Emetophobia is the abnormal and persistent fear of vomiting, thought to be the fifth-most common phobia in the world. The most extreme sufferers devote their lives to avoiding anything that might bring on illness — including seemingly innocuous everyday occurrences like a catered office lunch, an alcoholic drink, oyster happy hour, or a child in line at the supermarket complaining of a sore stomach. And those avoidance strategies can get extreme: Some sufferers will refuse to leave the house, eat, take medicine, get in a moving vehicle, or have children (according to a 2008 study, almost half of female emetophobes will delay pregnancy or bypass it completely).

Some studies indicate that a fear of losing control underpins emetophobia, which, like other anxiety disorders, tends to impact women more than men. The interview below — with a 23-year-old from Mt. Vernon, Ohio — was only one of a number of conversations I’ve had over the past several months with emetophobes, an overwhelming majority of whom grew up taking care of a chronically sick parent, though not typically one who suffered excessively from vomiting per se.

Is vomiting your biggest fear?

I would rather face death than vomit. I recently had a cancer scare and throughout the whole process all I was thinking was, I’m going to have to have surgery and chemo and these treatments are going to make me throw up. What am I going to do? Most people would say, “You’re crazy! You’re going to throw up, and you’ll get over it!” But to me it’s worse than hearing I have cancer, that’s how bad it is.

How much time do you spend thinking about vomiting?

My main focus in life is to not get sick. It’s in my head every single minute of the day, especially when I’m alone.

When was the last time you vomited?

It was in 2012 and I went into full melt-down mode. My mom had to hold me because I was so upset I made myself pass out. It’s a horrible experience for me. Before that, I hadn’t thrown up for six or seven years. People say it’s just a way for toxins to escape your body, but I never feel better afterward. I can still clearly remember that last time and when I’m nauseous I think about it and I picture myself over the toilet and it scares me even more.



Can you pinpoint when this fear began?

When I was in kindergarten I saw someone else throw up for the first time. It was this little kid called Kenny. He came out of a tiny playhouse and sat in the middle of the floor and just puked. I saw all these chewed-up pretzels, which we had been snacking on, and I got so upset. Everyone was running away from him, and I got really shaky and hid and plugged my ears. It happened again in fourth grade and that time I ran into the supply closet.



My dad was also really sick when I was growing up. He was in and out of the hospital, and he had nurses, but I don’t think I ever saw him puke. He passed away from an overdose when I was 10 years old. He was really ill (mentally and physically) and had numerous open-heart surgeries. His cardiologist gave him Oxycontin right before he was scheduled to have his latest surgery to repair his sternum, and he overdosed. I was the one who found him. I currently live with my mother, who has a lung condition. She’s on oxygen and also has stomach and bowel issues. Because her esophagus is herniated into her chest, when she eats a big meal and gets full she gets nauseous, and when she says she feels nauseous I freak out. It’s not an everyday thing but it is often, and I’ll never get used to it.



Do you remember a moment at which your fear got truly extreme?

The turning point was when I was about 15. I got tonsillitis and the stomach flu, and I’d never felt so sick in my life. That’s when I stopped eating when I feel sick, sometimes for days on end. Everyone thought I had an eating disorder and that I wanted to be skinny, and nobody would believe that I was just scared of vomiting. And then because you aren’t eating you feel even more anxious — it’s a vicious cycle. When you try to eat, your body is like, No! What are you doing? I don’t want that. It never ends. I’m always focused on my stomach. I think about my stomach constantly.



I tried to kill myself when I was 14 and following that I was hospitalized, and they overdosed me on lithium and I spent four days vomiting foam. That was one of the scariest experiences of my life. I was terrified. But I wasn’t anxious about vomiting — it just wasn’t on my mind. It was when I got tonsillitis and the stomach bug that the whole throwing-up fear began.



What’s a typical day like for you? Can you talk me through your routine?

After I wake up, I take my morning meds (Prilosec, propranolol for my heart, and some aspirin) then I spend the first hour of the day analyzing my body. Even before I get out of bed I’m thinking, “How’s my stomach today? Does it feel okay? Is it growling? If it is, is that because it’s hungry?” If I feel hungry then I know I’m not sick. I’ll smoke a cigarette while I gauge how my body is feeling. I’m on the lookout for pain, nausea, or anything weird. I don’t eat for at least three hours after I wake up and I’ll only eat if I know my stomach is okay and that everything is okay with everybody around me.

After I’ve eaten I wait for a couple more hours to see how it affects my stomach. In the meantime, I clean up the house, disinfect everything, take my dog out, check the mail, and try to stay busy. If I’m having a good day, I’ll eat more and more throughout the day, and some days I get brave and say, “Fuck it! I’m gonna eat whatever.” In the evening, I spend time with my fiancé, clean up after dinner, shower, and we lay in bed and watch Netflix until we fall asleep.



If that’s a good day, what’s a bad one like?

