain for 4-5 days. Abdominal pain was constant and located at right upper quandrant and epigastric region. She had associated complaint of nausea, vomiting, metallic taste and chills. Patient had been avoiding eating in fear of vomiting. She also had pale colored stool. Patient did not have any history of gall stones, hepatitis or alcohol use. On further inquiry, she reported being on Amoxicillin-Clavulanate for 4 days, for dental abscess, before onset of symptoms. She stopped taking antibiotic as soon as she started having above-mentioned symptoms. Patient was not on any other new medications during this time-period. On initial evaluation, patient was found to have elevated liver enzymes with T.bilirubin 6.4, AST 218, ALT 288, ALP 331. Due to broad differentials associated with elevated liver enzymes with abdominal pain, further workup was done. Abdominal CT scan and MRCP results were unremarkable. Hepatitis panel was also negative. Patient was provided with supportive care and hydration with IV fluids. Repeat labs done on 4th day after admission showed down trending LFTs – T.bill 3.8, AST 152, ALT 141, ALP 253. DISCUSSION: Amoxicillin-Clavulanate can cause hepatocellular, cholestasis or mix type of liver injuries depending upon genetic factors or pre-existing liver conditions. Early recognition and removal of offending medication is the initial mainstay of treatment along with supportive care. This case signifies proper history taking and review of medications could avoid unnecessary and expensive diagnostic tests for diagnosis. Our case emphasis importance of early recognition of this reversible condition due to Amoxicillin-Clavulanate or other medications to prevent worsening of liver faliure and its complication.

Case Study of Clinical Behavior Analysis for a 20-Year-Old Client With Emetophobia

This case study illustrates a clinical behavior analytic intervention for a female client with emetophobia, the fear of vomiting. Clinical behavior analysis is a recently developing branch of empirically supported psychotherapy, derived from behavior analysis. This case study presents modified case formulations and changed intervention strategies according to the results of repeated measuring. The intervention was six sessions and three gradual follow-up sessions; the effect of the intervention was monitored by a single-case design. The intervention strategies were changed from symptom-focused interventions, which are based on exposure, to value-focused gradual follow-up sessions. The client’s phobia and depression were alleviated through the intervention and gradual follow-up phases. Moreover, her value-based activities increased through the gradual follow-up phase. The Reliable Change Indexes (RCIs) were calculated to evaluate changes between the intervention and follow-up phases. There were large and clinically significant decreases on measures. The results highlight the utility of repeated measuring and importance of a value-focused approach.

A Transdiagnostic Approach to the Treatment of Emetophobia: A Single Case Study

The fear of vomiting (i.e., Emetophobia) causes substantial distress for affected individuals, and is associated with hypervigilance to somatic sensations, panic attacks, and behavioral avoidance. Interventions for Emetophobia have traditionally relied heavily on exposure to vomit, vomiting, and vomit-related cues, providing some challenges in identifying appropriate graded exposures for Emetophobia due to medical and hygiene concerns. Recent efforts have been made to treat psychopathology transdiagnostically; however, very few efforts have been made to reduce Emetophobia symptoms in such a fashion, without the explicit use of vomit-related exposures. The current case study describes the cognitive-behavioral, transdiagnostic treatment approach utilized to treat a young woman with Emetophobia. We report significant symptom reduction at the end of therapy, as well as at a 7-month follow-up. The current study provides further evidence that emetophobia can be effectively resolved utilizing transdiagnostic strategies and without direct exposure to vomit or vomit-like stimuli.

Transdiagnostic Approach to Food Avoidance After Bariatric Surgery: A Case Study

This study describes treatment of an adult woman, referred to as “Carla,” who was referred for psychological intervention following bariatric surgery due to recurrent nausea and vomiting along with food avoidance. Carla evinced symptoms including dietary range restriction, failure to progress to recommended caloric intake, fear of vomiting, and body dissatisfaction. She was diagnosed with generalized anxiety disorder, along with comorbidities including dysthymia, body dysmorphia, and subsyndromal specific phobia of vomiting (SPOV). Treatment included 20 weekly sessions utilizing a transdiagnostic approach to treatment, which has been shown to be efficacious in management of multiple comorbidities. The limited body of research and results of this case suggest expansion of the criteria for avoidant restrictive food intake disorder (ARFID) to allow for inclusion of this constellation of symptoms within bariatric patients.

