account of living with emetophobia

I came across this post on tumblr the other day describing what it's like to have emetophobia. It's a really good explanation of the various associated behaviors. My favorite part (so true, and the reason why I think emetophobia is in a league of its own when it comes to phobias in general):

"I’m scared of spiders, but my fear of spiders doesn’t spawn new spiders to come after me. However with emetophobia, my fear of vomiting creates a very real sick feeling."

This is why I wish there was more psychological research being done on emetophobia specifically (and similar anxiety issues, like general health anxiety), because this kind of physiological feedback loop adds another dimension that people who are afraid of heights or dogs or clowns are not experiencing.

logotherapy

I recently read Viktor Frankl's book Man's Search for Meaning, which is both a memoir about his experiences in concentration camps during the Holocaust and an explanation of his therapeutic method/theory called logotherapy.

It was an amazing book, as I knew it would be. I had wanted to read it for probably two years and kept putting it off because I was afraid. For the past two or three years I have been trying to avoid books, movies, news articles, etc. that I thought would make me have any kind of strong emotional reaction. My anxiety issues had gotten so bad that whenever I felt extreme sadness or fear or disgust I would feel "sick" or worry that the emotion would make me lose control or go crazy in some way.

Over the past few months I've been testing this boundary. I've watched a couple horror movies I had never seen before. I read a few books that were really sad or had disgusting parts. Nothing bad has happened. I enjoyed the movies and books and didn't freak out. Probably the ultimate test was going to see the movie August: Osage County last weekend. This one took me by surprise, as I actually thought it was going to be more light-hearted than it was. The previews showed a lot of Julia Roberts / Meryl Streep banter that reminded me of the interactions between Lorelai Gilmore and Emily Gilmore. But the movie was not like that at all. It was dark, dark, dark. From the very first scene, I became tense and felt kind of queasy and upset through the entire thing. I even thought about walking out at some points. But I stayed, and I felt like that was the final proof that I can handle pretty much any form of entertainment again.

Back to Man's Search for Meaning. I loved it and was extremely interested in the concept of logotherapy. I didn't know much about it. Basically it focuses on searching for the meaning in your life rather than trying to solve the problem of suffering (because there will always be suffering of some sort). From the wikipedia page:

"Frankl’s concept is based on the premise that the primary motivational force of an individual is to find a meaning in life. The following list of tenets represents basic principles of logotherapy:

• Life has meaning under all circumstances, even the most miserable ones.
• Our main motivation for living is our will to find meaning in life.
• We have freedom to find meaning in what we do, and what we experience, or at least in the stand we take when faced with a situation of unchangeable suffering."

The concept is appealing to me. I feel like what started to make me feel happier about my life was trying to ignore/minimize my anxiety and focus on the rest of my life instead ("Goals" from my list of coping techniques). Realizing that I would probably never get rid of this phobia (or anxiety in general) completely, and even if that was true, it didn't have to be my entire existence or identity.

It's as if a person wants to cook breakfast, but there is a giant box taking up most of the space in their kitchen. They are still able to make the meal. It's just a little more difficult because they have to work around the box, make sure not to trip over it and spill food, make sure not to stub their toe or bang their knee on it. I'm trying to think of anxiety as being like that annoying box. What's my objective? What do I want to do? Once I know that, I can figure out the exact ways that my anxiety will present itself as an obstacle. Then I can figure out (using various other coping techniques) how I can deal with that anxiety and do what I want to do anyway.

It's worth working around the box to get the delicious meal in the end. And even if the worst happens, like you trip over the box and spill all your ingredients, then you would just have to start over. Go to the store. Get new ingredients. Try again. Because you can't just not eat. And living your life and going after your goals, finding your purpose/meaning, should be as vital as eating.

One of my favorite quotes from the book:

"What man actually needs is not a tensionless state but rather the striving and struggling for a worthwhile goal, a freely chosen task. What he needs is not the discharge of tension at any cost but the call of a potential meaning waiting to be fulfilled by him."

mastering restaurants and other things

It's been way too long since I posted here. Last month I was working on another writing project and this month I've been preoccupied with Christmas, trying to think of what to get everyone. Other than that, not much has been happening.

