Also known as or emetophobia, refers to feeling intense panic and distress at the thought of vomiting or perceived consequences of vomiting (i.e. being embarrassed by vomiting in front of others, not getting to the bathroom in time, choking on vomit, etc.).

People may develop a fear of vomiting following a traumatic experience involving vomiting. The traumatic experience may be vicarious in which you watch a loved one vomit repeatedly from an illness or pregnancy.

No matter what the trigger is, the fear of vomiting develops to the point that the person begins to change their behavior in order to avoid vomiting (i.e. restricting diet, avoiding new foods, washing hands excessively to avoid illness, etc.). 

However, these behaviors not only restrict one’s life but they are ineffective to solving the problem! Engaging in these behaviors only sends the message to the brain that one must be hyper vigilant setting the person in a continuous state of alertness.

This leads to anxiety as the person believes with more and more conviction that they cannot tolerate vomiting and vomiting is dangerous. Unfortunately, anxiety can often lead to an upset stomach, which triggers the fear of vomiting response. This cycle can be interrupted with cognitive-behavioral therapy (CBT) and exposure response prevention (ERP) in which the person challenges their beliefs that vomiting is dangerous and stops avoiding triggers.

As a person does so, they begin to learn that vomiting is not dangerous and the fear begins to subside naturally. 

This is a type of anxiety disorder that leads to a consistent inability to speak in some environments, such as school, even though they are able to speak in other environments, such as home. In cases of selective mutism, there is not a language or communication disorder that would explain why the student is not speaking.

Selective mutism is associated with intense social anxiety. Others often view students as excessively shy or cling only to a select few people they are comfortable with. 

The challenges in communicating creates difficulties for students with selective mutism to expand their social circle and can lead to social isolation if the disorder is not well accommodated in the classroom.

Selective mutism often begins before age 5 but becomes increasingly problematic as the person ages and is unable to fully participate in school.