189 Emetophobia: The Specific Phobia of Vomiting: 2 Case Studies With 1-Year Follow-up

AbstractEDUCATIONAL OBJECTIVESAt the conclusion of the session, the participant should be able: 1) To recognize emetophobia & how it can lead to significant impairment & reduce quality of life; 2) To appreciate the prevalence of emetophobia among the general population, 3) To learn that the selective serotonin reuptake inhibitor sertraline can be effective for emetophobia; 4)Need for more research.INTRODUCTIONEmetophobia is an intense, irrational fear of vomiting. The prevalence rate of emetophobia in a community sample has been estimated to 8.8 % with a female to male ratio 4:1: It can occur at any age and can have a chronic course affecting one’s academic/career, family, and social life.METHODSCase 1: B. was a 7 year old female referred by her pediatrician for psychiatric evaluation for her intense fear ofvomiting. Mother shared that B’s overwhelming fear of vomiting started when she was 6 years old and it may have stemmed from an incident when one of B’s cousins threw up inside their van. At school, B constantly monitored whether or not anybody was getting sick around her. If she found out, someone was sick she began screaming and crying. B’s academic performance was negatively affected due to her intense irrational fear.Case 2: P was a 12 year male patient referred by his pediatrician for psychiatric evaluation after receiving 4 days inpatient treatment on the pediatric unit for dehydration. Patient reported that he was afraid of vomiting and gradually stopped eating and drinking & became so dehydrated that he was hospitalized. Several months prior to his hospitalization he had suffered from theflu & during that time he had intense vomiting and since then he has been fearful of a recurrence of the vomiting.After a complete psychiatric evaluation, a diagnosis of emetophobia was established for each patient. Both patients were treated with sertraline.RESULTSB and P both started with initial dose of sertraline 12.5mg daily and then increased gradually over a period of next few months. They responded well with sertraline. B and P continued sertraline 50mg daily and 25mg daily as a maintenance treatment respectively. At 1 year follow up visit both of them were symptoms free.CONCLUSIONSEmetophobia is a common and chronic debilitating mental illness. Still there are no treatment protocols and randomized controlled trials for the treatment of emetophobia. CBT/Exposure-based therapies are the most commonly used approaches for emetophobia per literature. More studies are needed for a better understanding of eremophobia, which is relatively deserted illness although it can cause as much suffering as other major psychiatric disorders do and any patient presenting with these symptoms deserve to be evaluated an managed with scientific understanding and guideline.Funding AcknowledgementsNo funding.

Examination of the Phenomenology and Clinical Correlates of Emetophobia in a Sample of Salvadorian Youths.

Emetophobia is an under-researched disorder characterized by a specific fear of vomiting. There is a paucity of research on this impairing condition, with extant examinations being largely limited to adult samples and online communities. The present study examined the incidence, phenomenology, and correlates of emetophobia in 305 Salvadorian youths. Caregivers completed a battery of questionnaires regarding the youth's symptoms of emetophobia, internalizing/externalizing symptoms, health anxiety, and obsessive-compulsive symptoms. Approximately 7.5% of the sample was elevated on emetophobia symptoms, and higher levels of emetophobia symptoms were correlated with higher levels of internalizing, externalizing, health anxiety, and obsessive-compulsive symptoms, and lower levels of adaptive functioning. Youths meeting the cutoff for elevated emetophobia symptoms versus those who did not demonstrated significantly higher levels of externalizing behaviors, as well as general obsessive-compulsive symptoms, especially doubting/checking and neutralizing behaviors. These findings are hoped to help improve the conceptualization and treatment of this poorly understood disorder.

Syndrome d’hyperémèse cannabique : revue de la littérature

Cannabis is the most widely used illicit drug in the world. In France, cannabis use has been increasing among youth since 2011, in both experimental use and regular consumption. A distinct syndrome, characterized by recurrent vomiting associated with abdominal pain and compulsive bathing, has been increasingly recognized in adult chronic users. Cannabinoid hyperemesis syndrome (CHS) is still underdiagnosed in adults and even more so among adolescents. Classically, CHS progresses into three distinct phases: prodromal, hyperemetic, and recovery. During the prodromal phase, the patient develops early morning nausea, a fear of vomiting, and abdominal discomfort. Afterward, the hyperemetic phase consists of incapacitating nausea and profuse vomiting. Most patients complain of mild abdominal pain and weight loss. Patients are relieved by taking hot showers. The recovery stage begins with cessation of cannabis use. The majority of patients will develop this symptom within 1-5years after the beginning of consumption. CHS is a clinical diagnosis and should be considered in every case of cyclical vomiting. To date, the specific etiology of CHS is unknown as is the pathophysiology of improvement with hot baths. All youth presenting with cyclic vomiting should be questioned about cannabis use and compulsive hot bathing. The early recognition of this syndrome will save unnecessary and invasive investigations.

