How I cured my fear of vomiting

Kneeling at a toilet in St Pancras Hospital, hands just above the seat, I looked up at psychotherapist Karen, made my last-ditch-reassurance-plea: “It’s mostly thighs that touch a toilet seat, isn’t it?”

I forget Karen’s reply. Probably something with the understated perfection of a therapist on a pretentious patient’s psychological pedestal. And so we both flattened our palms, contacted the ceramic, and went for it – rubbing those toilets like dust-seeking pedants on ‘Four in a Bed’.

“You got anything good to eat?” Karen asked. I had a banana – so no. I peeled it and rolled it between my toilet palms. “Do you want to snap me off a bit?” Karen asked. It was oddly intimate – arguably the second most intimate thing I’ve ever done – after biting into an extremely flaky croissant opposite a stranger on a train.

I divided the banana and we sat and chomped. I swallowed – committed – and instantly felt… invincible. My brain leapt into a capacious skull, my limbs were untied. I bounced home knowing something had fundamentally changed about how I’d felt since age five, in 1993.

The root cause

When he got his first company car, my dad definitely didn’t want me to christen it with fluorescent Play-Doh vomit. But abandoning me, my sister, and our mum on the hard shoulder of the A1 while he went off to a carwash was an overreaction.

A month later, at my sixth birthday party, every child except me vomited – presumably frenzied to emesis either by Darlington Leisure Centre’s “soft play” or its sausage, chips and beans. My dad comfortingly accompanied every child to the toilet, leaving me confused about the rules of vomiting.

These memories simmered away, camouflaged against a backdrop of my fighting, hypochondriac family, until I broke – aged 12 – at my then spiritual home: Pizza Hut, Hull. My mum confided in me my parents’ impending divorce. Overwhelmed, I had what I now know was my first panic attack, but then felt like overeating-based vomiting. But this was abnormal vomiting – where you feel worse, not better afterwards. It changed me. My veins hummed and wobbled with adrenaline. I wasn’t safe.

Emetophobia and panic disorder set in. I didn’t go to school for months. I couldn’t leave the sofa, and barely ate. A difficult adolescence of panic, anxiety, fear, avoidance, and always having a problem with everything – in case it caused vomiting – followed. Constant introspective symptom-monitoring. Does my stomach hurt? Is this cooked properly? Am I dizzy?

These questions create psychosomatic sensations and panic attacks. And panic attacks are – especially when you’re aged 12 – disarming, whatever their cause. But with emetophobia they’re especially challenging because the panic attacks themselves make you feel sick.

Then there are the sub-phobias emetophobia spawns: germs, food, toilets, alcohol, medication, transport. Everything becomes binary: “Will this make me vomit?”

Online “emetophobia support” forums reveal Britain’s 70,000 emetophobics – and two million “milder-form emetophobics” – discussing vomit-avoidance techniques, including starvation, abortion, chemotherapy-avoidance, or seeking fundoplication, acid-reflux surgery with a side-effect of rendering vomiting almost impossible.

But these are exemplars of severe emetophobia itself, not solutions. Solutions might include reducing fear, so you don’t need to seek such avoidance strategies.

Back to rock bottom

In 2018, aged 30, back at the same knotted, anxious low point I first met aged 12, I could sympathise…

I would wake at 10:00 (any earlier and I felt sick), immediately brush my teeth (to not feel stale and therefore sick), then move onto breakfast.

Bread-cushion-barrier-method pitta bread

Prep time: Ages | Cook time: 3 minutes

Method

• Wash hands. Shake dry (85–100 shakes) to avoid touching towel.
• Re-wash already clean plate.
• Mistrusting tea towel, dry plate with slice of bread.
• Bin the soggy bread.
• Still mistrusting plate’s cleanliness, cover it with slices of bread to make a bread-barrier.
• Toast pittas.
• Boil kettle.
• Sterilise knife with boiling water.
• Having touched the kettle, wash hands again. Shake dry.
• Butter pittas. Place on bread-barrier.
• Wash hands. Shake dry.
• Eat pittas.
• Realise, horrified, the pittas were “best before” yesterday.
• Email pitta manufacturer.

