Identifying The Problem

In my last post I vented my frustration at the process that lies before me. I was already coming around in my view of the situation, but I still needed an outlet for my disappointment. Now it is time to get to work. My plan is  to make sense of this by writing out the problem on paper, and I will post the results of that writing here. Be patient as these posts may ramble a bit.There is no obvious path ahead of me and the problem is a large and complex web of interrelated fears. There is only one way to deal with large complicated problems, and that is too break them down into smaller manageable pieces. The actual problem needs a clear and specific definition. The first question that needs to be answered is simply what it the problem? The problem is clearly emetophobia, but that is not specific enough for this purpose. Emetophobia references fear of vomit and/or vomiting that my actually mean a variety of different things depending upon the individual. So what specifically am I afraid off?

I have been wrestling with this question, what is the specific problem, since Sunday and I think I have an answer. Actually there are four answers:

1)      I am afraid of the physical act of being sick.

2)      I am afraid of becoming sick in a public space

3)      I am afraid of being in contact with a person who is vomiting

4)      I cannot properly interpret my bodies physical cues.

These four items constitute my working definition of the actual problem. These are the specific things that disrupt my life on a daily basis.In order to fashion some system by which each of these problems can be addressed they each need to dive into each a little deeper.

The first and largest fear is of the actual act of vomiting. I believe this to be the root of the entire problem. The best I can tell is that it stems from two childhood experiences that involved painful and scary experiences surrounding the act of being sick. I have only actually thrown up twice as an adult, and interestingly enough I actually recall thinking “that wasn’t so bad” after each incident, but those experiences have not been enough to quiet the fear. I believe that this is not only the biggest, but it will also be the hardest to conquer.

Fear of becoming sick in a public space. I am reasonable certain this stems from a specific incident in my youth when I became ill in a fast food restaurant. I was already terrified of actually vomiting by this time, and I was forced to do it alone in a dirty and public space, the men’s room. Throughout my life I have forced myself to go out despite this fear, but that exposure has not really lessened the anxiety. I think the real question to ask here may be why do I find this scary? Is it embarrassment? I am not really sure what else it could be. When I am in public spaces I will often look for a receptacle should I become sick. I want to know where the bathrooms are, or at least is there a garbage can handy. I have even identified a random plastic bag as an item to use should I need too. If I am unable to locate something my anxiety is greatly increased, likewise if I prefer to sit on the outside of restaurant booths or the aisles at theaters to be sure I can get to these places without delay. Why am I so preoccupied with having a space to do it? Does it really matter if it goes in a trash can or right on your plate? Is there security in having a plan?

My inability to properly read my bodies cues is like adding a slow burning fuel to the fire. Every twang or gurgle in my stomach is read as a sign of impending illness. I have never burped because I cannot distinguish between the sensation of gas rising and the feeling of illness. This makes it pretty much impossible to diminish any regularly occurring discomfort which also prolongs the mental anguish of feeling sick. I will often confuse hunger pain with feeling like I want to be sick until my stomach will actually growl which seems to cue me in to the actual signal my body is sending. Simple hunger is probably the most common source of stomach discomfort I face. People get hungry everyday after all. My awareness of this problem feeds into my concern of being ill in public. I know I have difficulty telling the real thing from random discomfort so if I keep telling myself that I need to go out because I am not really going to be sick, eventually I will be wrong because eventually everybody gets sick.

The last piece, fear of being around those that are ill, is simply a fear of catching whatever bug is floating around which will lead to the first two fears. If I am certain that the vomiting is not related to illness but rather something nontransmittable such as motion sickness or alcohol consumption I am markedly less concerned. I still do not do well with the sounds associated with the act, but Who really does right? Thinking about this problem further it occurs to me that if I can effectively tackle the first three this one might take care of itself.

These are the problems clearly identified and explained. I will think on these a little more and deicde if I want to add anything, but they seem pretty complete. Now that I have the actual problem laid out it is time to figure out what to do about it. This was definitely the easy part.

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6 thoughts on “Identifying The Problem

  1. Great post where you thoroughly consider all angles of your situation. Phobias are difficult nuts to crack.

    Did I tell you about my son who wouldn’t take a shot or have his blood drawn? He saw a wonderful behavioral therapist who diminished my son’s fear by making him look at it realistically. The dr asked him which would be worse getting a shot or falling off the roof of your house. Or would you rather be hit by a truck or get a flu shot? He would make him number the fear factor of each event. Getting mauled by a bear was a 10 and so was giving blood. Slowly, my son began to reorganize his fear and lower his fear of a shot because the other things are realistically so much more horrific. The dr also made my son go to the nurses lab and write down everything he saw. It desensitized the image of a giant needle that he had in his mind.

