Psychogenic Vomiting

Abstract

This paper reports on the clinical picture of the psychophysiologic disorder of psychogenic vomiting. This term is applied when it is the result of an emotional upset or of a more profound psychic disturbance, and only after no organic pathology was found. Especial emphasis is placed on the careful evaluation of various characteristics of the presenting symptom, i.e., accompanying manifestations, duration, time of day in which it occurs, stressing events related to the vomiting episode, patients’ motivation for psychiatric treatment, their ability to introspect, to verbalize their problems and emotions and their expectations from treatment. Since every variety of personality and every psychiatric disorder may show functional vomiting as a manifestation, the vomiting must be appraised in the context of a complete diagnostic work-up. Treatment will be different according to the various factors considered. For patients who principally present this psychophysiologic disorder, special psychotherapeutic tactics are suggested. The adherence to the tenet ‘treat the symptom, and the person as a whole will benefit’ is useful. The symptom is viewed as the fundamental step to develop the doctor-patient relationship. Special work is done in enabling the patient to become aware of his feelings, and to acknowledge the relationship between the emotions and the physical dysfunction. Clinical examples are described.

A Case of Psychogenic Belching

“…In a randomized trial 2 , 26 functional dyspepsia patients were randomized to hypnotherapy, supportive psychotherapy plus placebo medication, or medical treatment for 16 weeks. 1 Compared with the other approaches, hypnotherapy significantly improved symptoms in short term or long-term treatment. 3…”

All who vomit are not bulimic

“…The process of psychogenic vomiting may be "involuntary" (Morgan, 1985;Clarke, Salmons, & Hanson, 1988) or "self-induced," for example, by pharyngeal stimulation (Leibovitch, 1973;Wruble et al, 1982) or left unspecified (McDonal, 1982;Dura, 1988). It is unclear whether these differences have clinical relevance, although distinctions have been made between vomiting reactive to anxiety, a response to fear, and neurotic vomiting, an expression of symbolic conflict or repressed emotion.…”

“…Swanson (1976) emphasized that long-standing nausea persisting for more than 1 month is usually functional in origin. The emotional detachment and lack of inclination to introspect (Leibovitch, 1973) is reminiscent of hysterical dissociations (Kendell, 1974;Merskey, 1978) and the family are often more concerned than the patient (Wruble et al, 1982;Morgan, 1985). Obviously, a normal physical examination and routine blood investigations are further pointers, but it should be borne in mind that long-standing vomiting, from whatever cause, can result in substantial sequelae (Jewell, 1987).…”

“…This has been named psychogenic vomiting (Wruble, Rosenthal, & Webb, 1982;Morgan, 1985) and there have been no uniform descriptions of the disorder (Leibovitch 1973, Rosenthal, Webb, & Wruble 1980. Earlier studies on this population were complicated by changing definitions of bulimia (Russell, 1979;DSM-I11 1980;DSM-IIIR 1987), and populations often included patients now recognised as suffering from bulimia nervosa or anorexia nervosa (Leibovitch, 1973;Rosenthal et al, 1980). Psychogenic vomiting has been described as a conversion disorder (Garfinkel, Kaplan, Garner, & Darby, 1983), psychophysiological accompaniment of emotion, a conditioned response (Pavlov, 1923, learnt reaction response to stress in a familial setting (Hill, 1968;Morgan, 1985) or, in classic psychoanalytic terms, as an expression of unconscious sexual wishes (Freud & Breuer, 1946).…”

“…A further eating disorder appears to exist, although very rare, in which vomiting of nonorganic origin occurs but is not accompanied by the core psychopathology of bulimia nervosa. This has been named psychogenic vomiting (Wruble, Rosenthal, & Webb, 1982;Morgan, 1985) and there have been no uniform descriptions of the disorder (Leibovitch 1973, Rosenthal, Webb, & Wruble 1980. Earlier studies on this population were complicated by changing definitions of bulimia (Russell, 1979;DSM-I11 1980;DSM-IIIR 1987), and populations often included patients now recognised as suffering from bulimia nervosa or anorexia nervosa (Leibovitch, 1973;Rosenthal et al, 1980).…”