Exploring avoidant/restrictive food intake disorder in eating disordered patients: A descriptive study

To assess and compare clinical characteristics of patients with avoidant/restrictive food intake disorder (ARFID) to those with anorexia nervosa (AN). A retrospective review of adolescent eating disorder (ED) patients assessed between 2000 and 2011 that qualified for a diagnosis of ARFID was completed. A matched AN sample was used to compare characteristics between groups. Two hundred and five patients met inclusion criteria and were reviewed in detail. Of these, 34 (5%) patients met criteria for ARFID. A matched sample of 36 patients with AN was used to draw comparisons. Patients with ARFID were younger than those with AN, more likely to present before age 12, and more likely to be male. Patients in both groups presented at low weights. Common eating-specific behaviors and symptoms in the ARFID group included food avoidance, loss of appetite, abdominal pain, and fear of vomiting. Rates of comorbid psychiatric diagnoses and medical morbidity were high in both groups. Almost 80% of AN patients and one-third of ARFID patients required hospital admission as a result of medical instability. Symptom profiles in 4/34 ARFID patients resulted in eventual reclassification to AN. This study supports the notion that a small percentage of adolescent patients presenting with restrictive eating disorders meet criteria for ARFID. Patients are younger than average, more likely to be male compared to adolescent AN samples, and have high rates of psychiatric and medical morbidity. The study also suggests that a proportion of patients evolve into AN as treatment progresses.

Brief, Intensive Behavioral Treatment of Food Refusal Secondary to Emetophobia

Emetophobia, a fear of vomiting, has been reported in both adults and children but is not well documented. This study describes the treatment of an 8-year-old girl who developed emetophobia and food refusal after an acute illness. The intervention consisted of an exposure-based treatment conducted over 7 days at a feeding program. The girl was discharged consuming all of her nutrition by mouth, and her gastrostomy tube feedings were eliminated.

Index of Suspicion

A 14-year-old girl has experienced vomiting, abdominal pain, and weight loss over the past 11 months. The symptoms initially were associated with consumption of dairy products, and a switch to soy-based products led to temporary improvement. However, she continues to have nonbloody, nonbilious vomiting. She has restricted her intake for fear of vomiting. Four months earlier, an evaluation that included abdominal and pelvic ultrasonography and head CT scan was performed by a gastroenterologist and yielded normal results. Trials of prochlorperazine, metoclopramide, and proton pump inhibitor were unsuccessful. She denies diarrhea, headache, fevers, chills, dysuria, dysmenorrhea, binging, purging, and dieting as well as the use of laxatives, diuretics, tobacco, alcohol, or drugs. She reports regular menstrual periods monthly. Past medical history is significant for two episodes of urinary tract infections. Family history is noncontributory. She lives with her parents and siblings. She is in the ninth grade, has a grade point average of 4.0, and remains active in dance. She denies body dissatisfaction or pressure to lose weight. On physical examination, the girl's body mass index (BMI) is 17.3 kg/m2 (10th to 25th percentile for age), temperature is 35.6°C, and heart rate is 44 beats/min. She looks tired but is not in acute distress. Cardiovascular examination reveals bradycardia. Abdominal examination findings are unremarkable. She is admitted to the hospital for bradycardia and malnutrition. Results of CBC, serum electrolyte panel, and liver and thyroid function tests are normal. An additional study reveals the cause of her vomiting. A previously healthy 9-year-old boy returns with worsening right hip pain, limp, and inability to bear weight. He was hospitalized for similar symptoms 1 week ago. He denies cough, abdominal pain, back pain, recent illnesses, or trauma. During his hospitalization, laboratory evaluation showed an ESR of 17 mm/hr, a WBC count of 10.9×103 …

