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Hi everybody, it's stuff you should know co-host Chuck Bryant here, Charles W.
So I'm say, I'm in charge of picking up the Saturday select this week.
And we're going back to 2017 December 5th.
In fact, it's a Christmas episode.
It's called How Vomit Bobio Works.
Trigger warning, there will be talk of vomit.
Rated R. Welcome to Stuff You Should Know, a production of I Heart Radio.
Hey and welcome to the podcast.
So I'm Josh Clark, there's Charles W. Chuck Bryant and there's Jerry over there.
This is Stuff You Should Know, very special, surprisingly sad edition.
Oh yeah, I think so.
Yeah, of course it's sad.
It's really gross.
It is gross.
I'm going to have a hard time getting through this one.
So we should give everybody fair warning.
We are talking about a metaphobia, which is a specific phobia,
a fear of throwing up and we'll get way more into all of that and what it means.
But we're talking about vomiting.
It's basically tied for first as the subject of this episode.
So we're going to be talking about vomiting a lot and I found from researching this,
yeah, reading and I imagine hearing about vomiting for a good 30 minute, 40 minute stretch,
it can make one queasy.
So just fair warning.
I don't think it's actually going to make you queasy, but it's possible.
If it starts to happen, just plow through it.
Just say Josh and Chuck would want me to plow through it and your craziness will magically go away.
Oh yeah.
All right.
So like you said, it is a specific phobia and it is actually listed in the DSM now.
I'm not sure how long it's been in there, but it is...
Well, a metaphobia isn't.
Oh, well, I thought the specific phobia vomiting now.
I guess I think specific phobias are.
I don't know if it's a specifically listed Chuck.
So when this says it is a specific phobia occurring to the DSM,
what does that mean?
I think it means that it falls under the umbrella of a specific phobia.
Okay.
You see what I mean?
Not really, but that's okay.
This means, well, you're afraid you might vomit.
You're afraid someone else might vomit around you.
You're afraid what people will think of you if you do vomit?
Yeah.
It's just...
And it's not this article.
Where'd you get this stuff anyway?
Was this sort of cobbled?
It was cobbled together from some pretty good sources, including psychology today,
the American Association of Anxiety Disorders,
the National Institutes of Health Library, the BBC Vice.
And I want to give a shout out to the listener who wrote in to share her a metaphobias story.
Yeah.
I had never heard of it before.
And she had a very harrowing experience and overcame it just through sheer grit and willpower.
And came through the other side of this very serious phobia.
Yeah, which, you know, we'll get to how to do that later.
But these articles make great pains to point out that it is...
I think all people think it's gross and are very much repulsed and turned off
by the sound or the smell or the look or anything that deals with somebody getting sick like this.
But this is different than that.
This is a debilitating fear that can overtake your life.
Yeah.
That would specifically be a metaphobia.
There's actually, it seems like a spectrum where you can also suffer from what's called
fear of vomiting, which is much less overwhelming, but still you're preoccupied with the idea of
vomiting.
With the metaphobia, your life does not resemble what your life would be if you weren't afraid to
vomit.
Yeah, it's a real impairment to your life in a lot of different ways, which will go over.
It seems like there's not a lot of study about it.
I mean, I ran across a few studies, but even in the studies I found they specifically say...
There's not a lot of studies about it.
Not a lot of studies about it.
So a lot of the guesses about the prevalence are guesses.
One thing I saw was that in the general population, 8.8%,
I think that's actually fear of vomiting.
I think a metaphobia is more like less than 1% of the population has actual metaphobia.
But that it tends to be about 4-to-1 ratio of women to men.
Right.
Women suffer from it.
They have a tendency to suffer from it more.
Yeah, and I certainly do not have it, but like I said, almost everyone in the world probably
it is a trigger for most folks.
Yeah, nobody wants to throw up.
But if you have a metaphobia just seeing the title of this come through your podcast feed
could have set off an anxiety attack.
And like I feel very guilty about that.
There's nothing we could do because even if we warned everybody in the episode before this
that this was coming, that would set off a panic attack.
Just the mere mention of the word vomit can set the anxiety disorder into full gear.
Yeah, this one article you sent, one of the clinicians they interviewed who treats anxiety disorder said
it is in her practice the most common fear among children that they see.
Yeah, and that's typically how it starts.
So it's a chronic disease, meaning that if you don't treat this,
it's going to persist basically every day of your life and it tends to get worse over time.
And it usually starts with a traumatic experience of vomiting,
most frequently of all in childhood.
