When Eating With Others, I Have the Urge to Vomit

Reader’s Question

I’m 23 years old and have been suffering from this condition for about a year now. I cannot eat with people around on a table without feeling the urge to vomit. I’ve had similar symptoms in my earlier years but during the last several months it has become unbearable…

First it was only when new people were around and when I went to an unfamiliar place. Then it began to occur even when I am out with my friends or even my partner (5 times I ordered meals that I completely threw away without even touching them). Now I can’t even go to a restaurant or be invited to a place (even a friend’s house) for dinner/lunch. I always dread the outcome so I end up by either refusing to go or go feeling sick all the time and eat nothing.

I really need some advice, it’s destroying my social life: I don’t enjoy going out with my friends anymore, it’s affecting my relationship with my partner, and I reject every dinner/lunch invitation… I am a skinny guy too, and I was trying to gain some weight; unfortunately, with this condition it’s not happening, since constantly thinking about how pathetic it made me increases my loss of appetite throughout the day.

I’m afraid it’s part of a more complex disorder, social phobia (since I have difficulties meeting new people), or low self-confidence… Please I need help because I’ve overcome a lot throughout my life, accomplished a lot and still have a lot to achieve so I can’t allow this stupid situation to pull me down.

Our Clinical Psychologist’s Reply

You may have social phobia and low self-confidence, but a high level of anxiety and Emotional Memory (EM) keeps you from eating with others. Anytime we have a humiliating or traumatic experience, the brain memorizes both the details and the emotional state at the time of the event. This creates an Emotional Memory (see article on this website) that contains both details and moods. When we recall one of these EM, we not only remember the details but start to refeel and reexperience the original moods and physical reactions. Everytime you think of eating with others — you experience nausea, because the experience of nausea is in the memory. The more you think about it, the stronger the nausea and urge to vomit becomes. This is the mechanism that creates not only phobias, but Post-Traumatic Stress Disorder (PTSD) as well. Once bitten by a dog for example, the brain becomes instantly fearful when in the presence of any dog. We also become fearful when thinking of dogs…even though no dogs are in the area. That’s how Emotional Memory works.

To fix this, several approaches are needed:

• Since a high level of anxiety is amplifying this reaction, you might consider using a long-acting antianxiety medication. Once we have an EM, stress only increases its frequency and intensity. As your life becomes more complicated, this will increase your symptoms unless managed. A long-acting antianxiety medication helps keep the anxiety low — thus making the EM more manageable. With social phobia, we also have medications that are approved for the treatment of social phobia that contain both an antidepressant and antianxiety action.
• Read my article on Emotional Memory. It offers a discussion on how EM is developed as well as recommendations on managing emotional memories.
• Remember that by anticipating the problem at the dinner table, you are actually bringing up the Emotional Memory that includes the nausea. It’s like trying not to think of a white polar bear, a behavior that actually brings that thought into the forefront of our thinking.
• Consult with a therapist or counselor. We have a technique called “systematic desensitization” in which the phobic object or issue can be gradually approached — beginning with a low-stress experience and gradually returning to normal life. A series might include 1) driving through a restaurant parking lot, 2) going through a drive-thru, 3) going inside and getting food to go, 4) drinking a soda in a small restaurant, 5) drinking a soda with a friend, etc.
• It’s helpful to remember that while we’ve overcome a lot and achieved a lot, those positive events are also stressful events. When we’ve picked up an emotional memory along the way, we may need professional support to fix that so we may continue our journey.