IT HAPPENED TO ME: I Went Through Exposure Therapy To Confront My Fear of Vomit

I’m in the fetal position on the floor of my locked bedroom, 16 years old, sobbing hysterically, shielding my eyes from a piece of plastic vomit.
Publish date:
May 22, 2014
healthy, therapy, mental health, OCD, exposure therapy

I’m in the fetal position on the floor of my locked bedroom, 16 years old, sobbing hysterically, shielding my eyes from a piece of plastic vomit. It was the kind you buy at a Halloween store or a joke shop, with these big, fake-looking, rubbery chunks, and tapered edges so you could place it on a counter for a bad prank and it would look like it had been sitting there a while. My doctor told me I had to stare at it for 15 minutes, but I’d barely made it two.

There are a lot of details I don’t remember from that time in my life, one of which is this particular doctor’s name, so let’s just call him Dr. Doctor.

I remember sitting in Dr. Doctor’s waiting room with my parents, an Ativan dissolving under my tongue as I chewed Orbit Bubblemint gum and played Tetris on my flip phone, leg still jackhammering away on the floor. My mom put a hand on my knee to try and keep it down. We lived in Northern California, and on two separate occasions my leg’s incessant bouncing had been mistaken by strangers for an earthquake.

When Dr. Doctor came to get us, I couldn’t shake his hand. Hands were contaminated. So were doorknobs, tabletops, the whiteboard pens at school, and non-pre-packaged foods.

He sat me in a big leather chair -- the armrests were contaminated -- and he handed me a sheet of paper and a (contaminated) pen. The paper had a list of various OCD symptoms, and he asked me to put a check mark by each symptom I was experiencing. All but one, and that bugged the shit out of me. I voiced my concern that there would be a checkmark next to everything besides “I often find myself accumulating items I don’t need.”

“Would you feel better if you checked all of them? To make them even?” Asked Dr. Doctor.

“Yes,” I said.

“Why don’t you try leaving it blank and seeing if it might start to feel manageable?”

He was really nice. I reluctantly handed the paper back to him.

Dr. Doctor asked me a bunch of questions, some of which he already knew the answers to -- he’d already talked to Dr. Therapist and Dr. Psychopharmacologist, my therapist and psychopharmacologist, respectively. Then he asked me personal questions, about school and friends and my interests, and, young and exhausted and shy as I was, I looked to my parents to give the answers.

“So, what brings you here today?” he asked. I didn’t know how to respond. I wasn’t there to talk about the OCD or the panic attacks or the depression, and those were the things I’d long since learned how to talk about to mental health professionals. What brought me to Dr. Doctor scared me so much that I found it difficult to even say.

I was there to talk about puke.

“Why do you think you’re so afraid of vomiting?” asked Dr. Doctor. Again, I looked to my parents. I really didn’t know. The best guess anyone on the “Keep Jenny Jaffe Sane Squad” had was that, much like the ritualistic hand washing, it was an issue of control that had mutated into a paralyzing phobia.

I stopped eating for fear of food poisoning. I rushed home from school early to take my temperature so I could be sure I didn’t have a stomach flu (and then took it again, and again, and again over the course of the night). The mere suggestion of nausea sent me into a full-blown panic attack. The fear was all-consuming. Though it all looks kind of silly written out now, it was ruining my life. The forest of my anxiety was too thick to see for the trees, and I hoped that felling just the puke-fear tree would be a good first step in helping to deforest it. I’m not in love with this metaphor. Let’s move on.

Dr. Doctor specialized in Cognative Behavioral -- or Exposure -- Therapy. CBT is a specialized, hands-on approach to dealing with exactly the kind of phobic obsessions my brain had latched onto. Afraid of flying? CBT will force you to get on a plane. Afraid of heights? You’re going to the top of the Empire State Building. Afraid of death? Sorry, amigo, you’re just human and that’s just scary. The idea is that directly confronting your fears takes the power away from them.

If you’re ready.

I wasn’t ready.

I was terrified Dr. Doctor was going to suggest induced vomiting, as my mom once had in a moment of desperation. Dr. Doctor decided to take a slower approach, one he thought I’d be able to handle. First, he gave me a list of movies that include scenes of characters throwing up. It turns out that emetophobia (as I have since learned that it’s called) is a common enough fear that he just had this list on hand to give to patients who are struggling with it. I looked it over, and mentally added "Mean Girls" to the list (I always knew to leave the room when Cady is alone at the house party with Aaron Samuels. I even knew just when to tune out to miss her talking about “word vomit.”)

He asked if that felt OK to me, and I thought about it for a second.

“I kind of want to check off the last item on that list,” I said. It was still sitting in his lap.

“Do you want to check it because you agree with it or because you want it to be symmetrical?”

“I don’t know,” I said. “I have a lot of things I don’t need, so maybe it applies.”

“Jenny. Does watching the movies feel doable?”

I blinked back tears and shook my head. I felt pathetic beyond pathetic.

“That’s OK,” he said. “Can I make another suggestion?”

“I don’t know,” I said again. I was crying. My face felt numb. The Ativan I’d taken in the waiting room had left me sedate and I wanted to go home.

Dr. Doctor waited a few minutes. He talked to my parents. I don’t remember what they said.

“OK,” I said at last.

“You know that plastic vomit they have at House of Humor?” I don’t know if House of Humor is a chain, but it was a joke shop in Redwood City. I didn’t like going in there; some of the costumes were kind of scary. “I want you to buy a piece of plastic vomit and just sit with it in your line of sight for 15 minutes. Does that sound doable?”

So that's how I eneded up in the fetal position on the floor of my locked bedroom, 16 years old, sobbing hysterically, shielding my eyes from a piece of plastic vomit. I am sleep-deprived. I am starving. I am furious at myself. This shouldn’t be hard. This shouldn’t be hard.

I give up. I climb in bed with my mom and cry and tell her how much I hate myself. She tells me, “Every day in every way you’re getting better and better.”

I tell myself, “I’ll be stronger tomorrow.”

I went back to see Dr. Doctor the following week. In that session, he took me up and down the halls of his office and had me touch doorknobs without washing my hands immediately afterward or using my sleeves as germ guards. I think I successfully brushed one or two with the tips of my fingers, which, I must admit, was progress.

Then, he took me down to the office courtyard, opened a garbage can, and asked me to touch it.“No,” I said, and then, because I was angry at myself, “That’s dumb.”“Why is that dumb?” Asked Dr. Doctor. He demonstrated placing his hand on the garbage can lid. “You don’t have to touch it for more than a second.”“No, that’s dumb. Because normal people don’t go around touching garbage cans, so I’m not going to ever need to do that.”“But if you could touch a garbage can, think of what else you could do! Look, just make your fingers dance on the lid!” He closed the lid and had his index and middle finger do a little can-can for me. He smiled and I tried to smile back.“No,” I said, more quietly this time. He nodded, and we went back inside.On the ride home, I told my parents I didn’t think I wanted to do CBT anymore.

I am going to struggle with anxiety and OCD for the rest of my life. That was a difficult fact to accept. But it’s manageable now. Its intensity ebbs and flows, but haslargely been calmed thanks to years of therapy, medication, patience, and strength. I can shake hands with people now. I can eat food prepared by strangers. I still don’t like doorknobs. The Christmas after my sessions with Dr. Doctor, I caught a stomach flu. Thanks to the large volume of projectiles that made their way from my stomach to the toilet, I’m no longer afraid of throwing up. Exposure therapy does work -- but I’ve found it’s most effective when it takes the form of life experience.