Selects: How Vomit Phobia Works

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It's Stuff You Should Know co-host Chuck Bryant here, Charles W. Some say I'm in charge of picking out the Saturday Select this week. And we're going back to 2017, December 5th. In fact, it's a Christmas episode.

It's called How Vomit Bobia Works Trigger Warning. There will be talk of vomit. Right at R. Welcome to Stuff You Should Know, a production of iHeartRadio.

Hey, and welcome to the podcast. I'm Josh Clark. There's Charles W. I'm a story over there.

This is Stuff You Should Know, very special, surprisingly sad edition. Oh, yeah. I think so. Yeah, of course it's sad.

It's really gross. It is gross. I'm going to have a hard time getting through this one. So we should give everybody fair warning.

We are talking about a metaphobia, which is a specific phobia, a fear of throwing up. And we'll get way more into all of that and what it means. But we're talking about vomiting. It's basically tied for first as the subject of this episode.

So we're going to be talking about vomiting a lot. And I found from researching this. But reading, and I imagine hearing about vomiting for a good 30 minute stretch. It can make one queasy.

So just fair warning. I don't think it's actually going to make you queasy, but it's possible. If it starts to happen, just plow through it. Just say Josh and Chuck would want me to plow through it and your queasiness will magically go away.

Oh, yeah. All right. So like you said, it is a specific phobia. And it is actually listed in the DSM now.

I'm not sure how long it's been in there. But it is... Well, a metaphobia, isn't it? Oh, well, I thought the specific phobia vomiting now.

I guess I think specific phobias are... I don't know if it's specifically listed, Chuck. So when this says it is a specific phobia, according to the DSM, what does that mean? I think it means that it falls under the umbrella of a specific phobia.

Okay. You see what I mean? Not really, but that's okay. This means, well, you're afraid you might vomit.

You're afraid someone else might vomit around you. You're afraid what people will think of you if you do vomit? Yeah. It's just...

And it's not this article. Where did you get this stuff anyway? Was this sort of cobbled? Other than some pretty good sources including Psychology a Day, the American Association of Anxiety Disorders, the National Institutes of Health Library, the BBC, Vice, and I want to give a shout out to the listener who wrote in to share her a metaphobia story.

I had never heard of it before. And she had a very harrowing experience and overcame it just through sheer grit and willpower and came through the other side of this very serious phobia. Yeah, which... We'll get to how to do that later.

But these articles make great pains to point out that it is... I think all people think it's gross and are very much repulsed and turned off by the sound or the smell or the look or anything that deals with somebody getting sick like this. But this is different than that. This is a debilitating fear that can overtake your life.

Yeah. That would specifically be a metaphobia. There's actually, it seems like, a spectrum where you can also suffer from what's called fear of vomiting, which is much less overwhelming, but still you're preoccupied with the idea of vomiting. With a metaphobia, your life does not resemble what your life would be if you weren't afraid of vomiting.

Yeah, it's a real impairment to your life in a lot of different ways, which will go over. It seems like there's not a lot of study about it. I mean, I ran across a few studies, but even in the studies I found they specifically say there's not a lot of studies about it. So a lot of the guesses about the prevalence are guesses.

But one thing I saw was that in the general population, 8.8%, I think that's actually fear of vomiting. I think a metaphobia is more like less than 1% of the population has actual a metaphobia, but that it tends to be about four to one ratio of women to men. Women suffer from it. Yeah, and I certainly do not have it, but like I said, almost every one in the world probably, it is a trigger for most folks.

Yeah, nobody wants to throw up. But if you have a metaphobia, just seeing the title of this come through your podcast feed could have set off an anxiety attack. And I feel very guilty about that. There's nothing we could do.

Because even if we warned everybody in the episode before this, that was coming, that would set off a panic attack. Just the mere mention of the word vomit can set the anxiety disorder into full gear. Yeah, this one article you sent, one of the clinicians they interviewed who treats anxiety disorder said it is in her practice the most common fear among children that they see. Yeah, and that's typically how it starts.

