Bia

The Phobia Recovery App

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Stories of recovery and the science of phobia


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  • How common is emetophobia?

    An estimated 8% of people have emetophobia. You are not alone.

    Emetophobia falls under the Other Type umbrella of phobia classifications in the psychologist diagnostic guide, the DSM-5, which includes the phobias of choking, illness, children, loud sounds, and costumed characters.

    Emetophobia is more commonly reported in women than men, impacting 7% of women and 2% of men[2]. The severity and length of phobia can vary widely, with severe emetophobia appearing more rarely[3].

    Emetophobia appears all around the world[4][5] and most commonly starts in childhood.

    Sources:
    [1]: https://focus.psychiatryonline.org/doi/full/10.1176/appi.focus.20160042
    [2]: https://pubmed.ncbi.nlm.nih.gov/21695748/
    [3]: https://www.cambridge.org/core/journals/european-psychiatry/article/abs/epidemiology-of-specific-phobia-subtypes-findings-from-the-dresden-mental-health-study/B6C1FD0DB451EDA2CD216BD4BA91A5F6
    [4]: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5573556/
    [5]: https://onlinelibrary.wiley.com/doi/abs/10.1002/cpp.761

  • Bia – From Personal Project to Recovery Tool

    William, September 16th 2023

    How Bia came to be.

    The Motivation. Bia began as a personal project during my first attempt to overcome emetophobia. After a few weeks of in-person exposure therapy I had two realizations. First, I dreaded it. Second, I knew it was working. I dreaded it because each week my therapist pushed me further along in a hierarchy of exposure, and they were moving faster than I felt comfortable. It was working because each therapy session I conquered things I never imagined doing and I felt this growth positively impacting my life outside of therapy. This led me to start my own library of exposure content. I wanted a way to practice exposure and make progress on my own terms.

    Conquer Emetophobia. The original version of Bia was called Conquer Emetophobia. It was a list of exposures (words, sentences, and images) in a set order. I could load up this list on my phone or computer and practice moving through from start to finish. For a little while, this was enough, and I had taken a few things in my life back from emetophobia – like watching movies without fear of vomit scenes, or, hear words like vomit without having to leave the room. I shared this small site with a few other people who were also recovering from emetophobia and we shared in celebration when we conquered things we thought we never would.

    Tracking Progress. Conquer Emetophobia sat unchanged for a few years. Meanwhile emetophobia slowly crept back and it felt like I ‘lost’ my progress. I was motivated to gain the freedom I knew I could have. I added the ability for Conquer Emetophobia to record history over time. I wanted to know how uncomfortable each bit of content made me and then I wanted to track that over time as I repeated exposure. I knew that once I had this number it would motivate me to practice regularly.

    Research Based. I went back to therapy for emetophobia more motivated than ever. I truly believed exposure could work and I wanted someone to help me make progress. My second therapist was fantastic and for the first time in my life I could picture a life without emetophobia. I worked on Conquer Emetophobia every day and on every weekend. I bought a small library worth of books on phobia, OCD, and exposure. I reached out to therapists who specialize in emetophobia. All of this information went into the website as I expanded the capabilities to track progress, added more content, and ensured the exposure approach was based on research.

    Responsive, Personalized, Effective. Research of effective exposure led to a customizable hierarchy with enforced milestones. The site adapts to high or low levels of discomfort based on the same guidance given to therapists, and interactive component like typing, describing, and speaking, were added to increase content engagement. I received positive feedback from therapists and fellow emetophobes. I was using the site every morning. It was a massive confidence boost to start my day conquering my phobia. I started to believe this could help other people.

    The Ah-Ha Moment. I continued to conquer my own phobia in steps and as I did so I expanded the content available on Conquer Emetophobia. Cartoon images, cartoon videos, real images, real videos, activities, building out the website became my therapy. Every weekend I added new content, and during the week I conquered it through repeated exposure on my phone. This incremental approach was working for me – but I kept seeing comments on youtube, reddit, and elsewhere, people saying that emetophobia was ruining their life. They tried to watch this video but couldn’t. The same struggle I experienced during my first attempt at exposure therapy, it was too much too fast. So I knew, this tool had the potential to help people conquer their phobia in incremental, safe steps.

    I knew this tool could help someone start recovery by offering the lowest level of exposure and letting them control the pace. I knew this tool could help someone conquer specific goals. And I knew this tool could help someone build confidence for daily life. I knew all this because I was using it for that exact purpose.

