Emetophobie: Die spezifische Phobie des Erbrechens – ein Case Report

Zusammenfassung

Unter Emetophobie versteht man eine intensive und irrationale Angst vor dem Erbrechen. Sie zählt zu den spezifischen Phobien. Die Emetophobie ist eine bisher noch wenig erforschte Erkrankung. Über Ursachen und Prävalenz ist nur wenig bekannt, zudem fehlt es an systematisch gesichertem Wissen zur Behandlung. Die meisten Studien weisen jedoch darauf hin, dass die Emetophobie überwiegend Frauen betrifft, früh in der Kindheit beginnt, meist einen chronischen Verlauf nimmt, mit psychischen Komorbiditäten einhergeht und Betroffene oft aus Scham nicht von ihrem Leiden berichten. Die kognitive Verhaltenstherapie (KVT) mit Exposition und Reaktionsmanagement scheint das derzeit wirksamste Therapieverfahren zur Behandlung der Emetophobie. Wir berichten über den Fall einer 20-jährigen Frau, die initial wegen einer schweren depressiven Episode zur stationär-psychiatrischen Krankenhausbehandlung aufgenommen wurde. Das Erkennen der Emetophobie war dadurch erschwert, dass die Patientin aus Scham nicht spontan über ihre Symptome berichtete. Eine gründliche und strukturierte Anamneseerhebung ist daher unerlässlich, da Betroffene oft versuchen, ihre Symptome zu verheimlichen. Aus diesem Grunde wird die Erkrankung oft übersehen und meist erst spät diagnostiziert und behandelt. Unsere Patientin beklagte eine starke emotionale Belastung durch die Symptome der Emetophobie, zeigte Vermeidungs- und Sicherheitsverhalten und war in ihrer Lebensqualität und allgemeinen Funktionsfähigkeit erheblich eingeschränkt. Die Symptomatik unserer Patientin besserte sich nach Beginn der kognitiven Verhaltenstherapie. Diese beinhaltete Wissensvermittlung durch Psychoedukation, eine Überprüfung und Korrektur dysfunktionaler Kognitionen, graduierte Expositionen sowie der Aufbau positiver Selbstwirksamkeitserwartungen. Es besteht weiterer Bedarf an Forschung, um mehr über dieses noch recht unbekannte Krankheitsbild zu erfahren, das ebenso viel Leid und psychosoziale Einschränkungen versuchen kann wie andere schwere psychische Erkrankungen.

Abstract

Emetophobia is an intense and irrational fear of vomiting, and is classified as a specific phobia. However, this condition has been little researched to date, and little is known about its causes, prevalence, and validated treatments. Most studies indicate that emetophobia predominantly affects females, begins early in childhood, usually takes a chronic course, is associated with psychological comorbidities, and affected individuals often do not report their condition due to shame. Currently, cognitive behavioral therapy (CBT) with exposure and response management appears to be the most effective therapeutic modality for the treatment of emetophobia.We report the case of a 20-year-old woman who was initially admitted for inpatient psychiatric hospital treatment for a major depressive episode. Recognition of emetophobia was complicated by the patient's reluctance to spontaneously report her symptoms out of shame. Therefore, thorough and structured history taking is essential, as affected individuals often try to hide their symptoms. For this reason, the disease is often overlooked and usually diagnosed and treated late. Our patient complained of severe emotional distress due to the symptoms of emetophobia, exhibited avoidance and safety behaviors, and was significantly impaired in her quality of life and general functioning. However, our patient's symptomatology improved after starting cognitive behavioral therapy, which included psychoeducation, a review and correction of dysfunctional cognitions, graduated exposures, and building positive self-efficacy expectations.There is a need for further research to learn more about this still fairly unknown condition, which can cause as much suffering and psychosocial impairment as other severe mental illnesses.

Schlüsselwörter

Emetophobie - spezifische Phobie des Erbrechens - Erbrechen - kognitive Verhaltenstherapie - Expositionstherapie

Keywords

Emetophobia - Specific Phobia of Vomiting (SPOV) - vomiting - cognitive behavioral therapy - exposure therapy