So it's a chronic disease, meaning that if you don't treat this, it's going to persist basically every day of your life and it tends to get worse over time. And it usually starts with a traumatic experience of vomiting, most frequently of all in childhood. So it's more common, I think, among kids, but it can survive into adulthood and it can start in adults. But what seems to happen is you have a traumatic experience from vomiting.

And just like with any other traumatic experience, whether it's surviving a violent crime or being in war, vomiting can have that same effect on the brain, apparently. And you develop something pretty closely akin to PTSD at the thought of vomiting and it overwhelmed your life as a result. I had a traumatic experience with this when I was a kid. I might have told this story before for another reason.

But I was on the bus going to elementary school and there was a scary kid. Remember in elementary school, there were just the scary kids. I remember my scary kids first and last night. Yeah, right.

Scary for various reasons, whether they were bullies or, I mean, you could probably diagnose something that was wrong as an adult. But as a kid, they were just scary kids. And I'm not talking about like, I mean, I'm talking about sociopathic behavior, not something that, you know, like some. They weren't goth, you mean?

Yeah, exactly. They had like real issues that were affecting other people around. Exactly. So this one kid, I remember his name was Tony something, but he on the way to school one day would, or many days, he would make himself throw up outside of the, with his face out of the window and it would, you know, school bus was going down the road and it would fly down and land on the windows all the way down, turn in other windows and he would make himself vomit.

And it just, it scared the crap out of me, man. And it wasn't like, I was scared scared, scared, scared, scared of this dude. Yeah. Well, that's really bizarre behavior, especially if he was doing it to like, intimidate or freak other people out.

Yeah. And I think I might remember. You've never told that story before. Because it's, you know, how sometimes a certain event can tie something else in your brain?

You know, my dad was my elementary school principal. I don't know why I was writing the bus because he was just went to work with him. Well, he wanted to normalize things. Maybe.

But, um, I ran to my dad's office right when I got to school crying. He wasn't in there and the secretary, not Jones, let me in the office and let me stay in his office because I was sad and he had one of those big cabinet stereos, you know, the rest of your record. So the stereo was already on, but the song that was on weirdly was, uh, the Bee Gees, how deep is your love? Oh, it's good.

And to this day, I hear that song and it makes me want to cry. Really? Yeah. It's just a trigger from that day with that guy.

You know what? And that weird. That's a sad story because that's a good song. I know.

It makes me want to weep. It makes me want to weep for you. To get about Tony making himself throw up. I'm a side show right now.

Maybe. Is that still around? I don't know. Pukitoni.

But yeah, that's him. Pukitoni and Hippie Robert and like a little jug band together. But anyway, that's a long way of saying that that was not enough even the traumatizing me to the point where I have a Metaphobia. No, but I mean, it could have been.

It just seems to be like, and it's not even necessarily like a type of person or, um, it's the brain can just, the synopsis can fuse in a certain way and all of a sudden you have this phobia. And the problem is this, it starts from a traumatic experience. So let's say that that had had had this impact on you, Chuck, right? It would have come next if you were on the road to a Metaphobia would have been to start to fear throwing up, seeing somebody throw up probably is how it would have started.

And then that would have spread to throwing up yourself. And then you would have become hyper vigilant. You would want to protect yourself from seeing somebody throw up or from throwing up. Well, how do you do that?

To prevent yourself from throwing up, you're going to monitor every single weird feeling you have to say it would my body throw up and you do like, tamp this down or I can't eat that food. It might make me throw up or I can't read in the car. It might make me carsick and I'll throw up or that person looks kind of sick. I'm going to avoid them.

And then let's just take it a little further and avoid everybody altogether because anybody could really throw up at any given time. And you start to become preoccupied with this and you adjust your life and alter it. And then you're constantly worried about throwing up. And once that happens, the phobia is complete.

Your life has changed. You're constantly worried about it. And then the cherry on top of the whole thing is that when you finally are confronted with the word vomit, actually seeing somebody vomit, something like that, you enter a panic attack, an actual panic attack. Yeah, you can for sure.

And the only way to overcome that is to get away, to run, to get out of there to, I'm not sure all the ways you can handle a panic attack. But then it calms down and your anxiety returns to normal levels, which is to say high for the average person. Yeah. So in my case in elementary school, how that could have gone was I had another ride to school.