Chronic Cannabis Abuse Puts You in Hot Water

Purpose: A 36 yr old women presented to the hospital reporting chronic nausea and vomiting. She reported episodes of severe nausea and vomiting lasting for few weeks at a time associated with abdominal pain and intervening periods of relative quiescence. She had underwent an extensive evaluation including routine blood tests, EGD, CT scans of head, chest abdomen and pelvis which were unremarkable. SBFT, Metabolic and endocrine work up was negative. Urine drug screen on multiple occasions was positive for cananbis. On follow up in the clinic she revealed that sitting in the hot water is the only way to get relief from her symptoms. She reported that at times she sleeps in the water tub. On review of the literature it became apparent that chronic cannabis use can present in such a fashion. On confrontation she reported that she smokes cannabis for the last 15 yrs. She also reported that during her last pregnancy and 6 months post partum when she refrained from cannabis she felt better and did not have symptoms. Her current symptoms worsened after her relapse. She agreed on abstinence from cannanbis and is scheduled for close follow up. Discussion: Cannabis is widely known to have anti-emetic properties. Tetrahydrocannabinol is the major ingredient in marijuana. Cannabinoid hyperemesis is a paradoxical reaction which occurs with long term cannabis use resulting in severe nausea and vomiting. It includes a cluster of symptoms characterized by cyclical vomiting and compulsive bathing behaviours. In Southern Australia, Roche et al. found that cases previously termed as psychogenic vomiting are often related to chronic cannabis use. It was observed that cessation of cannabis leads to cessation of cyclical vomiting illness and reuse would result in a relapse of symptoms weeks or months later. The etiology of cannabinoid hyperemesis is not known. The various stages of the illness as discribed by Allen et al., are the prodromal phase which is characterized by early morning nausea and vomiting on one or more days of the week with fear of vomiting and severe nausea at the smell of food. In the later phase of the illness, symptoms are relatively stereotyped with profuse vomiting, intense sweating, colicky abdominal pain accompanied by polydipsia. Patients develop a compulsive bathing behaviour and take multiple hot showers or as in our case sit in a tub filled with hot water for prolonged periods of time. Management during the active phase of illness is supportive. Cessation of cannabis lead to cessation of symptoms. The diagnosis can be made with the aid of an inexpensive consented drug screen. This entity should be included as an important differential diagnosis for unexplained vomiting in communities with high prevalence of cannabis use.

Predictors of Prenatal Multivitamin Adherence in Pregnant Women

There is no study available that has investigated determinants of prenatal multivitamin adherence among pregnant women, based on gastrointestinal (GI) adverse events. The objective of this study was to identify determinants predicting adherence to prenatal multivitamins in pregnant women who were randomized to take 2 different supplements. The authors recruited and interviewed 70 women on the importance of various factors that may have affected adherence to previous and assigned multivitamins. The different factors included GI symptoms and swallowing difficulty. The authors used a 5-point scale to measure degree of importance. The highest scoring factors for not taking or discontinuing any previous multivitamins were fear of or experience of nausea, vomiting, and gagging. For women who never took the assigned prenatal multivitamins, the highest scoring factors contributing to that decision were fear of nausea, fear of vomiting, and health care provider advice. For women who started taking the assigned supplements, the most important factors affecting adherence were dosing regimen, health care provider advice, and mode of product distribution. Adherence to assigned prenatal multivitamins significantly correlated only with the importance of constipation in deciding to discontinue any previous multivitamins. It is concluded that predictors of adherence to recommended prenatal multivitamins during pregnancy are rooted in women's prior experiences with multivitamin use.

Cognitive-Behavioral Treatment of Emetophobia: The Role of Interoceptive Exposure

Emetophobia, or the fear of vomiting, is among the least studied phobias. The literature on the etiology, symptomatology, and treatment of this problem is just beginning to develop. Research to date suggests that for many people with emetophobia, anxiety is triggered by both external and internal factors, but to date only one English-language report describes an intervention that directly targets both external and internal triggers. This paper presents a case in which a cognitive-behavioral treatment (including education about the origin and implications of physical symptoms of anxiety, graduated exposure to feared situations, interoceptive exposure, and cognitive restructuring) was used successfully in the treatment of emetophobia.