    Bia. My wife said I needed a better name. She suggested Bia, coming from the end of phobia. I loved it. The site is about taking life back from phobia and the name even takes Bia back from phobia. I renamed the site and started sharing it around to positive feedback and growth ever since.

    For those following along, thank you for your support. I am now working on Bia full time. I’m always interested in your stories and feedback, please contact us anytime. Also, check out this related blog post about the evolution of the Bia’s design.

  • Gagging and Vomit in Comedy

    William, May 18th 2023

    Until my recent recovery from emetophobia, I dreaded vomit scenes in movies and tv shows. Even just 2 seconds of a character vomiting would send me into panic and my time relaxing on the couch would be spoiled along with the rest of my night. I didn’t understand it. Why put these scenes into the show? Are they just trying to be gross? Does anyone actually enjoy this? Why not just leave it out?

    For me, vomiting and gagging were not funny. I couldn’t imagine myself laughing at someone experiencing what I feared so strongly. But slowly this changed, and during my exposure therapy I watched a skit called ‘Waiters who are Nauseated by Food’ (for those of you using Bia, you will find this skit in the Fake Videos milestone) and for the first time in my life I found the idea of nausea and gagging funny. I didn’t understand it, and I even wondered if I was losing my empathy.

    I spoke to my therapist about this and I learned two things.

    1. Emetophobia was hijacking my empathy.

    I wasn’t just worried about myself throwing up, I was worried about everyone throwing up. That’s a lot of pressure to put on myself. Also as I evaluated what exactly about throwing up made me so uncomfortable (asking the question ‘what about this makes me uncomfortable?’ was a powerful tool for me) I realized I was afraid to vomit in front of other people. But why? Was I worried they would laugh at me? Maybe, but I was more worried that I would ruin their day, by causing them the same panic that I would feel if someone vomited near me.

    So look at what emetophobia was doing to me. Not only was I worried about myself throwing up all day every day, but I also worried about anyone around me throwing up, and now, I worried about other people worrying. I was three layers deep of worrying! It’s not fair, or reasonable, to expect me to save everyone around me. I had to let this go, but how?

    I could have told myself ‘Oh, you won’t upset other people if you vomit’. But that statement leaves room for what if questions, and emetophobia feeds on what if questions (What if someone else has emetophobia? What if someone is already nauseous? What if someone already had a bad experience at the theater and now I ruin it for them forever?). Instead, I followed the same pattern I had been building on through exposure therapy – assume the worst will happen. I told myself – I might vomit here, and if I do, I might upset someone and ruin their day. That doesn’t leave any room for what ifs, I have already accepted it. I was not dancing like no one was watching, I was dancing like everyone was watching. Of course, once in the room, emetophobia fights its way back in, the feelings try to bluff me out of what I know to be true. As Dr. Weekes says, ‘don’t get bluffed by a feeling’. With some practice, I have been able to get rid of these what if questions and take back my empathy from emetophobia.

    2. I have a theory for why gagging and vomiting is funny.

    I could not find any academic articles on this subject, I would love to hear a professionals opinion. But my theory is gagging and vomiting are funny because they are about losing control. Similar to watching your friend eat a hot pepper on a dare, the uncontrollable response is funny. It’s not that I no longer feel empathy for people, but I understand that gagging and vomiting are not as horrible as I had built them up to be, and this momentary lapse of bodily control will be over soon. As I built Bia, I gathered hundreds of images, audio clips, and videos of people gagging, pretending to gag, vomiting, etc, and a common theme across these were people laughing. I started to find the humor in vomit scenes. I still think vomit scenes are added a bit too often into media where they don’t really add value, but after therapy, I can confidently sit down and watch tv without fearing a scene will ruin my night.

    Do you think gagging and vomiting are funny? Has your opinion changed during your recovery? I’m always interested to hear from others, please don’t hesitate to write in or share your story to be added here on the Bia blog.

  • Dance Like Everyone is Watching

    William, April 22nd 2023

    Dance like no one is watching is a common phrase. It’s fun, it says no one is judging you, enjoy your life. I find this similar to my original approach to handling my emetophobia. I would tell myself, ‘I am not going to throw up’, ‘Dance like you are not going to throw up’. This was reinforced by everyone around me saying the same thing. Parents, friends, teachers would tell me I was not going to throw up. But this is a trap, because emetophobia is persistent and clever. If I said ‘I’m not going to throw up’ emetophobia would find some way to convince me I might. I would analyze my food, monitor for signs of illness in myself and others, smells, movements, temperature. It was a never-ending battle and usually emetophobia would win, convince me I might throw up, and ‘Dance like I won’t throw up’ became ‘Dance later when I feel better’, except I rarely felt better.

