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A message from Dr David Veale - 31 December 2007 It's been a while since I last contacted
you. I am now based part time in the NHS and I and my team developing a
treatment manual for treating vomit phobia. Our aim is to publish our results
and the manual (but this is likely to be a few years down line once we find out
what works best). I think this is the only NHS clinic in the UK trying to
develop this area and get better understanding of the problem and develop new
approaches. I'd be happy for you to leave our details on your website and to let
you when we do publish something.
The Psychopathology of Vomit Phobia David Veale and Christina Lambrou - A summary of the main findings and observations of the research
The survey was based on a a sample of 209 self-diagnosed emetophobes who were mostly female and had experienced symptoms for more than 25 years. The sample were recruited via Gut Reaction and the National Phobics Society. Results were compared with a group of 28 panic disorder sufferers and a control group of 81 who experience no clinical phobic/panic symptoms. The panic disorder sufferers were recruited from a formal clinical setting while the control group were friends and relatives of the emetophobes and panic disorder sufferers. Emetophobia is acknowledged to be an under-researched condition with little documented treatment. The study was mostly exploratory to learn more about the condition and associated behaviour patterns making comparisons with other anxiety disorders. Respondents completed a series of questionnaires - the most detailed being the Vomit Phobics' questionnaire which included 63 questions relating to frequency of nausea, Beck Anxiety Inventory, Panic Cognitions Questionnaire and the Safety Behaviours Questionnaire. Most emets did not discriminate between vomiting alone or in public Nearly half had an equal fear of either themselves or others vomiting One curious result obtained was the frequency with which vomiting had occurred during the respondents' lifetimes. The average given for emets was 4.71 times and 3.58 times for panic disorder sufferers. This contradicted my informal research which gives an average vomiting frequency for non-emets of once every 18 -24 months. I find it hard to believe that some non-emets with an average age of mid-30's, have only vomited 3-4 times during this time. (Perhaps it is worth asking your non-emet friends and relatives about their frequency - IF they can remember. Of course, emets are more likely to recall every incident in graphic detail than non-emets upon whom it might have little impact.) Nausea was experienced much more frequently in the emet group than the control group and the thoughts associated with this were investigated further to assess the frequency of certain thoughts eg "I am going to be sick", "I will choke to death"... The strength of belief in various outcomes was measured along with the perceived cause of the nausea eg anxiety, IBS, middle ear disorder together with the feared consequences eg "I will lose control", "I will faint". As expected, the emets recorded a significantly higher probability (of thought) that the feared events or consequences would occur. Questions were asked regarding emets' behaviour whilst feeling nauseous - responses included sucking mints (co-incidentally, a mint-sucker appeared on ITV's "This Morning " in summer 2006 suffering tooth loss due to sucking mints), seeking escape or taking medication. In contrast, panic disorder patients were more likely to check other bodily symptoms such as checking their heart rate. Emets had other safety behaviours including frequent hand-washing, checking their health and that of others and checking food sell-by dates. Emets were noted to indulge in much more avoidance behaviour than the control groups including travel, boarding boats or planes, taking overseas holidays, going on fairground rides or using public toilets due to their fear. Specific foods were avoided due to a perceived risk of food-poisoning and 49% avoided pregnancy due to the phobia. The impact on lifestyle was measured including ability to work, enjoy social relationships, family relationship and an intimate relationship with a partner. 70% of emets had sought treatment via their GP, the majority of whom were referred to the Mental Health Services Team. Of those who had received some treatment it was regarded as largely ineffective with Behaviour Therapy as the least effective, hypnotherapy only mildly effective while Cognitive Behaviour Therapy was noted as moderately effective although what the treatments actually involved was not recorded. Medication was the most effective treatment - including anti-depressants and anti-emetic drugs. The study concluded that although the condition is a 'simple' phobia, its impact upon life is more complex and it becomes a chronic long-term condition. Emets experience more nausea than the control groups and it is felt that the selective attention given to monitoring this nausea may simply prolong and intensify it in a vicious circle. A marked difference between emet and agoraphobia or panic disorder is that the patient does not seek to be with another person for support - and there is little difference between the avoidance behaviour when alone or with a trusted friend, relative or carer. Regarding treatment, there are obstacles. Exposure is not always effective since 'vomit videos' are not always very realistic practical and 'direct confrontation' which would involve administering an emetic drug for can be counter-productive by reinforcing the 'awfulness of vomiting'. Instead, perhaps treatment should be to reduce safety-seeking and avoidance behaviour and consider the problem to be a worry about vomiting and enter situations in which nausea (caused by anticipatory anxiety) might occur and try to ignore the sensations then, in a treatment setting, to reduce avoidance and checking behaviours and to consider it as a 'less awful' event which is not a catastrophe. This approach is based on any nausea being 'psychological' which, of course, it might not be and by making this observation I am probably adding to high ratings for beliefs about medical causes of nausea!
Complete copies of "The Psychopathology of Vomit Phobia" may be purchased online from the publisher via this link: http://journals.cambridge.org/action/displayIssue?jid=BCP&volumeId=34&issueId=02 |
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