Scared to lose control? General and health locus of control in females with a phobia of vomiting

The term emetophobia (i.e., a fear of vomiting) exists as rather an elusive predicament, often eluding conventional treatment. The present study involved 149 participants, consisting of 51 emetophobics, 48 phobic controls (i.e. those who suffered from a different phobia), and 50 nonphobic controls. Participants were administered the Rotter (1966) Locus of Control Scale and the Health Locus of Control Scale by B.S. Wallston, Wallston, Kaplan, and Maides (1976). Significant differences were found among the three groups; specifically, that emetophobics had a significantly higher internal Locus of Control Scale score with regard to both general and health-related issues than did the two control groups. It is suggested that vomiting phobics may have a fear of losing control, and that their vomiting phobia is reflective of this alternative, underlying problem. More research is required to explore the association between emetophobia and issues surrounding control; however, the current study suggests that it may be helpful for therapists to consider this aspect when treating a patient with vomiting phobia.

An internet-based study on the relation between disgust sensitivity and emetophobia

In the etiology of disgust-relevant psychopathology, such as emetophobia (fear of vomiting), two factors may be important: disgust propensity, i.e., how quickly the individual experiences disgust, and disgust sensitivity, i.e., how negatively does the individual evaluate this disgust experience [van Overveld, W. J. M., de Jong, P. J., Peters, M. L., Cavanagh, K., & Davey, G. C. L. (2006). Disgust propensity and disgust sensitivity: separate constructs that are differentially related to specific fears. Personality and Individual Differences, 41, 1241–1252]. Hence, the current study examines whether emetophobic participants display elevated levels of disgust propensity and sensitivity, and whether these factors are differentially related to emetophobia. A group of emetophobic members of a Dutch website on emetophobia ( n = 172), and a control group ( n = 39) completed an internet survey containing the Emetophobia Questionnaire, Disgust Propensity and Sensitivity Scale-Revised, Disgust Scale, and Disgust Questionnaire. Results showed that the emetophobic group displayed significantly elevated levels of both disgust propensity and disgust sensitivity compared to the control group. Most importantly, disgust sensitivity consistently was the best predictor of emetophobic complaints.

Cognitive-Behavioral Treatment of Generalized Anxiety

This case report describes cognitive-behavioral treatment (CBT) with a 7-year-old girl diagnosed with generalized anxiety disorder (GAD) and specific phobia (fear of vomiting). Developmental history was significant for excessive worry, pervasive anxiety, and complaints of stomach discomfort. Her fear of vomiting had resulted in eating inhibition and weight loss. Treatment focused on teaching behavioral skills to reduce anxiety (distraction, relaxation), correcting misattributions about physiological sensations, reducing anxiety-inducing self-statements, and eliminating reinforcement of somatic symptoms in the family system. Self-report on the State-Trait Anxiety Inventory for Children (STAIC) before and following CBT documented clinically significant changes in anxiety. At termination, the client no longer met diagnostic criteria for GAD or specific phobia. Over the course of treatment, complaints of stomachaches were significantly reduced, and the client demonstrated weight gain. A 5-month posttreatment evaluation revealed that clinical improvement was maintained.

Reconceptualizing emetophobia: A cognitive–behavioral formulation and research agenda

Fear of vomiting (emetophobia) is a poorly understood anxiety disorder, with little research published into its conceptualization or treatment. The current article uses established cognitive and behavioral models of other anxiety disorders as a basis from which to propose a detailed model of emetophobia. The model proposes that emetophobia results from a constellation of factors including a general anxiety-vulnerability factor, a tendency to somatize anxiety as gastrointestinal distress, a tendency to catastrophically misappraise nausea and other gastrointestinal symptoms, hypervigilance to gastrointestinal cues, beliefs about the unacceptability of vomiting, negatively reinforced avoidance behavior, and selective confirmation biases. A formulation-based treatment package for emetophobia is outlined, including arousal management skills, distraction/attention training, exposure and cognitive restructuring.

Emetophobia: preliminary results of an internet survey.

Through electronic mail, we surveyed members of an internet support group for emetophobia (fear of vomiting). Respondents were 50 women and 6 men with a mean age of 31 years. Results suggest that, for this sample, emetophobia is a disorder of early onset and chronic course, with highly persistent and intrusive symptoms. Emetophobia is implicated in social, home-marital, and occupational impairment and it causes significant constriction of leisure activities. Nearly half of women avoided or delayed becoming pregnant. About three quarters of respondents have eating rituals or significantly limit the foods they eat. Respondents describe other problems such as depression, panic attacks, social anxiety, compulsions, and frequent history of childhood separation anxiety.