"it's different this time"

This is usually how one of my emetophobic anxiety attacks plays out.

I notice something happening in my stomach. This leads me to think/say "I don't feel well."

I try to pinpoint the cause. In fact, I want to know the exact cause, which then leads to frustration, because that's almost always impossible. If I ate three different things an hour ago, I might spend way too much time and brainpower arguing with myself about which of the three things would be the most likely to make my stomach hurt.

I start assessing how bad the unpleasant feeling is. This is where things can quickly spin out of control. It doesn't really matter how bad the feeling is - what matters is how anxious I am. If I'm not careful, if I don't do something to try to calm down, I will soon arrive at the conclusion that this feeling is somehow different than any stomach-related feeling I have ever had before in my life. It's more severe, or it's in a different part of the stomach, or it feels like there's more _____ this time (churning, bubbling, flipping, whatever).

"It's different this time" - four words that I should never say, but I say them far too frequently. Other variations: "this feels different" or "what if this is something different?"

Sometimes it's not even the feeling itself that leads me to this "conclusion." Sometimes it's that I feel I was exposed to some illness a couple days ago, so this feeling MUST be related to that and therefore, it's different, where "different" really means "the moment I'm finally going to get sick."

From looking around at emetophobia blogs and forums, I can tell this thought is not unique to me. It seems like most, if not all, emetophobics get hung up on this idea of stomach pain being "different this time."

Maybe it's not only emetophobics, but all people with anxiety. One of the main cognitive distortions an anxious person will struggle with is catastrophizing, and if you are telling yourself "it's different this time" you are catastrophizing. Instantly you have changed something that is benign/harmless to something huge and scary. You have taken something you can handle, something you are familiar with (stomach pain for emetophobics, a panic attack for those with panic disorder, etc.) and made yourself believe it is unfamiliar and unmanageable.

You're basically saying "though every other time has been fine, this time I am clearly in great danger." Even if you don't fully believe that, that's the message you are reinforcing with your words, and it will only lead to more anxiety.

It seems like emetophobics have a kind of amnesia when it comes to their stomachs. With all the times in my life I have felt "sick," and all the times I have thought or said that what I was feeling was different than anything I had felt before, it's impossible that I could be right all those times. There isn't an unlimited number of unpleasant stomach sensations. If I am able to calm down some and then reassess, it's rare that I still believe it is a brand new feeling.

I think this irrational thought is one of the most harmful for me, so I have been putting a lot of effort into correcting myself whenever I catch myself thinking or saying it.

It is not different this time.
The truth is, I have been through this many, many times before.
I have had this same feeling at some point in the past and lived through it.
I know I can handle this. I'm practically an expert.
This feeling will pass.

regressing

The person I was going to meet for dinner cancelled, as they ended up not having enough time during their vacation to make the long drive over to my area. I can't say I wasn't partially relieved. I had been stressing about it every day. But at the same time, it would have been nice to prove to myself that I could get through a situation like that.

Then last weekend a friend came to visit and stayed with us. I had so much fun hanging out with him, but my anxiety spiked. Which was both surprising (because I'm close to and comfortable with this friend) and annoying.

We went on nature walks, and because it was hot, I worried I would get heat stroke and throw up. Or I worried I was overexerting myself, and that would make me sick. We went out to eat twice. The first time (breakfast) was absolutely fine, but the second time (dinner) I wasn't hungry, probably due to anxiety, and I was anxious that this meant I was getting sick and would throw up. We did a bunch of other things too. By the end of the day I was exhausted - it was more activity than I am used to - and then I worried I was sick because I felt tired! I had to repeat affirmations in my head in order to fall asleep and then woke up in a half-asleep panic at around 2 in the morning, feeling "sick" and trying to figure out where I could go to be sick in private, if it was going to happen.

I hardly ever wake up feeling like this anymore.