I can only think of two emetophobia-related incidents that happened recently. One good, one not so good.

The not so good one was a couple nights ago when I went out to eat with my wife. I've got to say, I think I've generally been doing really well with eating out at restaurants. I finally figured out how to deal with the situation, because two things happen to me when I eat at a restaurant. One is that I switch over to my "restaurant stomach" or in other words, my stomach appears to shrink in size. I know it must not actually be shrinking, but because of anxiety, I can never eat the amount in a restaurant that I could eat at home. But I always used to anyway. Out of habit, I would eat the same amount of food I typically eat at a meal, and then end up feeling awful. Now I have caught on to this and am forcing myself to eat way less. It usually means I don't even come close to finishing my meal, but oh well. Then I have tasty leftovers to eat later at home when I have my normal stomach back.

The other thing that happens because of anxiety: my throat becomes tight, feels more closed up, and this is mainly where I am still running into problems. I don't tend to notice this sensation in my throat, because it's very subtle, and it's a symptom I'm not that anxious about. But then sometimes when I swallow a bite of food, it feels stuck or like it's going down the wrong way or like I'm choking. That combined with the worries in the back of my mind about throwing up leads to a giant spike of panic. Which is what happened the other night. I'm talking to my wife, everything is good, and then suddenly I get this terrified look on my face as I panic that I'm choking or am going to throw up. The panic was over within a few seconds (aside from my heart continuing to pound for a while) and then I just felt silly and embarrassed. I'm pretty sure no one but my wife saw that look on my face, but the fact that I could not control it made me think about how awful it would have been if someone else had seen it. And made me flash back to all the many, many embarrassing incidents in my past where someone else did see a look like that on my face, including people who had no clue what was happening to me.

I guess I just need to keep this in mind when I go out to eat. Chew more, be conscious of swallowing and such. Sometimes I wonder if it's a good idea to work around these sensations because it feels like I am working with my anxiety instead of against it. But I don't seem to have much of a choice. I regularly go out to eat and that anxiety (so far) is not going away. The level of anxiety varies, of course, based on a million factors from my mood to the weather to whether I watched a movie/show earlier that day that showed someone vomiting. But there is always some level there, so if I want to be able to go out to eat at all, I need to adjust to these two symptoms. And like I said before, I think my adjustments are working out and making it so I can actually enjoy going out to eat, and that's nice. Not something I'm used to being able to enjoy, ever. Even with the brief panic the other night, I feel like the meal was a success.

Now for the good emetophobia-related incident. A friend came to stay with us at the end of November. He visits us pretty frequently, and over the last few years, I have been having a difficult time with these visits. Just like with going to restaurants, having someone stay with us makes my base level anxiety go up, and what tends to happen is I start getting a lot of stomach aches, almost constant stomach aches, especially if we go out anywhere. And when your friend comes to stay with you, they don't want to just sit around your house the entire time. And to make things even worse, I find it almost impossible to hide the fact that I feel sick and miserable or to keep quiet about it. So this friend has had to hear about how I don't feel well a ridiculous amount of the time, and it's a wonder he still comes to visit.

I'm sure you know where this is going. This last visit was practically PERFECT. It was the best time I've had hanging out with him in so long. I can't even say for sure why it went so well. Probably because I expected it to. I was feeling really great physically before he showed up, and I just felt confident that I would continue to feel great, that I could keep up the momentum of feeling good, if that makes sense. I was determined to. I've been feeling very guilty about what a terrible friend / hostess I've been.

As soon as he arrived, we went out to eat, and I ate more than I think I have in several years while at a restaurant with someone other than my wife. After that, we went somewhere else before going back home, which would normally make me very anxious (I always want to go straight home to digest and recover from the experience), and I was fine. We also went to see the movie Catching Fire (second in the Hunger Games series), and it was opening weekend, which meant the theater was completely packed. I was sure I would end up panicking at least a little during the movie, but nope, didn't happen, and I even had some popcorn. Also, he takes a bus when he comes to visit, and the bus station where we pick him up is a long drive from our house, about two hours one-way. I got through all eight hours of driving without any high anxiety periods (seriously, a miracle)!