    Have you ever seen those fake vomit gag jokes that look so realistic it’s disgusting (I think they make them for poop, too). Could you try using that to help you? I understand you are much older and the fears of yours are ingrained in almost all you do so there are no easy answers and I’m sure that’s why you CBT guy didn’t have any to give. I suspect he has ideas but you are at the beginning stages of working on this so he wants you to think on it for awhile.

    Enough from me already! xoxo -Daylily

    • The one time this was brought up in therapy she used a similar approach. She asked questions like “what is the worst that can really happen?” I found it moderately useful in the short term, but it was limited by my ability to use it when anxiety was very high. It may be worth mentioning that I had some success with this.

  2. Okay…so you knew I was going to weigh in. My thoughts….the first thing that stood out to me was actually your last one–#4. I’ll tell you why. It reminds me of my ASD girl. It is very common for people with Sensory Processing Disorder (SPD) to have problems with their own bodily cues. SPD is often co-morbid with ASDs. For instance, kids with SPD often take a long time to toilet train because they can’t tell when they have to go to the bathroom. They don’t recognize the urge to void their bladders. That’s a bodily cue. If you think about it, at some point, as children we learn to recognize that bodily cue. We didn’t always know what that feeling meant. It took “training”, and we all had accidents in the process. Learning to recognize the difference between nausea and the urge to burp is much like toilet training. They are, in fact, different, but you have come to associate any “discomfort” in your stomach as “bad” or “dangerous” or “fear-provoking” or “__________” fill in the blank. So, from an OT (occupational therapy) perspective, for #4, I would begin practicing learning how to read your body’s cues around your stomach and what it’s doing. I would learn to burp. In your home. I would learn about the stomach, what it does, how it behaves, and all the research coming out about the enteric nervous nervous or “second brain” which is found in, you guess it, your gut. Read this: http://www.scientificamerican.com/article.cfm?id=gut-second-brain

    You have to start learning the subtleties and movements of your own stomach and that involves knowing when you need to expel gas from your mouth, when you’re hungry–what a hunger pang WITHOUT a growl feels like, and what true nausea feels like, what a stomach cramp feels like that is caused by a virus vs. a stomach cramp caused by anxiety feels like. What nervous butterflies feel like vs. butterflies caused by sexual attraction feel like. The stomach is the source of a lot of sensation, and, once again, you are the expert on you, and you should not be deprived of your own self-awareness.

    And the issue of needing to vomit into something? That’s not unusual. I would say that might even be instinctual. I would be mortified if I vomited on my plate in a restaurant. My husband did that once–got sick in a restaurant, at the table, in front of God and everyone. That’s nightmare material for me. When puppies vomit or defecate, their mothers eat it. There is a deep mammalian urge to cover these things up or do it in private. Vomiting in front of other people is not something that anyone would seek out or want so your fear of doing that is not highly unusual. I don’t think that you are alone necessarily. I’m not normalizing it, but I don’t want you to look at yourself and think that 1) looking for a place to puke is weird. It’s not. 2) Not wanting to puke is weird. It’s not. 3) Fearing the experience is weird. It’s not. 4) Dissociating yourself from your own physical sensations because you found the original experiences so vile is weird. Franky, it’s not weird. It’s understandable.

    I’ve written a novella. Is this the longest comment yet? Boy….I could write even more. That’s the sad part.

    • I dont mind the long winded comments so dont worry about that. I found your comment about the second brain interesting. While talking on Friday I mentioned that SSRI medications make my stomach discomfort all but go away, and he wondered aloud if it could be related to serotonin receptors in the gut. I had never heard of this before, but it made sense. I will check out that link. I agree that learning to properly interpret my bodies signals will be critical to this process. I am still drawing a blank on how to go about it. This is proving to be a demanding week, and I haven’t been able to spend the time on this that I should. Thanks again for your thoughtful comment.

  3. I have emetophobia too. I am 34 now and haven’t actually physically been sick since I was 7. I have noticed over time my phobia isn’t as restricting. I used to never eat take out food and was really worried constantly about what I had eaten. I think that the severity of most phobias lies in how stressed you are in your life. If you are calmer, which would be difficult If you are constantly body checking you might well sometimes even forget your phobia (Or at least it wont play as big a part in your daily thoughts)
    Weirdly, I can’t burp. I always just thought it was just something strange about me but I suspected it had something to do with the fear of being sick. On the one hand it’s nice to meet someone similar because I know I’m not alone but sorry to hear that you have the same symptoms.
    I wish you healing! xx Lisa

    • I have seen cycles in the severity of this problem also, and agree it has a much to with the overall level of anxiety in my life. It is interesting to hear form another person who doesn’t burp. Thanks for commenting!

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