NEURO-PHYSIOLOGICAL PSYCHOLOGY -

Could there be a physical underlying factor contributing to Emetophobia (and Agoraphobia)?

Many Emetophobes claim to be mildly agoraphobic and report discomfort in walking any distance since this can induce feelings of unsteadiness, feeling 'off-balance', and/or a sensation of the footpath moving while buildings can appear to move or converge towards each other. A similar sensation can be experienced when looking up or down a staircase.' These symptoms can induce physical nausea which can thus trigger panic symptoms associated with emetophobia.

For many years, doctors have been insisting that phobic problems are "all in the mind" and dismissing us with endless prescriptions for anti-depressants (which themselves can cause nausea and dizziness) or the blatant insult of being told to "get a life". Counselling and other such treatments offered could, by their very nature, be only partly successful since the root causes are not being tackled.

In October 1997 GUT REACTION reported on how one agoraphobe experiencing such symptoms, improved considerably following having his underlying inappropriate childhood reflexes corrected. Some of the balance tests (which compared the inner ear function of agoraphobes with non-agoraphobes) undertaken by a research college in London are listed below:

Six main tests were undertaken and 'patients' were told they could stop at any time. In between each test, their anxiety was rated on a scale of 1 to 10.

1. TEST ONE: Patients stand on two footplate in front of a canvas wall which has a side panel attached to each side of the patient. A harness is fitted for safety to prevent the patient actually falling over (in severe cases) and the patient stares straight ahead while the canvas wall is moved forwards and backwards and then the side panels also move similarly. Next, the footplates are tilted slightly while the patient tries to maintain his/her balance as normal.
2. TEST TWO: Eardrum pressure is measure by fitting a small, soft, rubber earpiece in the ear and a slight pressure is applied.
3. TEST THREE: A hearing test is held in a small, sound-proof room with the patient pressing a buzzer each time a tone is heard through the headphones. The readings are plotted to form an audiograph.
4. TEST FOUR: Sitting in a chair, the patient has electrodes applied to above and the side of each eye to measure eye movement as the patient follows the movement of a red light across a screen in front. The patient must move only his/her eyes and not the head.
5. TEST FIVE: A black and white striped curtain is closed to form a cylinder around the seated patient and the cylinder is then revolved to the right and then to the left. Next the lights are turned out and the procedure repeated as the chair is spun slowly and gently in each direction.
6. TEST SIX: is the (notorious) caloric test whereby water of 42 degrees and 32 degrees centigrade (ie above and below normal body temperature) is poured into the ear canal and the eyes monitored for nystagmus (flickering). NB this stimulates the balance system and can actually lead to vomiting.

The above tests can determine whether a person has either a POSTURAL dysfunction or MIDDLE EAR dysfunction. If either should be the case, this is not always immediately apparent but sometimes only manifests itself if the person becomes acutely stressed. This may explain why some of us had a few balance problems in childhood but these suddenly became more acute and noticeable in our adult life when we became more aware of, and stressed by, our phobia.

These tests can be unpleasant and by stimulating the balance system in such ways would inevitably cause some dizziness and nausea. Generally, when the results of the tests are compared against a control group of people, who do not have problems of panic or dizziness, their eye movement test results are usually very similar. In contrast however, the tests of postural sway show that patients suffering from panic and agoraphobia are undeniably less stable and steady than normal, particularly when the screen and/or footplates were moving which could explain why both emetophobes and agoraphobes tend to avoid situations with similar motions which provoke a similar disorientation.

Early research results suggest that patients complaining of agoraphobia and dizziness do have genuine balance problems which should be investigated and treated. Such treatment normally consists of manipulative exercise - such as that proposed by UK-based organisations such as the Institute for Neuro-Physiological Psychology (Tel 01244 311414) and the Centre for Development Learning Difficulties (tel. 01753 582820).

While agoraphobia is, strictly speaking, a fear of public places (rather than 'open spaces' as misinterpreted by many), further research by Isaac Marks (one of the key 'phobia specialists') and Paul Bebbington has identified a 'space phobia' whereby the fear is of wide open spaces in which there is no means of physical support close by. Again, this has possible links to Neuro-physiological psychology. Back in 1870, German psychiatrist M Benedikt actually called agoraphobia 'platschwindel' meaning 'giddiness in open spaces' and he attributed this to a disease/malfunction of the inner ear. Again, this supports the concept of there being a physical underlying cause, or contributing factor, to agoraphobia, giddiness and the nausea this can produce.

The Institute for Neuro-Physiological Psychology (INPP) can be contacted at - http://www.inpp.org.uk