Emetophobia and Pregnancy Can Feel Impossible

Last month, I was sitting in my sister’s living room when she announced that one of her kids wasn’t feeling well, and needed to come home from school early. Even though she didn’t specify the illness, my mind immediately jumped to what could be wrong. To me, “not feeling well” is always code for something beyond the common cold or a mild fever. He must have a stomach bug, I thought.

At that moment, the shiplap ceilings in her house started to close in on me. My sister confirmed that her 7-year-old appeared to have norovirus—a virus that causes vomiting and diarrhea. (According to her mommy group chat, it was circulating within his second-grade classroom.) “I didn’t want to tell you,” she admitted, fully aware of my response being oh-so predictable. And by predictable, I mean the kind of reaction that someone who fears flying might get before takeoff: sweating, panic, a tad bit of nausea. The reaction I was having right that second. It’s unpleasant and unbearable, reaching the point of hysteria.

Only in recent years have I learned that my anxiety-filled response in situations like this has a name: emetophobia.

What is emetophobia?

“Emetophobia is the fear of vomiting. Some fear vomiting themselves, and some fear being around others who may vomit—or both,” says Amanda Petrik-Gardner, LPC, a therapist who specializes in obsessive-compulsive disorder (OCD) and phobias. Petrik-Gardner says emetophobia is a chronic and debilitating condition where people end up avoiding situations or activities that might increase the risk of vomiting—like going on a boat or roller coaster ride—or even refusing to take a medicine that might be uneasy on the stomach.

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Petrik-Gardner says that emetophobia can lead to excessive compulsions to help cope with a person’s anxiety surrounding vomiting. This might look like checking sensations (such as constantly self-assessing for signs of nausea or stomach issues), reassurance seeking (“Am I going to throw up?”; “Does this milk smell off?”; “Will I get sick?”), and carrying meds or other items around “just in case,” she says.

I’m genuinely terrified of vomit. It doesn’t matter what’s causing it, whether that’s food poisoning, motion sickness, migraine headaches, or just plain nausea. All of those scenarios can send me into a tailspin of fear.

All of these symptoms really fit my experience to a T. (In elementary school, I was the kid pitching the idea of bringing a personal trash can to class—just in case.) I’m genuinely terrified of vomit, whether it’s my own or someone else’s. It doesn’t matter what’s causing it, whether that’s food poisoning, motion sickness, migraine headaches, or just plain nausea. All of those scenarios—and their upchuck potential—can send me into a tailspin of fear and all-or-nothing thinking. (For example: “Oh, they must be vomiting because of an illness, and that will also result in me vomiting.”)

Emetophobia can be debilitating, and severely limiting on one’s life. Unfortunately, not many people quite “get” it. Although an estimated 7 percent of women and 3 percent of men¹ have it, it’s still super under-researched and not quite understood in the medical world. And in my experience, plenty of people outside the doctor’s office write it off as being trivial or easy to overcome. I remember middle school boys in my class pretending to gag, attempting to elicit a reaction from me when they found out about my phobia.

According to Jaclyn Alper, LPC, emetophobia (and the anxiety it creates) has quite a bit to do with a lack of control. Vomiting is an involuntary act, and when people with emetophobia feel nauseated, we often worry if it will escalate to vomiting. This fear can lead to various coping mechanisms as the worrier attempts to maintain a false sense of control and prevent themselves from getting sick, Alper says. Think: avoiding a new restaurant to prevent potential illness from unfamiliar food, or refraining from bars or venues serving alcohol due to an intense fear of vomiting.

When fears collide with parenting dreams

I finally understood how far avoidance behavior could go when I watched my sister raise four beautiful children—intelligent, strong, beautiful little vectors riddled with grade school illnesses. “How are you going to have children one day?” my sister would ask, seeing me panic over her 3-year-old with a stomach ache. (A 3-year-old with a stomach ache…because he ate too many fruit snack packs.)

I’d always wanted to be a parent. But the very idea of having a child would instantly switch to the very vivid and intrusive thought of them being sick. I’d be the chaperone on my daughter’s field trip to the museum in one. In the other, she’d be standing next to my bed, waking me in the middle of the night, telling me she’d just thrown up. It was enough for me to stop before I even could get started. I had to admit that my sister had a point: How do I plan on having kids?

It’s a question that Lauren Cook, PsyD, licensed clinical psychologist and author of Generation Anxiety: A Millennial and Gen Z Guide to Staying Afloat During Uncertain Times, once asked herself, too. “I almost let my anxiety decide for me to go childless,” she says. Dr. Cook, who also has emetophobia, says that navigating emetophobia and pregnancy (hello, morning sickness!) only to then raise a child who inevitably pukes, was initially enough for her never to have them at all. “And that’s just the vomiting part! What about how a baby would impact my career that I’ve worked so hard for, my finances, my marriage?” she says.

