A 16 year old girl presents with debilitating anxiety about vomiting. She hasn’t vomited since she was 6 years old yet she lives every day of her life in fear that she might lose control of her body. She says “the stuff on the inside isn’t supposed to be on the outside”. She finds vomiting to be disgusting and is appalled even by hearing the dreaded V word. She’s horrified by the memory of her last experience, recalling every moment as if it were in slow motion. She remembers everything she ate that day, what she was wearing, where she was standing, how each family member reacted, and the exact method of cleanup.
For the last 10 years of her life, she has avoided any potential threats that can inadvertently trigger illness. She attempts to alleviate the risks through compulsive hand washing, avoidance of touching possible contaminated surfaces, and keeping her distance from anyone she perceives to look ill. She avoids foods that are approaching their expiration date and won’t eat any leftovers for fear of spoilage.
She finds herself feeling angry at anyone who does become ill, thinking why can’t they have been more careful about contracting an illness. Why can’t they elicit more control over their body.
Movies, books, or discussions that involve vomit cause her to suffer nausea and severe panic symptoms. Her stomach feels queasy, her heart pounds violently, her throat tightens and her breathing becomes rapid and shallow. She worries that these out-of-control feelings will never go away. And when they do subside, she anticipates the next time they will come back.
In our treatment together, we delicately gather any and all information that is relevant in formulating a comprehensive treatment plan. We create a hierarchy of exposures to help her desensitize to the feelings in her body and to allow her to habituate to words, phrases, sights, sounds, smells, and places that are associated with vomit. We travel the sensitive journey together as her nervous system unlearns past trauma. Through repeated exposures, she opens up her mind to the possibility that the “stuff on the inside can be on the outside”. As her nervous system becomes less reactive, she invites new experiences, foods and socialization into her life. She no longer avoids her past triggers and is able to live her life unhindered by emetophobia.
