Paper presented at 2008 Alpbach Conference by Dr.Emanuel Mian, PhD-Psychologist and CBT therapist. INTRODUCTION:Emetophobia is the fear of vomiting or to see others doing the same. Sufferers are also scared of nausea because of its strong link with vomiting. Emetophobics pay great attention to every gastrointestinal symptom and refuse to consume foods with fats or carbohydrates needing continuos reassurances on food content and avoiding social occasions where they are pushed to eat. This behaviour quickly force them to stear to underweight and many are often wrongly diagnosed as having an Eating Disorder mainly Anorexia Nervosa. OBJECTIVE: The aim of this study was to evaluate differences between Emeophobia and Anorexia Nervosa patients. METHOD:Nineteen (19) women with Emetophobia (EPH) and twenty (20) women with Anorexia Nervosa Restricting Type (ANR) of the same age were recruited and randomly selected from an outpatients group at the beginning of treatment. They were subministered the Eating Disorders Inventory (Gardner et al, 1993), the Symptoms Checklist 90 (Derogatis, Lipman & Covi, 1973), the Body Attitude Test (Probst et al, 1995) and the Rosenberg Self Esteem Test (Rosenberg, 1965). RESULTS: EPH patients had significant higher scores in EDI Ineffectiveness, BAT Lack of Familiarity (factor 2), SLC90 Paranoid Ideation and RSE Total Score while ANR patients had higher scores in EDI Drive for Thinness, Body Dissatisfaction, Enteroceptive Awareness, SCL90 Interpersonal Sensitivity, Anxiety, BAT Total and Body Dissatisfaction. CONCLUSION: More research is required to explore the distinctive eating patterns and body image issues in order to discriminate these two distinct psycopathologies

1. 16-18 October 2008
Alpbach-Tyrol Austria
Is Emetophobia different from Anorexia Nervosa?
A preliminary investigation
Emanuel Mian
Eating Disorders Research Department, Eating Disorders Unit

2. Emetophobia is the fear of vomiting or to see others doing the same
It has not been well characterized and is a poorly understood anxiety disorder, with
little research published into its conceptualization or treatment
Sufferers are also scared of nausea because of its strong link with vomiting and do not
want to take pharmacs beacuse of the counterindications that are in the 90% described
with the term “nausea”.

3. Emetophobics pay great attention to every gastrointestinal symptom and refuse to
consume foods with fats or carbohydrates needing continuos reassurances on food
content and avoiding social occasions where they are pushed to eat.
Lydiard and colleagues [1986] present a case of sudden onset of nausea and fear of
vomiting as an example of panic disorder. Pollard and colleagues [1996] propose that
the extensive avoidance caused by fear of vomiting should be categorized as
agoraphobia without panic.
In children, authors have noted the clinical overlap of this syndrome with separation
anxiety disorder [Klonoff et al., 1984].

4. Kartsounis, Mervyn-Smith, and Pickersgill (1983), in a sample of 547 students, found
fear of becoming nauseous as the 16th most intense fear among a selection of 88 fears
from the Fear Survey Schedule III (Wolpe, 1973)—higher than recognized and
researched phobias such as spider phobia, and fear of heights.
Not only in prevalence studies, but across the literature, fear of vomiting has received
little attention from researchers, and has been placed in the mixed-bag category of
‘‘Specific Phobia (Other Type)’’ by the authors of the current edition of the Diagnostic
and Statistical Manual of Mental Disorders (APA, 2000).

6. Diagnosys and Anamnesys
Phase 1
Psychoeducation and Training techniques for Anxiety
Phase 2
Sistematic Desensitization
Phase 3
Cognitive Restructuring
Phse 3b
“in vitro “exposure”
Phase 4
Prevention of Relapse techinques
Fase 5

7. Since their behaviour and attitudes toward food quickly force to stear to underweight
EMETOPHOBICS are often wrongly diagnosed
as having an Eating Disorder mainly Anorexia Nervosa.

8. Anorexia Nervosa •• Disturbance in the way in which one ’s body weight or shape is
Disturbance in the way in which one ’s body weight or shape is
experienced, undue influence of body weight or shape on self
experienced, undue influence of body weight or shape on self
evaluation, or denial of the seriousness of current low body
evaluation, or denial of the seriousness of current low body
weight
weight
(AN) •• Self evaluation is unduly influenced by body shape and weight.
Self evaluation is unduly influenced by body shape and weight.
•• Body weight is maintained under 18.5 BMI
Body weight is maintained under 18.5 BMI
•• Amhenorrea
Amhenorrea
Emetophobia
Fat and Carbohydrates
Fat and Carbohydrates
Food Avoidance
Food Avoidance
(EPH)

9. Subjects
N= 39
Nineteen (19) women with Emetophobia (EPH) and twenty (20) women with Anorexia
Nervosa Restricting Type (ANR) of the same age were randomly selected from an outpatients
group at the beginning of treatment in Alpe Adria’s Clinic.
They were subministered:
•Eating Disorders Inventory (Gardner et al, 1993)
•Symptoms Checklist 90 (Derogatis, Lipman & Covi, 1973)
•Body Attitude Test (Probst et al, 1995)
•Rosenberg Self Esteem Test (Rosenberg, 1965)

10. Results

11. Results

12. Results

13. Discussion
On the RSES EPH demonstrated a low degree of self-esteem that
correlated with SCL ineffectiveness subscale.
This could be explained with the extreme limitations to quality of life linked
with this kind of psychopatology.
Emetophobics have no Body Image Disturbance and the underweight linked
with their food avoidance has different meanings and must be addressed in
a different way.
The degree of Paranoid Ideation linked with the Somatization and the
Interoceptive awareness provide evidence to previous research (Boschen,
2007)
We’ve also found distinctive eating patterns and “desire of control” different
from what lead to starvation in AN-r.

14. Limitations and Conclusions
We are enlarging sample size to ensure that our findings can explain in
detail EPH.
A lot of sufferers were wrongly diagnosed and treated for AN with every
kind of therapy (long-term psychoanalysis-hypnotherapy) and this lead to
discomfort to seek a cure.
In order to recognize and evaluate improvementes during therapy there is
an urgent need for a specific questionnaire to address Emetophobia’s
particular behaviours and characteristics.
We are working on it and so further research is on the pathway…

15. 16-18 October 2008
Alpbach-Tyrol Austria
Thanks to all of you for the attention
Emanuel Mian
segreteria@emetofobia.info

16. References
Boschen,, M.J. (2007)
Reconceptualizing emetophobia: A cognitive–behavioral formulation and research agenda
Journal of Anxiety Disorders 21 (2007) 407–419
Gardner, P. J., Taylor, M. P., & Polivy, J. (1983).
Development and validation of a multidimensional eating disorder inventory for anorexia nervosa and bulimia.
International Journal of Eating Disorders(2), 15-34.
Lipsitz, J. D., Fyer, A. J., Paterniti, A., & Klein, D. F. (2001).
Emetophobia: preliminary results of an internet survey.
Depression and Anxiety, 14, 149–152.
Philips, H. C. (1985).
Return of fear in the treatment of a fear of vomiting.
Behaviour Research and Therapy, 23, 45–52.
16-18 October 2008
Alpbach-Tyrol Austria