I feel like I've hit some kind of wall. I don't experience much anxiety anymore, but I guess it's only because I feel safe, because I'm only hanging out on a "narrow strip" of my room, as Rilke would say. I don't expect these (pretty minor) challenges to throw me so much, because I'm feeling so great most of the time. I really need to find more things to do around here that put me in situations where I am uncomfortable. I hate to think this is as good as it gets. I want to be able to go into any situation without returning to the mess I used to be.

making plans

I've been noticing that I'm afraid of making plans. I've pretty much always been that way. I hate telling someone days or weeks in advance that I'll meet them at [insert time] at [insert place], preferring to either have more casual (non-)plans or to make plans at the last minute. I think this is a result of the anxiety I've always had and knowing that if I make set-in-stone decisions it's harder to undo them later when I become too anxious to follow through. This has happened several times, and it's difficult and embarrassing to get yourself out of something you've already committed to. At a certain point I just started thinking 'I'll probably end up chickening out anyway, why bother?' and I still have that mentality.

It's clearly not leading me anywhere good. For one thing, most of the time I immediately decline invitations, not even wanting to get into the whole back-and-forth 'should I, should I not, what if' cycle of thinking. Then I end up missing out on a lot of potentially fun and/or rewarding experiences, sometimes even beating myself up about it or feeling plagued with regret. It's not even usually regret about any one specific outing, more a cumulative regret at this point, a feeling that I am missing out on almost everything.

Also, not-making-the-decisions becomes a strong habit. When I do agree to hang out with someone, I hem and haw about the specifics, asking them what they want to do, where they want to go, etc. until they have made all the plans and I end up in a situation even more unpleasant. Until recently, it never even occurred to me that I could take matters into my own hands and suggest times/places that would be more comfortable for me. Just the idea of doing so still makes me feel guilty, like it's wrong for me to be allowed to make choices.

I've been trying to stay aware of all this, and today a situation presented itself that gave me the perfect opportunity to break my habit. Someone I know (although not that well) is taking a vacation next week and will be close to where I live. So they emailed me and asked if we could get together one evening.

My first thought was 'there's no way I could handle that, I've got to think of some way out of it.' After I talked myself past that, I wrote her back saying yes and asking what she wanted to do (the habit takes control yet again). Finally, I sent a second response with a specific restaurant where we could meet. It's a place I've been many times, so I know how to get there, what I could eat there, and that I'll feel more relaxed in general being in a familiar setting. Better able to handle any anxiety brought on by the food or socializing.

This seems like such an effective strategy, I don't know why it took me so long to realize it and start taking advantage of it. Now I won't have to spend the next week looking up directions, taking practice drives, or obsessing over an online menu, trying to find the perfect "safe" dish. Not that I should be doing any of those things anyway, but it's nice to be able to take something extremely stressful and overwhelming and turn it into something slightly more manageable, even if it will still be a challenge.     

accomplishments

I finally did it. I made a doctor's appointment for a check-up. It's at the end of August, and I'm already really worried about it. I can't even put my finger on why exactly, but I guess it's a fear that I'll find out I have some horrible health problem. Or that I have one, but it won't be identified, because I will forget to bring something up or describe something incorrectly. I feel like I should make some long list of all my concerns to take with me, so I don't forget anything. But that would probably be annoying, huh?

I also have been trying to take better care of myself physically - exercising and eating healthy. I wouldn't say I'm doing either enough, but I'm keeping it in mind as a constant goal, and I have been doing better than usual. Last Friday I took the day off work and dedicated the day to relaxation. I didn't speak all day (just thought it'd be nice to have an atmosphere of absolute quiet). I tried to eat all my meals mindfully. I took a long walk around town (it was a gorgeous sunny day) and then did about 45 minutes of yoga. I worked on some writing projects and then later that evening, I listened to my meditation CD. It was the perfect vacation day.