So it's more common I think among kids, but it can survive into adulthood and it can start
in adults. But what seems to happen is you have a traumatic experience from vomiting and just like
with any other traumatic experience, whether it's surviving a violent crime or being in war,
vomiting can have that same effect on the brain apparently.
And you develop something pretty closely akin to PTSD at the thought of vomiting and it overwhelms
your life as a result. I had a traumatic experience with this one. I was a kid.
I might have told the story before for another reason, but I was on the bus going to elementary
school and there was a scary kid. Remember in elementary school, they were just the scary kids.
I remember my scary kids first and last night. Yeah, right. And they're scary for various reasons,
whether they were bullies or I mean, you could probably diagnose something that was wrong as an
adult, but as a kid, they were just scary kids. And I'm not talking about like, I mean, I'm talking
about like sociopathic behavior, not something that, you know, like some... They weren't goth, you mean?
Yeah, exactly. Right. They had like real issues that would affect other people around.
Exactly. So this one kid, I remember his name was Tony something, but he on the way to school one day
would, or many days, he would make himself throw up outside of the, with his face out of the window.
And it would, you know, the school bus was going down the road and it would fly down and land
on the windows all the way down. Oh my god. Come in other windows and he would make himself vomit.
And it just, it scared the crap out of me, man. And it wasn't like...
I'll bet it scared the crap out of the bus driver. I was scared, scared, scared, scared of this dude.
Yeah. Well, that's really bizarre. Yeah. Behavior, especially if he's doing it to like
intimitive freak other people out. Yeah. And I think I might remember.
You've never told that story before.
Because it's, you know, how sometimes a certain event can tie something else in your brain.
You know, my dad was my elementary school principal. I don't know why I was riding the bus
because he usually went to work with him. Well, he wanted to normalize things. Yeah, maybe.
But I ran to my dad's office right when I got to school crying. He wasn't in there and the
the secretary, dot Jones, let me in the office and dot, let me stay in his office because I was sad.
And he had one of those big cabinet stereos, you know, the secretary record.
So the stereo was already on, but the song that was on weirdly was the BG's, how deep is your love?
Oh, that's good. And to this day, I hear that song and it makes people want to cry.
Really? Yeah. It's just a trigger from that day with that guy.
You know what? Isn't that weird? That's a sad story because that's a good song.
I know. It makes me want to weep. It makes me want to weep for you.
Think about Tony, making himself throw up. And I always wonder what happened that guy.
He's in Jim Rose's side show right now. Maybe. Is that still around?
I don't know. Puky Tony.
But yeah, that was him. Puky Tony and hippie rover and like a little jug band together.
But anyway, that's a long way of saying that that was not enough even to traumatize me to the
point where I have a metaphobia. No, but I mean, it could have been it just. Sure.
It seems to be like, and it's not even necessarily like a type of person or
it's the brain can just the synapses can fuse in a certain way in all of a sudden.
You have this phobia and the problem is this is it starts from a traumatic experience.
So let's say that that had had this impact on you, Chuck, right?
What would have come next if you were on the road to a metaphobia would have been to start to
fear throwing up, seeing somebody throw up probably is how it would have started.
And then that would have spread to throwing up yourself.
And then you would have become hyper vigilant.
You would want to protect yourself from seeing somebody throw up or from throwing up.
Well, how do you do that? To prevent yourself from throwing up, you're going to monitor every
single weird feeling you have to say, am I about to throw up? I need to like tamp this down.
Or I can't eat that food. It might make me throw up or I can't read in the car.
It might make me car sick and I'll throw up or that person looks kind of sick.
I'm going to avoid them.
And then let's just take it a little further and avoid everybody altogether because
anybody could really throw up at any given time.
And you start to become preoccupied with this and you adjust your life and alter it.
And then you're constantly worried about throwing up.
And once that happens, it's the phobia is complete.
Your life has changed.
You're constantly worried about it. And then the cherry on top of the whole thing is that when
you finally are confronted with the word vomit, actually seeing somebody vomit, something like that,
you enter a panic attack, an actual panic attack.
Yeah, you can for sure.
And the only way to overcome that is to get away, to run, to get out of there, to
I'm not sure all the ways you can handle a panic attack. But then it calms down and your anxiety
returns to normal levels, which is to say high for the average person.
Yeah, so in my case, in elementary school, how that could have gone was,
I had another ride to school, but if I hadn't, I might have stopped taking the school bus.