But if I hadn't, I might have stopped taking the school bus and started skipping class and not going to school at all because I was afraid to get on the school bus because of puket Tony. Right. And gone weeks in a row and then my parents get a call saying Chuck hasn't been in school for weeks. And what's going on?

And that's exactly what's going on. Like it can get that severe. Right. And it all boils down to the, at least in most cases, the anticipation of this more so than the actual act.

In every case. Because the, the people that are struck with this, by all accounts are less vomitist than the general population. Right. So much so because they tried to avoid it.

So much so that this one article said that most of these people can even name like the three or four times in their life they have ever puked. Right. And what they ate that day and what they had on television and what they wore because it stands out that singularly to them. And then so that's horribly ironic that the people who are the most worried about throwing up are the people who are actually statistically speaking, they're least likely to throw up, right?

But there's an even greater irony to the whole thing. And we'll talk about that after this break. How about that? So Chuck, we were on the irony train and I want to keep going.

Okay. Yes. The irony of paying attention and being hyper vigilant about vomiting, especially when you are worried that you're going to vomit. Because again, there's a number of things that you're worried about.

You're going to be worried that you won't be able to find a bathroom in time to go throw up. You're worried about throwing up in front of other people and embarrassing yourself or being teased for throwing up. You're worried about just the experience of throwing up. It's just a horrible experience.

But once you start to get a metaphobia, you lose perspective completely. It becomes, I've seen multiple, they call them a metaphobia, people with a metaphobia, I've seen multiple people say you would prefer to die than to throw up. That's how much they fear throwing up. And to the rest of us, it's like, God, that would suck to throw up.

But I know I'll be fine on the other end of it. Not to a person with a metaphobia. So the irony of all this is the more you start to focus on this and you start to think about every gurgle in your stomach or every weird twist or turn, it actually produces more anxiety. And here's the ironic part, anxiety can actually make you queasy when you're thinking about throwing up.

That's right. So it makes the whole thing worse and it becomes this vicious cycle. Yeah, and they recommend trying to tell yourself, like, I might feel queasy, but I'm not going to throw up. My anxiety might be making me feel nauseous, but I'm not going to throw up.

Yeah, because there's a confusion of queasiness equals nausea equals throwing up and that's just not the case. Like, you can make yourself sick with anxiety, but you can't make yourself throw up from being anxious. So the whole thing is just wasted worry. Yeah, some of the other things you might do because of the spear, you might not shake hands with anyone ever again.

You, well, I think a lot of people avoid looking at television, puke scenes. Yeah, you cannot watch. You really can't watch those at all. You can't watch stand by me or the meaning of life.

Those are so funny looking though, but still probably not. You might throw away food in your fridge that is not even past its expiration date. You might have a trigger there. You might overcook your food on purpose.

And then before you eat it, you will lift the bread a bunch of times. It's called checking behavior. Sure. You might not eat on vacation as readily because you only trust your trusted food sources.

You might go into a place and when some people go into a music venue, they check for the exits, like you're checking for the bathrooms. You may not even make it to the music venue. A lot of people with a metaphor end up being a gouraphobic and just don't leave their house. Really debilitating it.

Or it's often confused for a gouraphobia by counselors and shrinks. I've got another one. Apparently, a lot of people who have a metaphor walk around with a plastic bag on them at all times, something to throw up into. Yeah.

An emergency throw up bag. They walk around with this because they're so afraid of throwing up. They never need to use because they probably don't ever throw up. I know.

Some of them actually carry a change of clothes around with them as well. Really? For the same reason. If they throw up on themselves, they can change their clothes.

Yeah. And of course air travel, drinking alcohol, any of those things or car travel even? Yeah. Any kind of travel is probably avoided.

Definitely don't booze it up. Yeah. They probably don't drink at all. Yeah.

And subsystem things like pasta and bananas and very, very safe, digestively speaking foods. Although a banana could gag you. Yeah. God, that would be a nightmare.

If you had a mevaphobia. I wonder if they mash them up and eat it, like mashed up with a fork maybe. Maybe. Yeah.