It was like I was a normal person for a whole weekend. He's coming to visit again in about two weeks, and I'm excited. Because now I know it's possible, that I'm capable of handling it without any problems. Maybe it won't be absolutely perfect again, but I'm at least positive that I won't be the complete downer I've grown so accustomed to being.  

emetophobia and high school

I hate having emetophobia, obviously. It impacts every area of my life and generally makes everything a little more difficult. But I’ve been thinking lately about what it was like to have this phobia during high school, and I have to say that was probably one of the biggest challenges I’ve ever faced – getting through every single day of those four years while having to deal with this fear. I’m so glad to have that behind me and have the utmost respect for anyone still in that situation, because it is incredibly difficult.

You are pretty much trapped in one building for the entire day, going straight from one class to another. You have all the usual stress of schoolwork, interacting with your classmates (some of them nice, some of them psychotic), interacting with teachers and counselors and administrators and security guards and bus drivers (some of them nice, some of them psychotic), and then when you add anxiety issues and panic attacks to all of that, things start to get incredibly messed up.

I definitely made the situation worse, because I didn’t take care of myself physically in any way. I thought it was fine to get four to six hours of sleep a night. I usually skipped breakfast and sometimes lunch too. Many days I just ate one giant meal after I got home from school and that was it. Plus my diet consisted mostly of things like frozen pizza and soda (yes, tons and tons of caffeine), which I guess is pretty normal for adolescents, but definitely not healthy. I wasn’t even really aware at the time of how unhealthy all this was, but I’m certain it’s the reason I had horrible stomach aches so frequently.

I’ve been remembering some of the ways I used to cope with these stomach aches and the anxiety that came along with them. For the most part, my coping skills back then were pretty unhealthy and I would not recommend them, but I’m going to list everything.

***
1) Probably my main coping mechanism was to dig my nails into my skin (usually the backs of my thumbs or other fingers) as a distraction from my stomach hurting. Not the worst form of self-harm, but it did sometimes leave marks that were embarrassing.

2) I skipped school a lot more than I should have because of feeling “sick” when I woke up in the morning.

3) Along the same lines, I went to the nurse’s office an abnormal amount of times and sometimes went home early from school. This fluctuated. I went through periods where I was in the nurse’s office almost every day, and other times it would be more like once a month.

4) I guess you could say skipping breakfast/lunch was a coping skill I used, although a really bad and counterproductive one. I was even afraid to drink anything at times and would end up dehydrating myself.

5) I would leave class to go to the bathroom just to calm myself down. Getting myself out of the classroom where I felt trapped would usually make me feel a lot better, and then I could convince myself that whatever was happening was mostly in my head. But obviously I could only do this one time per class, so I had to try to save it for when I really needed it. Sometimes I would break down early and then regret it later in the class.

6) In my notes for class, I would draw lines, each one representing a minute, for however many minutes were left in the class. I would watch the clock and keep telling myself “I can get through this next minute. I can get through this next minute” and then scribble through each minute line as the minutes passed.

7) I had a bunch of questions I asked myself to try to determine if I was actually ill, like "if I was home right now, would I still be feeling this way?"

8) I heavily relied on my friends. I was open with almost all of them about my phobia. Most of them understood, even if some didn’t grasp the full extent of the problem. My closest friends knew almost everything about it and were an amazing support system. It was so great to be able to talk to them and have them reassure me. They had mental health issues of their own, and we actually had a simple hand code to communicate with each other about how we were feeling (for when we were around a lot of other people, or when we were in class but sitting across the room from each other). Holding up a hand meant “are you okay?” or “what’s going on?” Then two fingers meant the person was sad, three fingers meant the person was fine, four fingers meant the person was anxious. One finger was the response that only I used. It meant “I feel sick” and everything implied along with that.