On a bad day, after my normal routine of taking my meds, I’ll realize I feel like crap and come to the conclusion it’s going to be an anxiety-fueled day. I’ll spend the day worrying about my stomach. I won’t eat in case it makes me sick. I’ll sip on water and chew gum or suck on peppermint candies. I’m usually in a bad mood. I just sit in a recliner with a heating pad and some ibuprofen and Sprite. I don’t get up, and I don’t talk to anybody. I make something quick and easy for my mom and fiancé to eat for dinner (but I won’t eat it), then I might try to take a shower and go to bed. I lie down, but my mind won’t allow me to sleep because I’m scared I’ll wake up in the middle of the night and vomit. So I usually just lie there until 4 or 5 a.m., fighting sleep, worrying, and trying to calm my stomach.



What other sorts of things do you avoid because of your fear?

I don’t work, and I opted to be homeschooled because I was scared of germs at school and of the thought of other students throwing up around me. I hate car rides with other people, as a lot of my friends get carsick, so I avoid that. Children are dirty and constantly sick, so I will avoid them at all costs. Waiting rooms of any sort are hard for me, whether it’s the DMV or a doctor’s office, because people are constantly coughing and sneezing, touching every surface, and they never wash their hands and I almost pass out from the panic. I hate going to crowded parties because people don’t wash their hands and that spreads germs like wildfire. I will not ride buses. I wash my hands much more than I should. I follow the 20-second scrubbing rule, and I have hand sanitizer. I never put my hands to my mouth, and I try to steer clear of anyone who is sick. When people tell me they think they just had food poisoning, I dwell on it, thinking, “But what if it’s not food poisoning? What if it’s a stomach virus and I was just talking to them?” I get incredibly antsy and immediately think, “When was the last time I ate? Do I have anything in my stomach that I might throw up?”



If I’ve been around someone who has a stomach bug I won’t eat until the incubation period has passed and I sanitize even more than usual and I make sure I keep washing my hands and I’m a wreck during that window of time — I watch for symptoms to show up and I just shut down. After I’ve cleared the incubation period, I calm down and get back into my routine. But I think about it nonstop and usually make myself feel sick, which then convinces me that I’ve caught it.

What about sex, or other intimate situations?

Sex and intimate situations with my fiancé (I’ve only ever had sex with two people) are no problem for me. He usually washes his hands as he should, and is a particularly clean person. If he’s sick, I will take care of him, all whilst taking any precaution I can to avoid contamination.

How has your phobia impacted your social life?

I’m scared of food, and I don’t drink alcohol. And when you’re out with people there’s always food and alcohol around, so I can’t really hang out with friends. Even watching a movie at a friend’s house is a risk because there will be snacks or someone will decide to order a pizza, and I go, “Oh no! Here we go again. Here’s food. It might make me sick.” I question my fiancé a lot and monitor how he’s feeling. I ask him: “Are you going to throw up? Is your stomach okay?”



So what sort of food do you eat?

I have a list of foods I consider safe.



What’s a “safe food”?

Things that haven’t ever made me sick or things prepared by me, this is the only food I will eat. My safe foods are pretzels, Cheez-It crackers, toast, boiled chicken, homemade beefs and noodles or homemade chicken noodle soup, steamed or boiled carrots, potatoes and noodles, cheesy poofs, and these little things we have here in Ohio called smiley fries, which are smiley-face-shaped fries with mashed potatoes inside — I nuke them or bake them.



What sort of foods do you consider unsafe?

Seafood, shellfish, and sushi are definite no-goes: They terrify me. Ground beef freaks me out (a few states around here recently had a contamination scare. There were no reported illnesses, but I won’t touch it. If I hear news about a recall I won’t touch whatever was recalled ever again) and so does anything spicy or with barbecue sauce. I don’t eat Chinese food. I stay away from butter, red pasta sauces, spaghetti, pizza, Hot Pockets, pizza rolls, or anything like that because they are heavy on my stomach. I never, ever, drink regular soda or tea (only caffeine-free stuff) and onions scare me. I eat chicken but I have a hard time with it, so I constantly check to make sure it’s fully cooked, and I’ll freak out for a while after eating it. I do not eat at buffets. I won’t eat salads unless they are prepared by me. When I cook I burn everything. I don’t mean to but I worry about getting sick from undercooked meat. I won’t ingest raw egg, and I don’t eat cookie dough. Even if the expiration date is still good, I’ll put eggs in water to see if they float.



Do you ever eat out?

No, never. The last time I went out to eat was over a year ago when my cousin was visiting, and we went to a steakhouse. I had a Reuben sandwich, fries, breadsticks, deep-fried mushrooms, and tons of other appetizers. I miss it so much; it was so much fun.



So do you ever eat food that’s prepared by someone else?

I’ll do drive-through at Burger King or Arby’s, but I’m really funny about eating stuff I haven’t made. At Burger King, I get chicken tenders or nuggets with French fries and a water or Sprite, and at Arby’s I get either a turkey sandwich or roast-beef sandwich with fries or mozzarella sticks and a Sprite or water. I order the same thing every time. I’d never, ever, eat anything fresh and never, ever, a sandwich. I’ll only eat food that I know has been thoroughly cooked and that I haven’t had a bad experience with.