Dr. Cook says that parenthood is often viewed as making life even more uncertain. “When we struggle for stability in such an unpredictable world, throwing in the ultimate lack of control with parenthood seemed almost ludicrous.” For some people with emetophobia, who already struggle with uncertainty, the thought of being a parent isn’t just challenging or overwhelming. It feels downright impossible, almost as impossible as not checking for a close trash can or a bathroom in case of impending sickness. Impossible enough to make someone stop their parenting journey² before it even starts.

This feeling rings true for Christina*, a 25-year-old LA-based copy editor. “For as long as I have cognizant memory, I have been dealing with emetophobia,” she says. Her fear of vomiting was so severe so early on that by the age of 4 or 5, she didn’t want to be around people or leave the house because she was so afraid of being sick.As she grew older and became an adult, she struggled to reconcile her desire to have children with her emetophobia. She told her husband about her condition when she married. “I was like, ‘Hey, here’s this thing I’m dealing with.’”

Finding a path forward to parenthood

When Christina and her husband were suddenly expecting their son just months later, he offered unwavering support. He understood that her anxiety could intensify due to morning sickness, the possibility of nausea during delivery, or the prospect of caring for an unwell child in the days to come. Having a supportive partner soothed her anxiety, says Christina, as well as doing Inference-based Cognitive Behavioral Therapy (a specific form of CBT designed to help treat obsessions, phobias, and OCD). “While I wasn’t fully prepared for the pregnancy, I recognized that these measures would support me during the postpartum period,” she says.

While a supportive and understanding partner is important, especially when having kids, Petrik-Gardner notes that therapy can be equally as important when emetophobia has overwhelmed one’s life. “Some clinicians are using Cognitive Behavioral Therapy (CBT), an evidence-based treatment for emetophobia. In this treatment, they explore the faulty reasoning process that causes the client to become absorbed into this obsessional story about how they are vomiting, even though it is not actually happening,” she says.

Clinicians may also try Exposure and Response Prevention (ERP) behavioral therapy, which is designed to slowly introduce people to situations designed to provoke their obsessions in a safe environment. In sessions, a therapist will help patients address the fear of throwing up by gradually exposing them to anxiety-provoking stimuli (like thoughts or images related to vomiting), while teaching coping mechanisms that will, in turn, reduce avoidance behaviors. This is the most evidence-based when it comes to treating phobias, panic attacks, social anxiety, and OCD³.

“I saw through exposure that I can endure discomfort, that vomiting—though not fun—is a temporary and survivable state, and I do not need to let my fear dictate my decisions for me.” —Lauren Cook, PsyD, licensed clinical psychologist

Dr. Cook says ERP was especially effective in helping with her decision to have children, because “actively facing fears, as difficult as it can be, proves that we can tolerate discomfort.” With the help of ERP, she was specifically exposed to looking at, listening to, and engaging with all things vomit. “It was done gradually, as we want to be careful about not ‘flooding’ and, in essence, further traumatizing ourselves with content that is highly triggering.” Instead, Dr. Cook worked her way up with exposures.

“I learned that, yes, vomit is gross. Most people will tell you that. But it’s not life or death, as my brain had told me in the past. I saw through exposure that I can endure discomfort, that vomiting—though not fun—is a temporary and survivable state, and I do not need to let my fear dictate my decisions for me,” Dr. Cook says.

Dr. Cook also notes that while she loved exposure therapy, she was quick to lean on coping skills, too. “I’m not about gritting my teeth and enduring discomfort without additional support,” she says. During her pregnancy, she relied on many tools—sour candies, an acupressure electrical band, nightly Unisom, soothing mantras—to help her manage morning sickness and the anxiety it provoked. She even hired a doula because labor often entails vomit, and she wanted to be in a healthy headspace going in.

She admits that managing her emetophobia on top of the normal difficulties of pregnancy was a lot of work. But she has zero regrets. Her son brings her an extreme amount of happiness she wouldn’t have known without facing her fears. “And I’ve had him vomit on me multiple times,” she says. “I have had the stomach flu twice. And guess what? It was no big deal.” A few years ago, she couldn’t have ever imagined saying that and meaning it.

Christina feels the same way. She says that through therapy and with the support of a partner who truly understands her phobia, she realized that her diagnosis and being a parent were not mutually exclusive. “I want to provide a hopeful tone for those on the fence,” she says, noting that emetophobia would not be enough to stop her from the joy her five-and-a-half-year-old son gives her.

These sentiments offer me comfort and assure me that valuable resources and supportive communities are available for a diagnosis that is still so often widely misunderstood. Personally, when the time comes for me to consider having children, I will do so with the knowledge that my emetophobia need not (and should not) be the determining factor in my decision. And should I choose that path, I know there are ways to manage the fears that have held me—and so many others—back for so long.

*Last name has been withheld.