And started skipping class and not going to school at all because I was afraid to get on the
school bus because of Puky Tony. And gone weeks in a row and then my parents get a call,
saying Chuck hasn't been in school for weeks.
And what's going on? And that's exactly what's going on.
Like it can get that severe.
And it all boils down to the, at least in most cases, the anticipation of this
more so than the actual act.
In every case.
Because the people that are struck with this, by all accounts, are less
vomitous than the general population.
So much so, because they've tried to avoid it, so much so that this one article said that most
of these people can even name like the three or four times in their life they have ever puked.
And what they ate that day and what they had on television and what they wore,
because it stands out that singularly to them.
And then, so that's horribly ironic that the people who are the most worried about throwing up
are the people who are actually statistically speaking, the least likely to throw up, right?
But there's an even greater irony to the whole thing. And we'll talk about that after this break.
How about that?
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So Chuck, we were on the irony train and I want to keep going, okay? Yes.
The irony of paying attention and being hyper vigilant about vomiting, especially when you are
worried that you're going to vomit. Because again, there's a number of things that you're worried
about. You're going to be worried that you won't be able to find a bathroom in time to go throw up.
You're worried about throwing up in front of other people and embarrassing yourself or being
teased for throwing up. You're worried about just the experience of throwing up. It's just a
horrible experience. But once you start to get a metaphobia, you lose perspective completely.
Like it becomes like I've seen multiple, they call them a metaphobes, people with a metaphobia,
I've seen multiple people say you would prefer to die than to throw up. Yeah.
That's how much they fear throwing up. And to the rest of us, it's like, God, that would suck
to throw up. But I know I'll be fine on the other end of it, not to a person with a metaphobia.
So the irony of all this is the more you start to focus on this and you start to
think about every gurgle in your stomach or every weird twist or turn.
It actually produces more anxiety and here's the ironic part. Anxiety can actually make you
queasy when you're thinking about throwing up. That's right. So it makes the whole thing worse and it
becomes this vicious cycle. Yeah. And they recommend trying to tell yourself, like I might feel
queasy, but I'm not going to throw up. My anxiety might be making me feel nauseous, but I am not
going to throw up. Yeah. Because there's a confusion of queesiness equals nausea, equals throwing up.
And that's just not the case. Like you can make yourself sick with anxiety, but you can't make
yourself throw up from being anxious. So the whole thing is just wasted worry. Yeah. Some of the
other things you might do because of the spear, you might not shake hands with anyone ever again.
You, well, I think a lot of people avoid looking at television puxines. Yeah, you cannot watch.
You really can't watch those at all. You can't watch stand by me or the meaning of life.
Those are so funny looking though, but still probably not. You might throw away food in your fridge
that is not even past this expiration date. You might have a trigger there. You might over cook your
food on purpose. And then before you eat it, you will lift the bread a bunch of times.
It's called checking behavior. Sure. You might not eat on vacation as readily because you only trust
your trusted food sources. You might go into a place and like, you know, when some people go into
a music venue, like they check for the exits, like you're checking for the bathrooms. You may not even
make it to the music venue. A lot of people with a metaphobia end up being a gorgphobic and just
don't leave their house. Really debilitating. It's often confused for a gorgphobia by
the counselors. Shrinks. I've got another one. Apparently a lot of people who have a metaphobia
walk around with a plastic bag on them at all times, something to throw up into. An emergency throw-up bag.
They walk around with this because they're so afraid of throwing up. They never need to use because
they probably don't ever throw up. I know. And some of them will actually carry a change of
clothes around with them as well. Really? For the same reason, if they throw up on themselves, they can
change their clothes. Yeah. And of course, air travel, drinking alcohol. Any of those things are
or car travel even. Yeah. Like any kind of travel is probably avoided. Definitely don't booze it up.
Or they probably don't drink at all. Yeah. And subsistence, things like pasta and bananas and
very, very safe digestively speaking foods. Although a banana could gag you. Yeah. That would be a nightmare.
If you had a metaphobia. I wonder if they mash them up and eat it, like mashed up with a fork
maybe. Maybe. If you could see it. Yeah. And I could see cutting your food up into the tiniest
pieces because you feel fear choking. And that's one of the fears too. And I think we mentioned like
they're not just afraid of the vomiting, but they sometimes can fear choking on vomit and dying
and fixating and or going to the hospital or starting the vomit and the vomiting never ending.
That's another fear of a metaphobia. One other thing that I saw people do is prevent getting pregnant
because of a fear of mourning sickness. Yeah. So yeah. So your life is altered and curtailed
because you're afraid of vomiting. Everywhere you look there's some potential trigger out there.