Publication History

Received: 16 July 2023

Accepted after revision: 12 January 2024

Article published online:
31 January 2024

• Literatur

• 1 World Health Organization. ICD-11: International classification of diseases (11th revision). 2022 https://icd.who.int/
• 2 American Psychiatric Association. Diagnostic and statistical manual of mental disorders (5th ed., text rev.) 2022; DOI: 10.1176/appi.books.9780890425787.
• 3 Faye AD, Gawande S, Tadke R. et al. Emetophobia: A fear of vomiting. Indian J Psychiatry 2013; 55: 390-392 DOI: 10.4103/0019-5545.120556.
• 4 Snaebjarnardottir K, Sigurdsson E. Emetophobia: morbid fear of vomiting and nausea. Laeknabladid 2014; 100: 281-284 DOI: 10.17992/lbl.2014.05.544.
• 5 van Hout WJ, Bouman TK. Clinical features, prevalence and psychiatric complaints in subjects with fear of vomiting. Clin Psychol Psychother 2012; 19: 531-539 DOI: 10.1002/cpp.761.
• 6 Dargis M, Burk L. A Transdiagnostic Approach to the Treatment of Emetophobia: A Single Case Study. Clinical Case Studies 2019; 18: 69-82 DOI: 10.1177/1534650118808600.
• 7 Simons M, Vloet TD. Emetophobia – A Metacognitive Therapeutic Approach for an Overlooked Disorder. Z Kinder Jugendpsychiatr Psychother 2018; 46: 57-66 DOI: 10.1024/1422-4917/a000464.
• 8 Becker ES, Rinck M, Türke V. et al. Epidemiology of specific phobia subtypes: Findings from the Dresden Mental Health Study. Eur Psychiatry 2007; 22: 69-74 DOI: 10.1016/j.eurpsy.2006.09.006.
• 9 Lipsitz JD, Fyer AJ, Paterniti A. et al. Emetophobia: preliminary results of an internet survey. Depr Anxiety 2001; 14: 149-152 DOI: 10.1002/da.1058.
• 10 Veale D, Lambrou C. The psychopathology of Vomit Phobia. Behavioral and Cognitive Psychotherapy 2006; 34: 139-150 DOI: 10.1017/S1352465805002754.
• 11 Veale D, Murphy P, Ellison N. et al. Autobiographical memories of vomiting in people with a specific phobia of vomiting (emetophobia). J Behav Ther Exp Psychiatry 2013; 44: 14-20 DOI: 10.1016/j.jbtep.2012.06.002.
• 12 Sykes M, Boschen MJ, Conlon EG. Comorbidity in Emetophobia (Specific Phobia of Vomiting). Clin Psychol Psychother 2016; 23: 363-367 DOI: 10.1002/cpp.1964.
• 13 Maertens C, Couturier J, Grant C. et al. Fear of Vomiting and Low Body Weight in Two Pediatric Patients: Diagnostic Challenges. J Can Acad Child Adolesc Psychiatry 2017; 26: 59-61
• 14 Hunter PV, Antony MM. Cognitive-Behavioral Treatment of Emetophobia: The Role of Interoceptive Exposure. Cogn and Behav Practice 2009; 16: 84-91 DOI: 10.1016/j.cbpra.2008.08.002.
• 15 Riddle-Walker L, Veale D, Chapman C. et al. Cognitive behaviour therapy for specific phobia of vomiting (Emetophobia): A pilot randomized controlled trial. J Anxiety Disord 2016; 43: 14-22 DOI: 10.1016/j.janxdis.2016.07.005.
• 16 Fix RL, Proctor KB, Gray WN. Treating Emetophobia and Panic Symptoms in an Adolescent Female: A Case Study. Clin Case Studies 2016; 15: 326-338 DOI: 10.1177/1534650116642576.
• 17 Dattilio FM. Emetic Exposure and Desensitization Procedures in the Reduction of Nausea and a Fear of Emesis. Clinical Case Studies 2003; 2: 199-210 DOI: 10.1177/1534650103002003003.
• 18 Moran DJ, O’Brien RM. Competence imagery: a case study treating emetophobia. Psychol Rep 2005; 96: 635-636 DOI: 10.2466/pr0.96.3.635-636.
• 19 Veale D. Cognitive behaviour therapy for a specific phobia of vomiting. The Cognitive Behaviour Therapist 2009; 2: 272-288 DOI: 10.1017/S1754470X09990080.
• 20 Maack DJ, Deacon BJ, Zhao M. Exposure therapy for emetophobia: A case study with three-year follow-up. J Anxiety Disord 2013; 27: 527-534 DOI: 10.1016/j.janxdis.2013.07.001.
• 21 Hoge EA, Bui E, Marques L. et al. Randomized controlled trial of mindfulness meditation for generalized anxiety disorder: effects on anxiety and stress reactivity. J Clin Psychiatry 2013; 74: 786-792 DOI: 10.4088/JCP.12m08083.
• 22 Leite CEP, Vicentini H, Santos Neves Jd. et al. Emetophobia: A critical review about an understudied disorder. J Bras Psiquiatr 2010; 60: 123-130
• 23 Hantsoo L, Epperson CN. Anxiety Disorders Among Women: A Female Lifespan Approach. Focus (Am Psychiatr Publ) 2017; 15: 162-172 DOI: 10.1176/appi.focus.20160042.