Then over the weekend, I went to see the new Pixar movie Brave. There were of course children in the theater, and as a general rule, I try to stay away from them. They scare me quite a bit, because I see them as being constantly sick. Seriously, it seems like my (almost 2 year old) nephew is sick with something different every single week, sometimes things I have never heard of. But I was able to handle the movie without feeling much extra anxiety. I tensed up slightly every time one of the children walked by me and kind of leaned away from them. That was about it. The movie was incredible, by the way. It was the best kids' movie I've seen in a long time.

After the movie, I went out to eat at a restaurant I've only been to once before. I was really hungry and ate a lot, including dessert. I only had a little anxiety, and it was in the car after leaving, when I realized how full I felt. But it (the anxiety) passed quickly.

I'm so happy with all of this. I feel like I'm doing really well, other than freaking out about the doctor's appointment. It's not for a while, which could either mean I have plenty of time to calm down about it or that I have plenty of time to get more and more anxious. Of course, that's up to me and what I choose to think, so... time for affirmations! 

blah

I haven't had that much emetophobic anxiety lately. I even went out to dinner recently and ate until I was overly full and didn't feel the slightest bit worried about it. I can't remember the last time that happened. So there's the good news.

But I've been having tons of anxiety about my health in general. I keep noticing little aches and pains and feeling like there is something wrong with me. Plus I feel low-energy. All of this could, of course, be caused by anxiety and anxiety alone. But how can I know for sure? I can't. I can't know anything for sure, and my refusal to accept this is basically the root of all my problems.

My only option really is to start up an anxiety-fighting regimen again to see if that makes me feel any better physically. I think the main area I need to focus on is exercise. But I also bought a CD player for the bedroom so that I can listen to guided meditation CDs in there, away from distractions (naughty cat, TV, noisy air conditioner).

And I'm trying to work up the courage to make a doctor's appointment. This was one of my New Year's resolutions, to get a check-up this summer, and now it's summer, but I've yet to make the appointment. It'd be nice to be officially told there is nothing wrong with me, and then I'll have that as ammunition against all these irrational thoughts.

signs of emetophobia as a child

I haven't ever known someone else with emetophobia in my "real life" (offline). I did have a strange indirect encounter with it several years ago when I happened to hear one of my bosses talking on the phone about her seven year old niece being hospitalized for refusing to eat while sick, because she was terrified of vomiting.

I don't really like telling people about my phobia in detail, and it especially seemed weird to tell my boss, but after hearing that, I couldn't resist emailing her and attaching some websites with more information. She thanked me for the information and said she would pass it on to the girl's mother. We never talked about it after that (which was a relief to me), so I don't know what happened with the girl, but I hope that if she did have the phobia, she got help for it early on. I know from experience that it only gets worse and more ingrained as you get older - you keep developing more and more avoidance behaviors.

I can think of so many obvious red flags from when I was younger that I'm sometimes shocked my family missed them:

• The biggest one, of course, being that whenever someone around me vomited, I would become upset or panicked. When I was very young, this usually bordered on hysteria. I can remember one time in a restaurant where I catapulted over a chair and ran out of the building to escape (and refused to go back in). As I got older, I tried to hide the response more, but I still would usually walk away quickly, avoid looking at the person, and then get extremely upset if I had to be in a confined space with them. I would try not to breathe or would bury my face in something thinking that might protect me from the germs. I would cry or sulk. Sometimes I would get really angry and be hostile to everyone around me.
• There was a time period (not sure how long it lasted) where I decided it was not safe to touch my food at all and would lift my plate or bowl to my mouth and eat like an animal.
• If anyone in the house was sick, I stayed in my room as much as possible. I tried to eat very little. I would sneak "safe food" into my room like individually wrapped packs of crackers. I was afraid to use the bathroom where someone had vomited, which usually meant I would start using my parents' bathroom, because the sick person was almost always one of my sisters.
• I can remember at least a couple freak-outs over me getting a little food stuck in my throat. It wasn't even enough to make me cough, but I still feared it meant I was choking, and that could lead to vomiting. One day my mom explained to me that I wouldn't be able to breathe or talk if I was choking, so then those panics stopped.
• I became extremely opposed to taking vacations with my family, because someone would usually get sick on them. When I vomited last, I was on one of these vacations. I also once had to spend eight hours in a car with my family after one of my sisters had almost vomited that morning.
• I would miss school because of my stomach hurting. From second to fourth grade, this happened rarely, about twice a year. In fifth grade, I had a period of about two weeks where I went home or stayed home every day. Each time I tried to go back, my stomach would hurt again as soon as I got into class, and I would have to leave. Since I was perfectly healthy, people were all over me asking what was "really" wrong, but I didn't know what to tell them, because I had no knowledge of anxiety at that point. In the years after that, I still sometimes went home "sick" because of panicking about something I imagined I felt, but never that many days in a row. I would say it was probably about seven days a year, spread out.