And I could see cutting your food up into the tiniest pieces because you feel you're choking. And that's one of the fears too, I think we mentioned. They're not just afraid of the vomiting, but they're sometimes getting fear choking on vomit and dying and fixiating and we're going to the hospital. Or starting to vomit and the vomiting never ending.

That's another fear of a mevaphobia. One other thing that I saw people do is prevent getting pregnant because of a fear of mourning sickness. Yeah. And so, this is altered and curtailed because you're afraid of vomiting everywhere you look.

There's a potential trigger out there. So just be easier to stay home and eat your pasta and not watch movies. Basically. And it's just lie there and monitor your stomach for signs that you're about to throw up.

That's what they do. That's what you do when you have a mevaphobia. That's your life. Yeah.

It's no way to live. It is not. So, like, this is not all just academic and stuff we're grasping at straws and pulling together from different cases. Like, this is, there's actually a case study we found that was of an eight year old girl who had a terrible experience throwing up and really kind of encapsulates the experience of a mevaphobia.

She had full blown a mevaphobia. She had appendicitis and had been throwing up before the doctors figured out she had appendicitis and had her appendix removed. And that experience throwing up was while it triggered a mevaphobia in her. When she came to and was recovering from her surgery about ten days later, she started getting really worried she was going to start throwing up like that again.

Yeah, it was a really sad case. And pretty much covered everything we said and even then some to the point where her father traveled for business and she didn't want him to travel anymore. Her father to travel anymore. Right.

Get some sickness and then bring it back to the house. Right. And I mean that's pretty extensive. Yeah, like she didn't want to eat herself.

She didn't want to eat any outside food. She had her safe food. But she also didn't want her parents to eat any outside food either because she didn't want them throwing up. She stopped playing with other kids because she was worried about throwing up in front of them and being teased.

That was her big thing. And as one of the clinicians who we came across in this research said it's not the vomiting that's really the problem. Like that's the focus. That's the obsession.

But the real problem is the worry, the constant worry. It's the worry that's altering your life. And it altered this little girl's life. You know?

Very sad. So let's take another break and then we'll come back and put a silver lining on this thing and talk about treatment. All right. So we've talked a lot on the show over the years about CBT cognitive behavioral therapy or exposure and response prevention ERP, basically exposure therapy.

And this is definitely probably the way to go when it comes to emetophobia. So depending on who you go see, you might undergo various kinds of treatments ranging from starting out by literally saying the words vomit out loud or throw up or puke or just all the words because that's literally the first step sometimes into getting over this is just to be able to speak the word. Yeah, you may have to start out by writing it down first before you say it out loud. For real.

And so once you move past that, the therapies range from kind of all over the board from looking at fake vomit that your therapist has made in a toilet. Yeah. Now you're starting to move into exposure therapy, right? Yeah.

I mean, this is all of this stuff ERP and CBT. Okay. But you know, they'll make up some fake vomit, put it in the toilet, make you go look at it. They themselves, the therapist might make the noises in front of you.

This is how I know where. Well, imagine they probably prep them or maybe not. It may go in the bathroom and jump up and say, I got to go get sick. And all this is just exposing this patient over and over to the point where they can handle hearing the sound, seeing the thing, saying the word, hearing the word.

Smell is another one too. Sure. One of the recommendations for exposure therapy is you make your own throw up, like in the toilet, a little bit of cold soup or something like that, maybe mixed in some oatmeal with it. Yeah.

And then pour a little vinegar in there to like make it pungent and sit around and think about that being vomit. Maybe try to make the sound of throwing up yourself, try to make yourself gag. And all this is to show you when you have a metaphobia that this is, first of all, it's manageable. That's the first part.

What you're trying to do is get to this point without having a panic attack. But then also that if you gag, it doesn't mean you're automatically going to throw up. And if you do throw up, it doesn't mean you're never going to stop throwing up or that everyone's going to ridicule you for throwing up. And that's the point of any cognitive behavioral therapy is just kind of change your perspective and give you a more realistic view of the thing you're worried about.

There's also a website called RightMyVomit. Have you heard of it? Yeah, I wouldn't mention that. But go ahead.

You have heard of it before? No, no, no. I read about it. But I just, yeah.