After a while we started using these numbers in our notes/emails and when speaking to each other too. I can remember many times answering the question “what’s wrong?” with “I feel one” or “oneness.” Even though “oneness” is basically a philosophy of unity/harmony to everyone else in the world, it will always make me think of feeling anxiety-related sickness.

Anyway, having that code and knowing that I usually had someone around who would understand how I was feeling was a big comfort to me.

***

I would say numbers 5-8 are the only good responses, and #5 is iffy since it’s better to wait out your anxiety than flee the situation you’re in.

I so wish I had been aware of all the anxiety-reducing techniques I know now during those years. I know just making the changes to my diet and sleep schedule would have had such a huge impact on how I felt, and using affirmations, mindfulness, and breathing techniques would have helped with the rest.

But I would recommend telling friends if at all possible. Unless your friends are jerks and you know they would only use the information to make fun of you or torment you (in which case it might be a good idea to get some new friends), having them know takes so much pressure off. Before I started telling people, it felt like this huge weight/burden and this shameful secret I had to keep, and that tended to make the anxiety attacks even worse, feeling like I was not just trapped in the situation and in the feeling of anxiety but also trapped inside my mind, alone, with the secret of what was happening to me.

I still find that in any situation where I feel anxious, if I can say it out loud to the person I’m with, it helps diffuse a lot of the anxiety. And most people are understanding about it, many more than I would have imagined back when I tried to hide it.

In general, I was embarrassed by the way I acted a lot of the time in high school. I’m still embarrassed thinking back on some of these things. So I just want to say that if anyone reading this is in high school and feels this way, cut yourself some slack. Emetophobia and high school don’t mix well. You’re basically a superhero for every day you deal with both. Whatever you can do to get through it (aside from hurting yourself/others), it won’t be that big a deal in the long run. And college (where you have a little more freedom to design your schedule and can include breaks between your classes) is not nearly as terrible.

obsessive thoughts

I can't decide if I'm doing a particularly good job lately of living by the "emetophobia shmemetophobia" motto. I guess in some ways. But I've been noticing many areas where I need serious improvement.

I volunteered to help out at an event at my old college this weekend. I was at a registration table for some of Friday and most of Saturday, which meant having to socialize with a lot of people (and reflect on how terrible my social skills are, but that's a whole other issue).

It was early afternoon on Friday when I first got there, and one of the very first things that happened - I mean, probably within fifteen minutes of me showing up - was that a janitor walked by and stopped to inform me that I should be glad I hadn't been around this morning, because someone had thrown up in that room. She of course didn't know about my phobia and was just following that weird custom of gossiping about any vomit one has seen or heard about recently. I don't quite understand why people love to do this - maybe they feel compelled to because of their own disgust over the situation. I've encountered it many times in my life, but this was probably the first time in several years. It gave me déjà vu, because it's always so similar with the person lowering their voice and giving you this sly and almost gleeful smile. I've got something good, it's really really good, it's going to make me super popular with everyone, because it's about vomit! It's stuff like this that makes me want to stay home and never interact with anyone again.

She didn't give too much detail except to say it was "gross" and that it had all been cleaned up, but after she left I could not stop thinking about it. Wondering where it had been. Was I sitting right on top of it. Wondering, of course, if it had been from sickness or drunkenness or something else. I couldn't let it go, and it tainted the whole weekend for me.

My one success is that I still ate, and I ate pretty normal amounts. I'm proud of myself for that, because having heard this story, I didn't particularly want to anymore. I also only had one brief period (about five to ten seconds) of feeling on the verge of panic because of imaginary "sick" feelings. The rest of the time I felt fine.

But I couldn't bring myself to eat in the campus dining hall (the closest available food) and walked to a restaurant in town instead. The dining hall is buffet style, and I kept thinking the most likely way to catch any sickness going around would be to share food with all the students.