Do you have any rituals or crutches that you depend on to calm you down?

I pace a lot and sometimes, I’ll chain smoke. Sipping on ice water helps me if I’m nauseous or if someone around me feels sick or if I’m dealing with the possibility that I’ve been exposed to germs. I chew a lot of gum, and I have hard candies. When I start to panic I try to distract myself; sometimes I’ll clean. I have Xanax but I don’t like to rely on anything like that, and I keep antiemetics with me to help calm me down and help settle down my stomach, but I try not to take them too often because I’ve taken so much I was in danger of paralyzing my stomach muscles. I drink ginger ale and Sprite and stuff like that. Sometimes I can breathe in through my mouth and zone out into space, but I usually don’t have a warning before I’m in full-blown panic mode, and then I have to bring myself down.



Do you think your fear will stop you from having children?

I’ve been with my fiancé for eight years and we are not ready for kids, but I’ve thought about pregnancy and the morning sickness and the prospect of caring for a sick child and it all scares me. When little kids vomit it’s worse than an adult vomiting. They’re upset and messy, and they get it everywhere. I couldn’t deal with that as a mother. Even when my dog gets sick I freak out and have to leave the room. I don’t think I’d be suited to having kids if I can’t even take care of them when they’re sick.

What happens when someone close to you gets sick?

It happened on Saturday. My best friend got hammered and threw up in my car. I pulled over and I just plugged my ears and hummed, and I was just shaking. My heart was racing.



What’s the hardest part of the day?

Nighttime. If I get nauseous before bed I get my mom to stay up with me rubbing my back until about 7 or 8 a.m. I hate nighttime. It always seems to hit me then. I always take at least half an antiemetic before I go to bed so I’m not as freaked out in the morning. That’s the only time I take it. My thing is worrying about waking up in the middle of the night and feeling sick. Every time I’ve woken up in the middle of the night it’s because I felt like I was going to puke. So whenever I startle awake I’m like, “Oh my God! Why am I awake? Am I nauseous? Am I going to get nauseous? Am I going to puke?” My mom is the one who usually calms me down. I’ll let her know I’m freaking out because my stomach feels funny or I’ve been around someone who is sick, and she’ll try and talk to me about other things and take my mind off it. We’ll watch a movie, or she’ll rub my back.



What’s the worst panic attack you’ve had?

I had a nervous breakdown in a hospital bed. I hadn’t eaten for over a week, and the doctor told me that I had starvation-induced metabolic acidosis and if I didn’t eat my organs would shut down. My fiancé and our friends were there and I was crying and snot was running out of my nose. I was hooked up to a heart monitor and IVs and they were like, “Please! Just eat something!” And I was like, “No, because it’s going to make me vomit.” I felt like the world was ending. I was screaming so loud doctors and nurses came rushing in from other rooms. I was scared because I knew what was going to happen, I was going to be forced to eat, and I just wanted it all to end; I wanted to go home and just wake myself up from this nightmare.



Eventually the doctor sat with me and just asked what was going on. He came to the conclusion that I’d had a nervous breakdown and loaded me up on so much anxiety medication I couldn’t stand. I eventually came out of the acidosis and was able to go home, but I didn’t start eating. It still took a few months to come back from all of it and get my body where it needed to be.



Have you ever spent a night alone? Do you think you could?

No. I’ve spent nights alone in hospital, but that’s the most alone I’ve been. The thought of it scares me so much: If something were to happen and there wasn’t anyone there to comfort me or take care of me what would happen to me?



Does your fear prevent you from working?

I’m not doing anything right now. I do plan on going back to work, but I’m not sure what I’ll do. I don’t want to do anything too public, where I have to be around a lot of people or handle money. I’m still freaked out about that but I don’t plan on staying a recluse for the rest of my life. Looking back on it, I really don’t think I would go back to being a nursing assistant. I did really well with it, but I couldn’t physically be there when patients were vomiting. I thought about nursing school and that just freaks me out too much. I’ve never been a cashier but I know how dirty money and people are.



Have you ever sat down and analyzed what’s at the bottom of this? Have you come up with a grand theory about your phobia?

Yes, the last time I was in the hospital I really wanted to try and figure it out for myself. I came to the conclusion that for me, it’s about not having control. I was always the person who took care of everybody else. When I would get sick I would get right back up and take care of everything and everybody, waiting on them hand and foot. I loved that, it just felt like what I’m here to do. When I was growing up, with my mom being sick and my dad’s death, everyone would always tell me, “You’re so strong! You’re so strong! I don’t know how you do it!” But when I’m sick, I’m so vulnerable and all of that goes out the window. I have no control and I think, “What if I get so sick I die?” “What if this is it?” “What if I can’t quit throwing up and this is going to be the rest of my life?”

This interview has been edited and condensed.