It just sounds like, I mean, that's like classic internet stuff, right? Somebody's like, oh, let's put pictures of throw up on there. And you guys tell me how gross it is. Well, it's actually used by people with a metaphobia to, as exposure therapy at home to just go look at this stuff and see it.

There's also videos of people throwing up. There's a lot of stuff that internet, like unintentionally is this great place for people with a metaphobia to go get over their fears. And I'm sure like, if you have a fear of snakes, it's good for that too. But so is like a time life book.

You're not going to find a time life book that's nothing but pictures of vomit. No, you're going to find it on the internet, though. Yes, you will. That's not an old West series.

No. And then I found this other type of therapy called Eye Movement Decensitization and Reprocessing, EMDR. And it's used for post-traumatic stress disorder. And it's the most bizarre treatment I've ever heard of in my life.

But apparently it really, really works. Yeah. You ready for this? Yeah.

So say I was your therapist and you were, you had PTSD. And it's been used to treat a metaphobia a couple of times. But you're talking about the thing that gave you PTSD. You're focusing on the worst aspect of this traumatic experience.

And you're talking about it out loud. But while you're doing it, I'm moving my finger back and forth and up and down, maybe in a slow circle. And I've instructed you to follow my finger wherever I move it while you're recounting this horrible traumatic experience. Supposedly just doing this over multiple sessions, but sometimes just in one long session.

PTSD can be treated. And the way that they think this happens, if it actually does work, it just sounds like such, just like totally made up that in 50 years, you're going to be like, actually thought this worked. But if it does work, they think that it works because it taxes your working memory to follow the finger. And your recall then is not aided fully by your working memory.

So the vividness of this horrible memory isn't as robust as it would be if your full working memory was working on it. And so when you reprocess it, when you file it away again, this memory, it's lost its luster. It's lost a lot of its bite because you've gotten it out there and reprocess it in a way that's not nearly as traumatic because your working memory was being used in part to follow your therapist's finger. Supposedly it works.

Wow. Yeah. Isn't that nuts? Pretty neat.

Yeah, I think so too. I wonder if it really does work. You should try it. Anyone who has ever undergone eye movement desensitization and reprocessing, I would love to hear your story if it actually helped you or not.

For sure. And if you have a metaphobia, Godspeed, we hope you get well soon. And to take this on or any phobia really has so much courage and grit that just taking a first step toward treatment my hat is off to you for life. Yes.

And chances are you probably didn't even listen to this episode. Yeah. But if you have a different phobia, any phobia, and since I said phobia a couple of times, that means it's time for listening to me. I'm going to call this our second PSA in as many weeks if this releases the same week.

Okay. But this one's about dogs. It's very sad. Hey guys, take me to Wiles to write this because it's been very difficult to talk about.

Now your animal lover's oh, so probably a good majority of your listeners are. I thought sharing our tragic story would help prevent others from experiencing the same thing. We lost our dog river about two months ago because I left the bag of chips out. We were at work while she got her head stuck in the bag and we came home to find our dog stiff and lifeless from suffocation.

We've always been careful about plastic bags and stuff like that and kept them stored away for recycling. But never occurred to us that a chips bag on the counter would something we need to be concerned about. No, no one ever would ever think about that. Everyone we've also told said it was something they never thought about either.

So now we keep all of our bag foods and the cupboard cut the bottoms off of anything that goes into the recycling and waste bins. Yeah. I started doing that since these guys wrote in. We were and still are extremely heartbroken.

I hope no one else left to go through this experience. It was the worst and if I can help save just one other dog's life in worthwhile. So thanks for being you guys. Thanks for being you guys.

There's a comment there. There's not but I think that's how I'm supposed to read it. I hope you make it into your next Seattle show. That's Jackie W from Seattle.

Jackie, thank you for writing in. I'm so sorry about River. But hope you guys are doing okay. Yeah, that sounds like a guest list.

Yeah, I agreed. Action to me. Yeah, right back in and we'll guest list. Yeah, so just right back in.

We'll throw you on there. Yeah. And she sent a picture of River. Beautiful dog.

Very, very sad. River looked very sweet. It happened to you that you think we should share to warn everybody else about. We want to do that.

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