Psychogenesis of Emesis

Abstract

1. Emesis, or vomiting, considered historically, can be seen in three roles. First it was induced for convivial reasons, to permit continued gormandizing, secondly, on cultural grounds, as part of purification rites and thirdly for curative purposes in the treatment of illness, including mental disorders. Its importance in medicine stems from the fact that it is probably second only to pain in frequency as a symptom of emotional disturbances. Its importance in psychiatry lies in the fact that it is observed in a variety of situations in which its occurrence has different psychological meanings and since it occupies a controversial position in the conceptualizing about conversion phenomena. 2. The physiology of emesis is reviewed and the sequential participation of autonomic and somatic factors is detailed. Psychophysiological aspects of nausea are briefly considered. The roles of various neurophysiological functions, including the limbic system, are discussed in connection with the psychogenic aspects of emesis. 3. Reference is made to pertinent papers on ‘neurotic vomiting’ and to some offering psychodynamic explanations. The relevance of organ language to emesis or ‘neurotic vomiting’ is mentioned. 4. An endeavour is made to separate reflex from psychogenic emesis and a classification of the latter is presented. This shows an increasing complexity as one passes from states in which the mechanism is characterized as arousal to those designated symbolic, expressive and disintegrative. 5. Some semantic implications of the words symbolic, conversion, hysteria, and expressive, are discussed and the unsatisfactory state of ambiguity which surrounds the first three in the psychiatric literature is noted. 6. Certain psychodynamic characteristics of those patients in whom vomiting was a major psychiatric symptom are summarized from the psychiatric literature.

The role of anxiety in the development of anticipatory nausea in cancer chemotherapy: a review and synthesis.

“…Innervation of the vomiting center via psychological pathways is also evidenced by the ability of emotional states, such as state anxiety, to trigger nausea and vomiting (23)(24)(25). This can account for the occurrence of such symptoms in athletes or thespians prior to competition or performance (26).…”

“…While the relationship between state anxiety and gastrointestinal distress has been discussed earlier (23)(24)(25), little research has examined the relationship between state anxiety and PNV. An exception is the study by Jacobsen et al (51).…”

The role of psychological variables in post-chemotherapy nausea: anxiety and expectation.

“…Afferent input from several sources, including the higher brain stem and cortical structures, is capable of initiating the emetic process. This accounts for the ability of cognitive (i.e., psychological] stimuli, such as state anxiety, to trigger nausea and vomiting (6)(7)(8). The occurrence of nausea and vomiting in athletes or stage performers prior to a competition or performance (9) is a good illustration of the potential for state anxiety to initiate the emetic process, even in the absence of a pharmacologic stimulus.…”

Sexuality and Body Weight in Normal, Anorectic and Obese Young People

“…It has been reported from Canada (Cleghorn and Brown, 1964) that some 5% of women vomit periodically as a means of losing weight. Further, it is known (Crisp and Kalucy, 1974) that normal girls over-perceive their body shape, particularly their thighs, and Lacey.…”