Those are all the signs I see looking back, and I imagine they'd be similar for any child developing this phobia. Not that I'm in a position to give parenting advice, but I would hope that any parent who saw their child exhibiting such irrational and anxious behavior would sit down with them and try to talk to them about it. And then if it does turn out that they fear vomiting, get them some counseling. I'm sure it's much easier to get something like this under control at a young age, maybe even cure it completely.     

dentist anxiety

I had to go to the dentist today to get some filling work done. They gave me a tiny partial filling in one tooth, and they also removed a filling I got when I was a child (one of those old mercury ones) and replaced it with the upgraded version.

I'm surprised at how anxious I was. This procedure was nothing compared to the wisdom teeth extraction, but for some reason I had lower anxiety during that one. Maybe just because I had lower anxiety in general back then.

I wish I was more comfortable talking to people (like dentists, doctors) about my phobia. I always think to myself that maybe I should give some brief explanation before they do whatever they're going to do, but I usually chicken out. They see I'm anxious, but they assume it's because of the pain, so that's what they reassure me about. I don't worry about the pain that much. I worry about all the objects and substances being shoved in my mouth, especially the substances. I worry about my mouth being numb. I also don't like being horizontal while they're doing all this, and I really hate it when they adjust the chair to the point where my head is lower than the rest of my body. It's awful to feel like you're upside down when you're anxious.

There were all these nasty tastes in my mouth after a while, and I could feel myself getting very scared. I was starting to feel "sick" and could feel my heart pounding in my stomach. Sometimes (here being a good example) I'm almost grateful for my social anxiety, because I fear that without it I would be much more likely to escape situations, to sit up right in the middle of my filling and say "okay, I'm done here." But I don't want to embarrass myself, so I search around desperately for things to tell myself to make myself stay, like:

• They do this procedure all the time. They can't possibly expect that whatever they are putting in my mouth would cause nausea/vomiting. If they did, they would have something ready in case of that happening. They would have warned me.
• My heart is pounding. This is clearly anxiety. Don't forget to keep breathing, slowly and calmly.
• Even if I did vomit, it's not as though this is a normal public place, like a mall. It's like a doctor's office. I wouldn't have to feel as humiliated about it here.

If I can visualize my mouth as disconnected from the rest of my body, it's easier. All the numbness and drilling and other stuff is going on there, not anywhere else. I can use my nose for breathing. I don't have to swallow. I just pretend it's not a part of me, or at least not a part that I need for the moment.

The procedure only took about fifteen minutes. When I sat up at the end, I discovered I was really shaky, so walking out to the car felt weird. Also, once I started driving, I started feeling even more "sick" and had to pull into a parking lot and sit for ten minutes to calm down. I had a bottle of water and probably would have felt better if I had rinsed out my mouth, but there's the downside of the social anxiety. I couldn't talk myself into doing that where other people could possibly see me. So I just took sips of the water instead, which helped a lot. Every time I swallowed a little water, the sick feeling went away temporarily, so I started driving again and kept taking sips all the way home. By the time I got there, I was feeling better.

I know I should be proud of myself for getting through it. I won't have to worry about it anymore, and it's nice to know I no longer have mercury in my mouth. But man. Right now I just feel wiped out. Anxiety is exhausting.