    My breakthrough with emetophobia came with a subtle but extremely powerful mind shift. It took years of therapy and practice to make this shift, but when my brain finally believed it I knew I had taken my life back from emetophobia.

    Dance Like Everyone Is Watching

    Dance like everyone is watching is powerful. There is no more what if. You’ve already decided it’s happening. Emetophobia feeds on the what if. Take away the what if and emetophobia will starve. But just stopping ‘what if’ is hard, we’ve been practicing and getting good at asking what if our whole lives. To stop the ‘what if’, we need a new skill, to say ‘It will happen’. Just like we built up and practiced asking what if, we need to practice saying ‘It will’. Once I could tell myself, ‘I might throw up today’ emetophobia had no more power over me. Again, this shift didn’t happen overnight. I had to tell myself this over and over before I believed it. It was similar to the battle I had been having my whole life.

    I used to say “I’m not going to throw up” and emetophobia would find ways to convince me. Fighting that battle made emetophobia stronger, more clever.

    Now I say “I might throw up” and emetophobia tries to tell me all the ways that would be awful and horrible. I have to sit in that discomfort, and not let emetophobia scare me out of my life. Fighting this battle was very hard, and took a long time, but as I beat emetophobia back I felt my life growing.

    Ultimately, I had to choose which of these paths I wanted to take. For 20 years I was fighting the ‘I wont throw up’ battle, and I am not sure it can be won. My therapist told me, I could always go back to that fight, why not try another approach? ‘I might throw up’ has been a life-saving approach, a battle I can win. Now, I dance like everyone is watching.

  • My Emetophobia Timeline

    William, March 21st 2023

    My therapist would often ask ‘How does this make sense?’. Asking and answering that question has become a way to pause and process when I feel frustrated, sad, or overwhelmed. As I worked through my emetophobia, I found it very helpful to understand how emetophobia evolved throughout my life. Below, I share the timeline of my emetophobia as I understand it.

    • 7 Years Old – My earliest memory of emetophobia was laying awake at night, imagining myself throwing up over and over on repeat. This caused significant distress. To try to stop it, I invented a scene to think of instead. I pictured a boat traveling along a canal, its wake bouncing and rippling. I imagined the sound, the smell, how the boat would slow for turns in the canal and accelerate along the straight. Specifically, I imagined this boat making a right turn, resetting, repeat, over and over. This was my first ‘clean thought’ that I used to try to drown out emetophobia thoughts for nearly 20 years

      My theory is something was making me chronically nauseous. Whatever the cause, chronic nausea led to obsession of vomiting – I always felt sick, so I thought about it, planned for it. This kicked off the vicious cycle. Nausea triggered anxiety, anxiety made me nauseous.
    • 11 Years Old – I dreaded the dentist. I didn’t understand how anyone could sit through it. I understand now, my dread of the dentist was rooted in the fear of them gagging me. This is how emetophobia impacted me as a kid. The dentist was harder (what if they gag me and I vomit?), going to the movie theater was harder (what if I have to vomit but can’t get to the bathroom in time?), car rides and planes (what if I get car/air sick?), test day at school (what if I have to vomit in the middle of the test?). Everything was harder. I was good at thinking of the worst case scenario.
    • 14 Years Old – I quit soccer. At the time I thought I wasn’t good enough, but reflecting on this decision, I know now it was completely driven by emetophobia. Our coach would threaten to run us until we puked, and the nervousness before a big game triggered nausea and anxiety. Quitting soccer brought the familiar feeling of instant massive relief, but long term reinforced the avoidance cycle and increased my anxiety response.
    • 16 Years Old – I had my first panic attack at a school assembly. I specifically remember imagining myself throwing up in front of the entire school, triggering a wave of anxiety. I thought I was having a heart attack and made it to the hallway where a very kind teacher helped me through it. I did see a doctor, and they suggested it was anxiety and prescribed me xanax, although I still didn’t know (or admit) I had emetophobia. I knew throwing up bothered me much more than it bothered my friends, but I still didn’t understand what was going on. Emetophobia really had a hold on me from this point on.
    • 17 Years Old – I finally googled ‘Why am I so afraid of throwing up’ and discovered emetophobia. I found a list, something like 20 signs of emetophobia, and almost coming to tears as I read down the list and related to each one. It felt amazing to have a word to describe what I was feeling, and for a while, that was enough. I treated emetophobia as a part of my identity, I embraced the idea that I would not be a world traveler, an adventurous eater, an athlete. I settled with living with emetophobia.
    • 19 Years Old – I saw a few doctors on and off for occasional panic attacks and anxiety. I avoided telling anyone I had emetophobia, including doctors.
    • 22 Years Old – Tired of chronic nausea, I saw a therapist with the goal of taming my anxiety. I remember in my first appointment, trying not to reveal that I had emetophobia and focus on anxiety. I had convinced myself that I would always have emetophobia, and I didn’t want to talk about that. Immediately, the therapist recognized my phobia and encouraged me to try exposure therapy. He taught me the concept of ‘clean and dirty discomfort’ which was a very helpful lens for me. However, he moved too fast through exposure and I lost trust in him. I stopped therapy before making any recovery. This is also when I made the first version of Bia, in an attempt to continue my exposure sessions at home without my therapist.
    • 26 Years Old – I buried myself in work as a distraction from emetophobia. It was my excuse. I didn’t have to say ‘I don’t want to go out tonight because I am terrified I will get sick and not find a bathroom’. I could just say ‘I have to work’. But, over time, emetophobia was taking more and more away from me. I would have intrusive thoughts about the food I had just purchased, surfing was no longer a relaxing activity but a trigger (what if there is bacteria in the water that makes me sick?). I started to skip meals. I thought that being hungry was better than eating and potentially feeling sick. One morning, hungry but deciding to skip breakfast, it clicked, and I knew I needed to fight. Emetophobia had taken enough of my life for long enough, I was ready to face it head on.

