Emetophobia: When vomiting is not only gross but scary

Nobody likes vomiting, but for some people, they feel terrified of it. Emetophobia means fear of vomiting, and this phobia is more common than you think. In fact, it’s probably the most common phobia I’ve come across in my career. And it can be extremely debilitating.

People with emetophobia may do a whole host of things to try to avoid vomiting, like checking ‘used by’ dates on food or just avoiding some (many) foods altogether; avoiding eating out; staying well away from people who are sick even if it’s just a cold; limit travel in cars, trains, buses or planes; or constantly checking in with themselves to see if they feel sick. This can then cause anxiety, which can lead to tummy discomfort, or worse, nausea, and so it becomes a vicious cycle.

If you or someone you know looks like they have emetophobia, there are a number of different online resources you can have a look at. A great emetophobia website that helps people help themselves is www.emetophobiahelp.org . This website has a heap of resources to help you overcome your fears of vomiting, including some great breathing relaxation exercises which can be found on this page. Mastering relaxing breathing skills can give you a lot more control over your fear.

But if your emetophobia is causing significant interference in your daily life, speak to your GP about getting a referral to a psychologist. A psychologist can help you learn skills to gradually face, and overcome, your anxiety and stop if from controlling your life.

I offer CBT treatment for emetophobia, and have treated a number of clients with this condition.

Misophonia: When sounds drive you mad

Ever heard of misophonia? It’s a condition where the person has extreme sensitivity to certain sounds such as other people chewing food, breathing loudly, or repetitive noises like clicking a pen. The reactions people with misophonia might have can range from irritation and anger to panic.

“Misophonia” literally means hatred of sound. Although this condition is pretty common (3 to 5 people per 100 are estimated to have it), it’s not recognised in the DSM 5, the book in which mental disorders are listed. Yet misophonia can cause a lot of difficulties in daily life. Imagine trying to have dinner with friends or family and then flying into a rage because you hear someone chewing their steak.

Misophonia is not a recognised disorder, and so there isn’t a lot of research into it. The research that is out there suggests that Cognitive Behaviour Therapy can help. Along with this, gradual desensitisation to sounds is also suggested by some research. One misophonia researcher has even made an app, called the Trigger Tamer App, which helps people gradually get used to their “trigger” sounds by playing clips of these sounds at regular intervals while the person listens to their favourite music.

When I have provided treatment for misophonia, I have relied heavily on reading the scientific research evidence into various treatments, and then working with clients to apply this to their symptoms. If you are interested in receiving treatment for misophonia, please contact me via the Contact tab on this site.

Autism in girls

The ratio of girls to boys with an autism diagnosis is around 1:4. However researchers believe this statistic belies the true number of girls on the autism spectrum. Researchers predict that under-diagnosis of girls is (too) frequent due to the diagnostic criteria, and assessment instruments, being based on the typical male autistic presentation, or phenotype. In addition, practitioners will sometimes fail to pick up autism in girls because girls are generally much better at social imitation than boys, and are more socially aware. This means they're more likely to engage in eye contact, and attempt to play with, or talk to, others. Girls on the spectrum rarely exhibit aggressive behaviours, and are far more likely to experience high anxiety, which may not be attributed to autism. Signs to watch out for in girls include noticing how they're playing with toys; sometimes it can appear like imaginary play, but on closer observation, she may actually be re-arranging her toys. Girls on the spectrum may appear shy, be regarded as timid, and be on the periphery during social activities. Their special interests are often closer to 'mainstream' than boys special interests, and may include animals, fan fiction, and celebrities. Sometimes girls will be diagnosed with a language disorder, but this diagnosis won't feel like it fully explains what's going on for her. The link below describes some stories about girls who have been misdiagnosed with autism, and some of the reasons why this occurred.

The Lost Girls

Why is school so hard? A clinical perspective

As an adult, going to school may seem a pretty good deal - you don't have to decide what to wear, you do what the teachers tell you, see friends, and then come home and do some homework. But in reality school poses many hidden challenges and is a great source of distress for many children and young people. There are several reasons for this.