So it'd just be easier to stay home and eat your pasta and not watch movies.
Basically. And to just lie there and monitor your stomach for signs that you're about to throw
up. That's what they do. That's what you do when you have a metaphobia. That's your life. Yeah.
It's no way to live. It is not. So like this is not all just academic and stuff. We're grasping
it, strapping it, pulling it together from different cases. Like this is there's actually a case
study we found that is was of an eight year old girl who had a terrible experience throwing up.
And really kind of encapsulates the experience of a metaphobia. She had full blown a metaphobia. She
had appendicitis and had been throwing up before the doctors figured out she had a appendicitis
and had her appendix removed. And that experience throwing up was a wallet triggered a metaphobia
in her. When she came to and was recovering from her surgery about 10 days later she started
getting really worried she was going to start throwing up like that again. Yeah. It was a really
sad case and pretty much covered everything we've said and even then some to the point where
her father traveled for business and she didn't want him to travel anymore. Her father to travel
anymore. Right. For fear that he would get some sickness and then bring it back to the house.
And I mean that's pretty extensive. Yeah. Like she didn't want to eat herself. She didn't
want to eat any outside food. She had her safe food. But she also didn't want her parents to eat
any outside food either. Yeah. Because she didn't want them throwing up. She stopped playing with
other kids because she was worried about throwing up in front of them and being teased. That was her
big thing. Yeah. And as as one of the clinicians who we came across in this research said it's not
the vomiting that's really the problem. Like that's the focus. That's the obsession. But the real
problem is the worry, the constant worry. It's the worry that's altering your life. And it altered
this little girl's life. You know. Very sad. So let's let's take another break and then we'll come
back and put a silver lining on this thing and talk about treatment.
Today's episode is brought to you by Al Toids because let's face it, unraveling the mysteries of
the universe's tough work. But with Al Toids, your breath will be stronger than a black hole's gravitational
pole or intense than an alien abduction. And more reliable than your phone's battery during a
podcast marathon. When it comes to needing intense freshness, al Toids have you covered.
Al Toids are stronger than your favorite conspiracy theory, more intense than the latest true crime
docu-series and more reliable than a big foot-sighting. They're not just mints. They're curiously
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All right, so we've talked a lot on the show over the years about CBT, Cognitive Behavioral Therapy,
or Exposure and Response Prevention, ERP, basically Exposure Therapy. This is definitely
probably the way to go when it comes to Emefobia. Depending on who you go see,
you might undergo various kinds of treatments ranging from starting out by literally saying the
words, vomit, out loud, or throw up or puke, or just all the words. That's literally the first step
sometimes into getting over this, just being able to speak the word. You may have to start out by
writing it down first before you say it out loud. For real. Once you move past that,
the therapies range from kind of all over the board from looking at fake vomit that your
therapist has made in a toilet. Now you're starting to move into Exposure Therapy, right?
Yeah, I mean, this is all of this stuff, ERP and CBT. But they'll make up some fake vomit,
put it in the toilet, make you go look at it. They themselves, the therapist might make the noises
in front of you. I just have nowhere to go. Well, imagine they probably prep them or maybe not.
They may go in the bathroom and jump up and say, I gotta go get sick. All of this is just exposing
this patient over and over to the point where they can handle hearing the sound, seeing the thing,
saying the word, hearing the word. Smell is another one too. One of the recommendations for
Exposure Therapy is you make your own throw up like in the toilet, a little bit of cold soup,
something like that. Maybe mix in some oatmeal with it. And then pour a little vinegar in there
to like make it pungent and sit around and think about that being vomit. Maybe try to make the sound
of throwing up yourself. Try to make yourself gag. And all this is to show you when you have a
metaphobia that this is, first of all, it's manageable. That's the first part. What you're trying
to do is get to this point without having a panic attack. But then also that if you gag, it doesn't
mean you're automatically going to throw up. And if you do throw up, it doesn't mean you're never
going to stop throwing up. Or that everyone's going to ridicule you for throwing up. And that's,
you know, the point of any cognitive behavioral therapy is just kind of change your perspective and
give you a more realistic view of the thing you're worried about. There's also a website called
Rate My Vomit. Have you heard of it? Yeah. I wouldn't get to mention that. But go ahead.
