A 12 Year Old Boy with Fear of Vomiting
A mother walked in to see me accompanied by her 12-year-old son. The young boy avoided looking at me and sat down fixing his gaze at the floor while his mother explained the why they had come to ask for my help.
“My son Joey has anxiety and is afraid of vomiting”, explained the mother. “Since he was 9 years old he hasn’t wanted to eat because he fears that he will vomit. He is under the normal healthy weight for a boy his age because eats very little. As soon as he feels something in his stomach or when he burps he becomes very anxious thinking that he is about to vomit. One day he had a bit of indigestion and had a panic attack. He always checks the expiration date on every food we buy to make sure that they are fresh. We cannot go to other people’s homes because of his fear. He cannot ride on the school bus because once a child vomited there and so we have to take him to school. He is also afraid of doctors, blood, dentists, needles, and even flying.”
I asked the mother what they had done to solve all these fears and phobias. She said that as soon as Joey started developing emetophobia, they had taken him to see a child psychologist. Which meant that Joey had been in therapy for three years. Now he was seeing two different psychologists who were teaching him relaxation exercises and talking to him about life in general, his school, his relationships with his siblings and his parents. She also said that, on the recommendations of the psychologists, she (the mother) would help Joey to calm down. As soon as he would start to have fear or doubt about a meal she had prepared, she would try to convince Joey that the food was fine and sooth him.
After listening to the mother explaining in detail what the problem was and what they had done to help Joey, I asked her if she thought that her strategy to convince Joey about the irrationality of his phobias and trying to soothe him had helped. She said that maybe she hadn’t done it properly because despite her efforts Joey’s phobias continued to worsen in the past three years. I said that he started with a specific phobia but after three years he had developed more fears. I explained her that it wasn’t because of her lack of attention or insistence, rather it was due to the nature of phobias.
I told her that one of her goals was that Joey would become independent and wouldn’t need her constant soothing or support. However if she insisted in offering Joey her help, she wouldn’t let him build the necessary skills he needed to face these challenges on his own. I pointed out that she was a loving and sacrificial mother who had been diligently trying to help her son. And I wondered if she was willing to make another sacrifice to help her son.
“Of course”, she replied immediately, “I’ll do anything.”
“I’m glad Joey has a loving mother who is willing to do anything to help him. Your task for the next two weeks is to avoid rushing to his aid. Joey knows relaxation techniques and other skills that he has learned from psychologists over the last three years. Let him handle it on his own. You will be around of course but avoid soothing his fears. If a swimming coach keeps throwing the rubber ring into the pool, the child will never learn to swim on his own.”
I also ‘told off’ the mother, with a slightly harsh tone of voice, for treating Joey like a little child. She, of course, realized that my criticism was only a therapeutic maneuver. On hearing this, Joey lifted his head and looked at me with interest. I said that enough was enough and that Joey was 12 years old after all. Let’s give him a chance.
I then looked at Joey and told him all this help from his mom hadn’t allowed him to really know what’s going on. So I asked him to think about the worse possible scenario. He should be thinking every day how things could go wrong. Instead of trying to feel better, he was supposed to think about his fears getting worse than ever. After all this wasn’t new to him. He was doing it all the time. However, I wanted him to feel his fears getting even more intense.
Two weeks later, the mother said that there was a calmer atmosphere in the house. Joey had his usual doubts and fears but she managed to keep her cool and avoided rushing to his help. Joey didn’t talk much. His mother said that he had come to tell her that he was afraid or that such and such food might be bad and cause him vomit. His mother, however, had avoided convincing him and reminded him to do what the psychologists had taught him. Joey had tried to feel good but the relaxation technique hadn’t helped.
At this session I asked the mother to continue and avoid soothing Joey. I also told Joey that I wanted him to do a task and when he came back I would teach him a magic trick.
“For the next two weeks”, I said to Joey, “I want you to borrow a few books from the library about birds. I want you to do some research on how they build their nests, took care of their eggs, and how they feed their chicks. You could make drawings and take some notes to bring back and tell me about your findings.”
A few weeks later Joey walked in with his mother to see me again and I noticed right away that he was much more relaxed. He no longer was staring at the floor. As his mother and I talked he was looking at us and seemed much more interested than before. His mother said that one day, one of Joey’s siblings had vomited and Joey had become anxious. However she had still stopped herself from calming him down.
Later Joey showed me the result of his library research and we talked for a while about birds. Then, at one point, I looked directly into Joey’s eyes and with a deep voice and slow pace mentioned how birds feed their young. I then gradually went on describing in detail how birds carried the food and flew back to their nests. There they would regurgitate the food into the mouth of their chicks. I described in detail how different birds must store the food in their beaks or in their throat, and how they would in a comfortable and natural way offer it to their offspring. They did this without noticing it because it was such an easy task. I then remarked that he must have seen them do that on television nature shows.
Almost without blinking, Joey was listening to me telling him about how birds feed their young. He didn’t react negatively when I described how birds ‘vomit’ food in the mouth of their chicks. I then asked him to narrow his research on the feeding habits of birds, and make some drawings. I suggested that he could copy from books by looking at the photos of birds regurgitating food.
Then, as I had promised him, I mentioned that I was going to teach him something that actually was magic.
“I’m not just going to show you a magic trick. I want you to practice it at home. As you know Harry Potter had to practice before he could win over the evil forces.”
I had Joey’s undivided attention.
“Before I talk about magic, I want you to plant a seed. You will be watering it regularly. This task is for you but mostly it is for your mother that who very eager that you change and feel better quickly. The slow growth of the seed turning into a tiny plant will teach your mom to be patient and not interfere with all the hard work that you will be doing.”
Then I asked Joey to dedicate some time every day to think about his fears. He had to imagine that, like Harry Potter, he was in possession of magical powers. He then was to summon the fearful thoughts. He had to call up every single nasty-looking demon. He was to do this for 15 minutes every day.
Two weeks later Joey came back with his mother. She said that things had improved. One Saturday Joey had stayed at his grandparents’ home for the first time since his first episode of emetophobia. One night Joey had even slept in the same room as his sister. He would always avoid this because of his fear that his sister would throw up. Another night when they left him at home to come back at 10:30 at night, Joey hadn’t call his mother’s cell. Before he always called her up to get reassurances from her that he was well and would not feel sick.
Joey said that he had practiced the ‘magic’ and had thought of his fears. At first he felt scared but gradually he felt more confident. He was also enjoying taking care of his seed growing into a plant. I asked him to keep practicing his magic and keep an eye on the seed because very soon he would see its tiny head emerging from the earth. I went on describing to him how seeds grow: they begin growing roots that are tiny like a single hair but they are very strong. There is no rock that could resist their growth. They may look tiny and weak but they are able to break into the hardest rock.
A month later, Joey walked into my office carrying a small plant. He told me that he enjoyed taking care of his plant and that his sister had also planted her own seed. Joey’s mother was very happy because he was free from anxiety and wasn’t afraid getting sick nor afraid for others. In fact, Joey had stayed over for several nights at a friend’s house. I explained to Joey that all the improvements were his doing because he had managed to courageously face all those scary thoughts. I told him that, like a true magician, he had conquered his fears.
Three months later his mother called me to say that her son was continuing to be well and happy.