Reassured, I go to meet a client, who mentions his wife is unwell. I can’t ask outright if it’s vomit-related, and my generic investigative sympathy leads nowhere, so I fake a phone call and leave. “Always a different drama,” people must think. I rush home, googling same-day-delivery black-market anti-emetics.

I cancel visiting a friend to play on his VR headset (potential motion sickness), avoid a concert (fearing nausea on the bus), and cancel dinner plans because the restaurant has no green “scores on the doors“ hygiene-rating sticker visible in its window on Google Street View.

Into therapy

“I can’t live like this,” I told therapist Karen at session one. I felt doomed to live in fear until I’d next vomit and be unable to cope. This fear had never really gone away, but now it kept striking me anew, like a loved one’s death suddenly resurfaces, fresh as the day they went.

Lots happened pre-toilet-banana – watching vomiting videos, reducing handwashing, sitting through panic attacks without fighting them (a strain of hell inadequately summarised in a half-sentence), and hanging my head above fake vomit – soup, Parmesan, and rotten milk.

I was changing. I remember taking the boat from Westminster to Greenwich as therapy ‘homework’. As the Jubilee line gadunked into Westminster, I had sweaty palms, weak limbs, and a rising feeling in my throat I couldn’t burp away – because it was anxiety, not wind. What should I do? I thought. An answer came – keep walking until you’re on the boat.

Confronting my emetophobia culminated in the toilet banana, because if I can eat with dirty-toilet hands – and not vomit (which I didn’t) – everything less dirty becomes fine – my safety behaviours dissolve. So I faced my fear, voluntarily, rubbed the toilet, and something different – besides traces of urine – lodged in my veins. And I can still feel it with me.

To cement the change, I repeated the exercise in a different public toilet every day that week. Pubs, train stations, but worst of all: Gail’s Bakery, West Hampstead. Writing in there for an hour beforehand, I observed the toilet-goers: a doddery old man (twice), two homeless people (together), and a man who bought nothing, sprinted into the toilet, then emerged ten minutes later, ashen-faced. Regardless, I grabbed my Wotsits and faced my fate.

My anxiety lived in the uncertain anticipation of hovering my hands above the toilet. When they met the cold hard rim, my anxiety went, and never returned. I’ve had barely an anxious day since, despite most days in the previous 20 years being obsessively fearful.

My fear wasn’t in the things I was avoiding. It was in the act of avoiding. The message-to-self had been: This thing should be feared. The new message: I can handle it.

I struggled with the concept, though, that the key to my healing was removing my anxiety-sustaining behaviours, not that supposed psychotherapeutic pinnacle – the root cause.

“Aren’t we treating the symptoms here, not the root cause?” I’d ask Karen. “I do these safety behaviours because I’m emetophobic.”

She explained: “Other way around – you’re emetophobic because you do these safety behaviours. You don’t avoid things because of emetophobia. You have emetophobia because you avoid things – training yourself to fear them.”

It clicked: it’s not cause and effect. It’s effect and cause. Avoiding germs, foods, situations, in fear, shapes them into demons, to be feared. Soon you’re avoiding the demons you shaped, not the original things. This felt so powerful, yet conceptually elusive. So I drew it:

March 2022: Unwell, I vomited multiple times. Since finishing therapy, I’d had a single worry nagging at my recovery: I feel my emetophobia has gone… but what’ll happen next time I vomit?

Well – nothing happened. No fear, no anxiety – nothing. I wasn’t ill like an emetophobic. I was ill like a completely recovered emetophobic. My brain had sympathy for my body. I rested, watched ‘Traffic Cops’ and sort of enjoyed the whole thing.

Finally, I’ve got it out.