Simply being at school encourages peer group comparison. What I mean by this is comparing yourself to others. When we compare unfavourably to others - maybe because others seem more popular, better looking than us, or maybe their family life seems easier, or they have more money, feelings of sadness and anxiety are bound to arise. Comparison of test results and academic achievement is unavoidable at school, and this can be particularly upsetting for students who work hard but don't achieve commensurate results.

Learning difficulties (particularly undiagnosed learning difficulties) can make school an excruciating experience. Learning difficulties may result in young people spending much of their time trying to catch up, or feeling stupid because school work is more onerous for them than their friends. Children and adolescents with learning difficulties may dread school, or pine for recess, lunch breaks, and home time. Wishing away most of the day for upward of 10 years or more is a hefty burden for anyone.

Then there are the peer and friendship issues. Research has shown that adolescents are particularly vulnerable to interpreting neutral facial expressions as hostile. Couple this with adolescent insecurity and self-consciousness, and school can become an anxiety minefield.

The competitive nature of some schools can also be a burden. Students can fall into the trap of setting unrealistic expectations for themselves in an attempt to excel, leading to procrastination, and subsequently poor academic results due to lack of preparation. This can create a self-fulfilling prophecy about limited academic talent, which has the potential to stymie achievement across the lifespan.

But school doesn't have to be this bad. If school is causing significant emotional pain for your child, consider approaching the school about your concerns. The School Counsellor is a good person to start with. If you're uncomfortable approaching the school, consider speaking to your GP or a mental health professional about your concerns.

Childhood anxiety disorders: Raising awareness with the MHA NSW

It might surprise you to learn that anxiety disorders typically start in childhood; around 1 in 10 children will experience an anxiety disorder at some point in their early years. If they don't receive professional treatment for their anxiety, children become much more vulnerable to depression in adolescence, as well as a range of other disorders including developing a secondary anxiety disorder, drug/alcohol use, and personality disorders in adulthood. Although the "1 in 10" statistic is alarming, if children with anxiety disorders receive evidence-based treatment (CBT has the most evidence for effectively treating childhood anxiety), they usually improve to the point of being anxiety disorder free. CBT for children with anxiety teaches a range of skills including challenging negative or worried thoughts, relaxation training, and learning to tolerate anxiety. Parents are also involved in the treatment process.

The Mental Health Association (MHA) NSW runs the Small Steps program, which is about raising awareness of childhood anxiety disorders amongst primary school teachers and parents in NSW. I will be partnering with the MHA NSW to deliver Small Steps seminars in the Blue Mountains region. The seminars are free (funded by NSW Health), run for about 1 hour, and provide a comprehensive overview of what anxiety looks like in children, and when and how to help.

If you're interested in having a Small Steps anxiety seminar held at your child's school, contact the MHA NSW on (02) 9339 6003, or follow this link to the website.

So you want your teen to see a psychologist...

I've seen many an adolescent who doesn't want to be on my couch but for some (good) reason their parents do. Maybe the adolescent is telling everyone she's miserable but in the next breath says therapy can't help her because her depression is "chemical", or perhaps she identifies as a "tortured soul". Regardless of the severity of an adolescent's symptoms, if they're unwilling to be in therapy, it's probably going to take more than the 10 sessions available under Australia's Medicare Better Access Scheme to get them to actively participate in the process, if at all.

In these cases, my preferred approach is to focus on what can be changed. Typically this means working with parents, and the school if relevant - looking for what triggers the adolescent's symptoms, where and when problem behaviours arise, and identifying what the adolescent gains from continuing to suffer from, for instance, depression (this is called secondary gain and may include having an unusually close relationship with a parent, or school avoidance). Most importantly, this approach aims to help parents understand the emotional system that exists in their family, and how interactions between family members may lead to an escalation in symptoms, or help to maintain them. Parents then have the opportunity to understand what changes they have the power to make irrespective of their adolescent's desire to keep the status quo. Obviously this runs counter to the commonly held assumption that the problem is "in" the individual, and that it's only a matter of time before the therapist "fixes" the teen - but this assumption is often not reflected by reality; we are significantly affected by our closest relationships, and at no time is this greater than during childhood and adolescence. While working on understanding our role in unhelpful family dynamics can be confronting, it is almost always worthwhile if we have the courage to do it. But more importantly, it creates a much better chance for change than dragging an unwilling adolescent to therapy hoping an hour a week will "fix" them.