What really bums me out about this is that when I was a student there, I ate in that dining hall almost every single day and usually didn't worry about it that much. Now it seems like a terrible and dangerous idea. I've been thinking about this and realizing that my germophobic tendencies have gotten much worse since college. I guess that makes sense, because these days I am usually at home, which means I feel like I'm rarely in contact with other people's germs. That's not true at all. I still go out places, and even if I didn't, my wife does, and other people come to visit here occasionally. I'm not at all isolated, I just have the illusion of being isolated. It makes me feel safer, and then on the other hand it makes me much more anxious about certain situations and places that I used to be able to handle.

Logically I know that someone has probably thrown up in every single room on that campus, and that it was even happening when I was living there. I lived there for four years and encountered plenty of illnesses. I caught a lot of colds but managed to avoid the stomach bugs. Possibly that was just luck. Either way, it makes much more sense that I would have gotten sick then, while living there, than now, when I was just working there for the weekend. But it didn't feel that way to me. I felt like I left the safety of my apartment and walked into a hotbed of various illnesses.

On both days, the first thing I did when I got home was put my clothes in the hamper and jump in the shower. Then I thought about how that behavior has been gradually developing over the past few years, where I feel the need to get rid of all contact with the outside world when I come home from certain places that I feel were particularly dirty or germ-filled. In some of the books on OCD I've read, they talked about how people with extreme germ-focused OCD will have "outside clothes" and then have to change into their inside/home clothes as soon as they get home. This reminds me of that, and while the thought of me getting to that point seems ridiculous right now, I probably shouldn't dismiss the possibility. Which is unsettling.

All that extra anxiety just because I happened to hear about an instance of vomit that happened that day, even though it's likely happening all the time without me hearing about it. It's so difficult to get something like that out of your head once it's in there. It makes me think about how I watched the original short for the horror movie Mama on Youtube a few weeks ago and ever since then, I can't stop myself from imagining her standing behind me at night when I turn off the lights to go to bed. I normally don't let myself watch anything in the horror genre anymore. It was a tiny act of defiance (against my own limitations) that was clearly oh so stupid.

Sometimes I stop right before I flip the light switch and wait until I can think of something that is not scary that will hold my attention long enough for me to get to the bed. Sometimes that works. I wish that technique was as effective in the emetophobia situations, but there is no destination point (like the bed) where it feels like the obsessive thoughts can be let go, so instead I just have to keep reminding myself to replace them with positive thoughts, over and over and over.  

a month of nothing / thoughts on family

Last month was the (fun but crazy) Warped Tour, and next month is going to be busy-ish. We're going to have a friend staying here one weekend, and we'll be taking a little trip another weekend to go to a festival. Then I have a check-up near the end of the month, and going to the doctor always stresses me out. So I've been taking this month to relax and do pretty much nothing. Nothing big, anyway. No major challenges.

I got an email from my mother asking me if I would meet her in NYC sometime to hang out. She said she wanted to take me to a play. I know this is contradicting my last two posts, but this is something I can't say yes to. There is a difference between challenging yourself to move a little bit out of your comfort zone and attempting to do something so beyond your comfort zone that you know it can't possibly go well.

About five years ago, I took a trip to NYC with my wife. We spent five days there. She understands what I can handle, and we did everything as low key as possible - didn't plan a ton of things to do, took frequent breaks between activities, spent a ridiculous amount of time in our hotel room. Even though I was with the person who makes me feel safest, and we took all those steps to make it a calm trip, my anxiety was still a huge problem. I suppose I can say that I handled it okay for the most part, but there was one night where I got so anxious that I spent most of the night in the bathtub. I was watching episodes of Family Guy on my iPod trying to drown out the noise of rain hitting our hotel room's air conditioner, because I actually thought it was going to make me go insane if I had to listen to it for one more second.

Looking back on that now, it seems like such an obvious sign of the breakdown that was coming two years later.

I do feel guilty sometimes, because I've cut off my family in a way. It's too expensive and too much of an ordeal anxiety-wise to go down to visit them. I definitely can't go off to meet them in some big city for a Broadway play and a carefree good time. But also, I don't like the idea of them coming here unless I could convince them to do absolutely everything on my terms. I just feel like they don't understand anxiety or at least don't understand what my life is like because of it. I don't know how to explain it to them, and I worry that if I tried, they would think it was something that could be easily and pretty quickly fixed (such as by throwing some medication at the problem) and would see me as an idiot for not having done so already.