You have heard of it before? No, no, no. I read about it. But I just, yeah. It just sounds like,
I mean, that's like classic internet stuff, right? Somebody's like, oh, let's put pictures of
throw up on there. And you guys tell me how gross it is. Well, it's actually used by people with
a metaphobia to, as exposure therapy at home, to just go look at this stuff and see it. There's
also videos of people throwing up. There's a lot of stuff that internet, like unintentionally,
is this great place for people with a metaphobia to go get over their fears. And I'm sure if you
have a fear of snakes, it's good for that too. Yeah. But so is like a time lifebook. You're
not going to find a time lifebook that's nothing but pictures of vomit. No, that's not. You're
going to find it on the internet though. Yes, you will. That's not in the Old West series. No.
And then I found this other, this other type of therapy, called iMovement Decentrization
and Reprocessing EMDR. And it's used for post-traumatic stress disorder. And it's the most bizarre
treatment I've ever heard of in my life. But apparently, it really, really works. Yeah. You ready for this?
Yep. So say I was your therapist and you were, you had PTSD. And it's been used to treat a
metaphobia a couple of times. But you're talking about the thing that gave you PTSD.
You're focusing on the worst aspect of this traumatic experience. And you're talking about it
out loud. But while you're doing it, I'm moving my finger back and forth and up and down,
maybe in a slow circle. And I've instructed you to follow my finger wherever I move it. Yeah.
While you're recounting this horrible traumatic experience, supposedly just doing this over
multiple sessions, but sometimes just in one long session, PTSD can be treated. And the way that
this, they think this happens, if it actually does work, it just sounds like such, just like totally
made up that in 50 years, they're going to be like, they actually thought this worked. But if it
does work, they think that it works because it, it, it taxes your working memory to follow the
finger. And your recall then is not aided fully by your working memory. So the vividness of this
horrible memory isn't as robust as it would be if your full working memory was, was working on it.
And so it, when it, when you reprocess it, when you file it away again, this memory, it's lost,
it's luster, it's lost a lot of its bite. Right. Because you've gotten it out there and reprocess
it in a way that's not nearly as traumatic because your working memory was being used in part to
follow your therapist's finger. Supposedly it worked. Wow. Yeah. Isn't that nuts? Pretty neat. Yeah,
I think so too. I wonder if it really does work. You should try it. Anyone who has ever
undergone eye movement desensitization and reprocessing, I would love to hear your story
if it actually helped you or not. For sure. And if you have a metaphobia, Godspeed, we hope you
get well soon. And to take this on or any phobia really has so much courage and grit that just
taking a first step toward treatment, my hat is off to you for life. Yes. And chances are you
probably didn't even listen to this episode. Yeah. But if you have a different phobia, yeah,
you know, any phobia. And since I said phobia a couple of times, it means it's time for listening to
your mail. I'm going to call this our second PSA in as many weeks if this releases the same week.
Okay. But this one's about dogs. It's very sad. Hey guys, take me a while to write this because
it's been very difficult to talk about. You know, your animal overzo so probably a good majority of
listeners are. And I thought sharing our tragic story would help prevent others from experiencing
the same thing. We lost our dog river about two months ago because I left a bag of chips out.
We were at work while she got her head stuck in the bag and we came home to find
our dogs stiff and lifeless from suffocation. We've always been careful about plastic bags and
stuff like that and kept them stored away for recycling. But never occurred to us that a chips bag on
the counter would something would need to be concerned about. No, no one ever would ever think about
that. Everyone we've also told said it was something they never thought about either. So now we
keep all of our bag foods in the cupboard and cut the bottoms off of anything that goes into the
recycling and waste bin since good idea too. I started doing that since these guys rode in.
Oh yeah. We were and still are extremely heartbroken. I hope no one else will have to go through
this experience. It was the worst and if I can help save just one other dog's life, it's been
worthwhile. So thanks for being you guys. Thanks for being you guys. There's a comment there.
There's not but I think that's how I'm supposed to read it. I hope we make it into your next
Seattle show. That's Jackie W. from Seattle. Jackie, thank you for writing in. I'm so sorry about
River. But I hope you guys are doing okay. Yeah, that sounds like a guest list.
Yeah, I agree. Action to me. Yeah, right back in and we'll guest list. Yeah. So just right back in,
we'll throw you on there. Yeah. And she sent a picture of River. Beautiful dog. Very, very sad.
River. Look very sweet. If you have a PSA that happened to you that you think we should share to
warn everybody else about, we want to do that. You can tweet to us at SISK podcast. You can send
all of us a injury an email to stuffpodcast.house.gov.com and as always join us at our home on the web
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