Afraid to Eat, Travel & Touch: Inside the lives defined by Emetophobia

An expert's opinion: Professor Veale & Dr Keyes

Professor David Veale is a consultant psychiatrist at the South London and Maudsley NHS Trust and is a leading expert in anxiety disorders, including Emetophobia. He has spent decades working with patients to treat this often misunderstood condition.

Professor Veale is one of the founders of the world's first Emetophobia charity, Emetophobia Action. Founded in 2020, the charity is specifically targeted at helping sufferers. He also co-authored, alongside Dr Alexandra Keyes, the self-help book“Free Yourself from Emetophobia: A CBT Self‑Help Guide," which has been lifesaving for so many.

Professor Veale has been responsible for some of the most effective and life-altering CBT treatments for Emetophobia. When discussing treatment approaches, he noted the importance of patient's relinquishing control to be successful at recovery long-term. He said: "It's all about giving up control, tolerating uncertainty and allowing yourself to experience the anxiety and disgust and be able to do the things in life which are important to you."

Dr Alexandra Keyes is a Clinical Psychologist at the Centre for Anxiety Disorders and Trauma. She has also worked closely with Professor Veale, co-authoring their self-help guide and co-founding their charity Emetophobia Action. Dr Keyes noted that research has been challenging due to lack of awareness surrounding the condition: "One of the biggest findings so far is just the lack of an evidence base for this, as there are for other types of anxiety disorders. So we don't really know with the same level of certainty what is as effective in treating this condition from the limited evidence there is."

She added: "But it's really striking actually how little work and research has been done with Emetophobia and I think that's for quite a lot of reasons, maybe because it often gets misdiagnosed or sort of it's considered quite difficult to treat.

"Emetophobia also often gets lumped into lots of other things where it actually is a lot more severe and has a hugely devastating impact on people."

Dr Keyes also noted that it is vital for parents, carers and other adults to try to notice the signs of the condition in childhood, as this is where the condition is most often triggered.

She continued: "I think prevention is always going to be better than a cure with any sort of mental health problem. What we know for Emetophobia is that it typically starts earlier in childhood than other phobias and other anxiety disorders.

"So I think definitely like the early signs that I would want to look out for and encourage parents to look out for is if there's any sort of behaviors around food refusal, food pickiness, any sort of concerns or over exaggerated concerns or worry about illnesses or viruses spreading .

"Sometimes children can show very subtle signs of distress that maybe they don't understand themselves and they might not go to their parents to ask about.

"Anxiety manifesting in other ways like tummy aches or sort of physical sensations like headaches.

"I think that's the way that children often show distress and that can be particularly important to pay attention to if there has been an episode of vomiting where the child was very distressed."

"I think if GPs and schools could better recognize this problem and signpost earlier and offer signposts to psychoeducation, books, websites, self-help, I think that would be amazing."

"I'd say the most extreme case I saw was someone who told me that they electrocuted themselves when they thought they were going to be sick."