      I found a therapist near me. He listened, and when I was mad or frustrated with emetophobia he helped me make sense of it. He introduced me to Dr. Claire Weekes and the Ironic Process Theory. Slowly, I started to take my life back. I revived the Bia project that I had set aside 4 years ago and continued to build it out. It was a therapeutic exercise for me, I wasn’t just doing exposure, I was thinking about exposure, how it works, why it works, treating it like learning a language. This was when I realized Bia might be able to help other people.
    • 27 Years Old – After another 8 months of therapy, I had a breakthrough. One day, I felt zero fear. It was a completely new feeling for me, and I just wanted to go for walks, listen to the birds, and enjoy eating and drinking. Since then, emetophobia has made its attempts to return. I’m not confident emetophobia will ever be gone, but, I am 100% confident that I have the tools and ability to conquer whatever comes my way. Therapy and exposure saved my life. I do what I want when I want now. I decided to quit my job and focus on Bia, with the goal of helping people along their emetophobia journey. I know recovery is hard, but I know it is possible. My therapist would say, “Life lives on the other side of fear.”

    Thank you for reading about my journey with emetophobia.

  • Guilty Memories of Emetophobia

    William, October 7th 2022

    I have had emetophobia for as long as I could remember, but I didn’t know what it was for a long time. Instead of knowing I had emetophobia, I thought I was sensitive, weak, I thought maybe I was a hypochondriac. I didn’t understand why things were so easy for everyone around me while I struggled to go to movie theaters, sit through class, or go out to dinner.

    During my time in therapy and recovery from emetophobia, I realized how much emetophobia was really behind my decisions for the past 20 years. For example, I left my high school prom after a short 15 minutes, I thought it was because I had to take an elevator, but the only reason I was afraid of the elevator was again because of emetophobia. I quit soccer at 14 because I was afraid my coach would run me until I was sick, but at the time I convinced myself I wasn’t cut out for it. I loved soccer and I wish I had kept playing. In college, I never went out to bars with my friends, I convinced myself it just wasn’t my thing.

    As I worked through exposure therapy my life got bigger from all the new experiences I could enjoy. But I felt guilty and disappointed in myself for all the decisions I had already made with emetophobia at the controls. My therapist asked me to think about my past self as someone else. How would I feel for them? Would I think they were weak? I thought about it, and I pictured my young cousin who has driving anxiety and my friend who also struggles with emetophobia, and my perspective on my past self shifted.

    I had 20 years of memories categorized as ‘I messed this up’ and I finally re-categorized them to ‘I was suffering and did the best I could’. A mountain of guilt was lifted from my shoulders. I have since spent hours thinking of times in my life; prom, soccer, missed concerts, time missed with friends and family, food I never tried, remembering each one and how mean I have been to myself over the years. With this new perspective and understanding of OCD, I could see those decisions with more context, and I finally understood and forgave myself. I am happier, sleeping better, and importantly, being nicer to myself as I continue on my journey with emetophobia.