I’d rather die than vomit – how does catastrophic thinking play a role in emetophobia?

‘I’d rather die than vomit’ – how does catastrophic thinking play a role in emetophobia?

 “Most people with a SPOV [specific phobia of vomiting] evaluate vomiting as being 100% awful and if given the choice would prefer to die rather than to vomit.”

Veale (2009)

If you don’t have emetophobia, you will probably find it hard to imagine hoe someone could think about being sick in such a catastrophic manner! For those with this fear, however, this kind of thinking is part of every day life and contributes to maintaining their symptoms. The following abridged extract from Rob Kelly’s book, ‘Cure Your Emetophobia and Thrive’, discusses catastrophic thinking in relation to emetophobia:

“Catastrophising is the process where a person emotionally magnifies, exaggerates or blows out of proportion a perceived threat or worry. The ‘catastrophiser’ is the person who uses very strong (exaggerated) language and who thinks and feels in a dramatic fashion.

If you are a catastrophiser, instead of saying, ‘I’ve got a headache’, you might say, ‘My head is killing me.’ Instead of saying, ‘I feel I’m stuck at home all the time,’ you might say, ‘I’m stuck in this prison cell and I don’t know where the key is to get out.’ When you have a sore leg, you might think, ‘Oh my god, I’ve got a deep vein thrombosis.’ When you have a spot on your arm, you worry it is a cancer. When you have hiccups, it’s a heart attack. When the phone rings, it’s your mum to say someone has died.

You are likely to have strong catastrophic thinking, especially surrounding your fear. Research has supported the notion that people with emetophobia tend to be catastrophisers! Boschen (2007), for example, suggested that those with emetophobia have ‘a tendency to catastrophically misappraise nausea and other gastrointestinal symptoms’. They assume that any such symptoms are signs of impending vomiting, rather than being down to anxiety, which is far more likely given the stress that they are creating through their unhelpful thinking.

The main problem with catastrophising is that it leads people to lose perspective and create a great deal of anxiety and panic. Catastrophising about a feared situation often results in the person then experiencing the feared consequences! For example, someone who catastrophises: ‘Oh my god, I’m going to be so terrified at the dentist this afternoon, it’s going to be so awful,’ is very likely to indeed feel very anxious and panicky. Catastrophising builds up small things into big ones! Minor problems become ‘unbelievable disasters’ very quickly! This can lead to your limiting belief systems being reinforced by many seemingly ‘hugely significant’ experiences that were in fact fairly minor before you built them up by catastrophising.

You should bear in mind that your catastrophising about vomiting will likely mean that whenever you are sick, your experience is worse than it otherwise would have been. If you believe that being sick is terrible, frightening and so bad you would rather die than experience it, then, due to the amount of anxiety and stress arousal you will create, you are likely to experience vomiting as far more traumatic than someone who just thinks of vomiting as being a little bit unpleasant.

Catastrophising is more common in people whose parents tended to catastrophise. If, as a child, your parents usually responded to you in an ‘over the top’ catastrophic manner, you are likely to pick up on this and learn to catastrophise yourself. Obviously all parents shout unnecessarily at, or worry overly about their kids from time to time. It is when the child is consistently presented with extreme emotional reactions to perceived mistakes or threats that he or she is likely to learn to respond in the same way.

Specifically, it is possible that parents who tend to catastrophise are visibly anxious and demonstrate anxious behaviors in the presence of their child. It is also possible that child learning of anxiety develops, at least in part, from parents modeling anxious interpretation of situations. Thus, children may also come to interpret situations in an overly anxious or catastrophising manner, further contributing to their experience of anxiety symptoms.

Fisak and Grills-Taquechel (2007)

Emetophobes are highly likely to have had a parent who catastrophised and they have picked up this thinking style from them. Some people with a fear of vomiting will have had a mother (or potentially a father) with the same fear. They will have witnessed a parent responding to vomiting in a highly anxious and over the top manner and learnt to do this themselves. Indeed most people with emetophobia will have some reinforcement from a significant other, who has responded to either vomiting or the phobia in a catastrophic, overly emotional manner.”

The ‘Cure Your Emetophobia and Thrive’ book discusses how catastrophising helps to maintain emetophobia in more detail and teaches people how to challenge and change their unhelpful thinking. The Thrive Programme also provides people with other psychological insights and skills that enable them to overcome their emetophobia.

For more information about the Thrive Programme, click here: http://www.emetophobia.co.uk/about-thrive.html

For more information about the ‘Cure Your Emetophobia and Thrive’ book, click here: http://www.emetophobia.co.uk/about-the-book.html

To read about our research into emetophobia and the Thrive Programme, click here: http://www.emetophobia.co.uk/research.html



Boschen, M. J. (2007). ‘Reconceptualizing emetophobia: A cognitive–behavioral formulation and research agenda.’ Journal of anxiety disorders, 21(3), 407–419

Fisak, B and Grills-Taquechel, A.E (2007). ‘Parental Modeling, Reinforcement, and Information Transfer: Risk Factors in the Development of Child Anxiety?’ Clinical Child and Family Psychology, 10 (3) 213-231

Veale, D. (2009). ‘Cognitive behaviour therapy for a specific phobia of vomiting.’ The Cognitive Behaviour Therapist, 2(04), 272–288.