So I guess in general, it always feels like a bad idea to even be around them, because who knows what might happen? And then what? I wouldn't be able to explain and/or they wouldn't be able to deal with it. I'm sure it would just result in me feeling embarrassed. It's a weird situation when your family basically doesn't know you at all.

I've been thinking and thinking about this but haven't responded to my mom's email yet (which is about two weeks old at this point), because with all the thinking, I haven't figured out what to say to her. At some point, I have to give them something, so I'll probably suggest they come here. It seems like the easiest option. 

warped tour!

Last weekend I went to the Warped Tour music festival for the first time ever. It's a pretty intense event and I imagine it'd be intimidating for anyone with anxiety issues. With my blend of emetophobia and social anxiety, I considered it a major accomplishment that I even made it inside the festival. Before it opens, a line forms outside that is not really a line at all, but more a gigantic chaotic blob of people moving every which way. It was the biggest crowd I'd been part of in a long time. I was lucky to have two feet of personal space in any direction. As it got closer to the opening time, it was more like half a foot as everyone started pushing forward and compressing.

Also during this wait, lesser-known bands were walking through the crowd asking people in line to listen to their music and buy their CD/mp3. Which meant having to talk to people I didn't know and use headphones that tons of other people had been wearing before me. 

Aside from the stress of interacting with the people, it was insanely hot, which was my main worry emetophobia-wise. I was very concerned that the heat would make me sick. I rarely spend that much time in the sun, and it was 80-90 degrees. I only had one bottle of water that I was trying to conserve while waiting in the line, but then the event workers made me pour it out on the way inside (only one water bottle is allowed, but it must be sealed if you want to take it in). Basically, they want you to buy the drinks and food they are selling inside that is mega-expensive. But at least their drinks are packed in ice, so I was happy when I bought my new water bottle. I could hold it against my neck and get some relief from the heat.

Even though there was a lot more space inside the festival, it was still super crowded with people everywhere. Bands were playing all over the place, so loudly that I could feel the beat in my stomach, which made me worry for a moment that this would cause me to feel sick or panic. But with all this going on, I managed to keep it together and felt really calm the entire time I was there.

I only stayed about two or three hours, because it was just too hot and after a while I felt like I couldn't stand it anymore. I was all sweaty and sunburned (I wore sunscreen but didn't put enough on my face/neck) and started to feel dizzy, probably from hunger and dehydration. They don't let you leave and then come back, so I knew that if I stayed for most of the event, I would have to eat and drink while there. But still I let the habits of my anxiety take over and avoided anything but water, partially because I was afraid of getting or feeling sick and partially because I didn't want to use the public restrooms that were constantly packed with people. I'm sure this contributed to the dizziness/exhaustion I felt after a while that prompted me to leave much sooner than I would have wanted.

Still, I'm thrilled that I went and was able to have a good time for the most part. I can hardly believe how chill I was, especially considering how nervous I had been in the hours, days, weeks before I went. I had been obsessing about this for so long and feeling like I probably couldn't handle it at all.

But as I said in my post last month, I am trying to say yes to whatever comes along and to try things, even if I think they won't go well. There were many times I desperately wanted to back out of going. I was able to get through this because I kept saying to myself "maybe I won't be able to handle the whole event, but I can at least do this next small step." When I thought about calling it off in the days before I left, I told myself there was no need to make that decision yet. When I thought about turning the car around and driving back home while heading to the event (which was about three hours away), I told myself I would at least make the drive, and I could always turn around once I got there. When I thought about walking away when I saw that giant crowd of people standing in line, fanning themselves, I told myself I could at least try joining them and see how long I could deal with that. On and on, until I was inside actually enjoying myself.

Plus, now that it's over and I have a clearer idea of what it's like, I imagine I'll be able to handle it even better if I go again next year. I will definitely make sure to eat and drink more so that I have more energy and can stay longer, enjoy more bands.