Anxiety Chronicles is a series from The Lily that examines the journeys different women have with anxiety.
This week, we hear from Marisol Cortez, a writer, community scholar and cultural arts worker based in San Antonio, Tex.
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I’ve had anxiety since childhood, largely manifesting as emetophobia — an extreme fear of vomit and vomiting. At the age of 4, seeing other kids puke plunged me into a dread and despair that felt both incomprehensible and inexpressible. At 8, I had my first panic attack, seized out-of-the-blue by a certainty that I was about to vomit publicly and humiliate myself, after which I began ruminating constantly about getting sick in public. At 13, a bizarre episode of severe nausea with no clear physical cause debilitated me for nearly a year. And in my 20s I shrank to the size of a child as I struggled to manage these ruminations, triggered by the stress of graduate school, by not eating. For most of my life I had no language for these things, and early on concluded that I was simply strange — a secret to conceal at all costs. The trauma arising from this effort led to other mental health problems as I managed my symptoms maladaptively, through the magical thinking of OCD ritual or, later, through self-injuring behaviors (starving, cutting) that acted out the intense internal distress I didn’t know how to express directly.
It’s always been difficult for me to disentangle what is physical about anxiety and what is mental. Am I anxious because I feel physically sick? Or do I feel physically sick because I’m anxious? Especially before I understood my experiences as anxiety, I frequently had sudden attacks of acute nausea, usually in public, where I felt sure I was about to vomit in front of others. Now I know these were panic attacks, often triggered by bodily sensations I found ambiguous or uninterpretable (“What’s that feeling in my stomach? What does it mean? Am I about to feel sick? Oh no, it’s happening—I gotta get out of here!”).
At times my anxiety has been purely physical, without any apparent mental basis, as during the episode of unexplained nausea I experienced at 13, which ended as suddenly and mysteriously as it began. Another time, at 17, I lost the ability to swallow for several months and lived on peanut butter and raisins, the only foods thick and sticky enough not to send my throat into spasms.
In many respects, emetophobia works like any other simple phobia, where an encounter with vomit or vomiting will trigger an immediate panic response. Depending on how close an encounter it is, this response might be intense and even debilitating (crying, shaking, having to leave the house, being unable to leave the house) or it can be a low-level feeling of pervasive dread — a feeling that something bad is about to happen that I am powerless to stop. However, my experience of emetophobia has always been more complex, in that stressors completely unrelated to vomiting also trigger anxieties about feeling or getting sick, especially stressors involving social expectations that feel inflexible or situations I can’t easily physically escape (like riding on an airplane, or having to show up to teach every day looking professional, competent and prepared). Mentally, then, emetophobia is one part specific phobia and one part social anxiety, with aspects of panic disorder, somatoform disorder, and OCD thrown in for good measure.
At its worst, I’ve had to leave town during the middle of a school/work week because my roommate was sick. It didn’t feel safe to eat inside the apartment, so I ate my meals in the car (only safe foods like bananas and Gatorade, in case I got sick). The following day I had an episode of diarrhea, triggering a flood of panic so intense I left work, driving 200 miles away to stay somewhere safe for the rest of the week. At other times, my ruminations about vomiting have been more low-level, but so persistent that for years at a time I can’t eat enough to maintain a healthy weight. On my worst days, I find it hard to leave the house and show up for work (what if I start feeling sick and can’t leave?), hard to eat (if you don’t eat you can’t get sick, of course) and hard to sleep (what if I wake up sick in the middle of the night? Better to stay up and keep watch over how my body feels). I feel desperate to withdraw from all social interactions and hole up on the couch with a book or my phone.
The turning point in my ability to cope with emetophobia was recognizing my condition as anxiety — a common condition experienced collectively by many others, and not a shameful strangeness to hide. Not until my 30s did I understand the profound difference between, “What if I get sick? Better not eat” and “I’m feeling a lot of anxiety right now...what can I do to address it?”
What’s also helped me cope is discovering that my anxiety likely has a genetic cause. A few years ago, my psychiatrist suggested getting tested for the MTHFR mutation, which is associated with mental illness in that the mutation affects the body’s ability to metabolize folate and thereby produce neurotransmitters. After tests revealed that I have two mutated MTHFR genes, I started taking a prescription-strength, bioavailable folate and was shocked to see my symptoms reduced by 90 percent. While I still freak out when I have direct encounters with vomit or vomiting, the generalized, day-to-day ruminations are largely gone, as is the bizarre somatic anxiety. When I do have a flare up, what works best for me is distraction — I play Candy Crush on my phone. Oh, and Xanax. Seriously, thank God for Xanax.
I spent many years thinking I’d feel better if I could figure out what the content of my anxiety meant — the symbology of eating and vomiting — or theorize its social determinants. But I didn’t actually start feeling better until I stopped chasing after the narrative content of my anxiety and instead learned concrete techniques for responding to panic as a physiological experience of suffering, including finding pharmaceutical treatments that effectively addressed its biological causes.
I wish people knew that anxiety doesn’t necessarily mean anything; not all anxiety is “about” something. Relatedly, I wish people knew that not all anxiety originates in trauma. Undoubtedly, some does. But some anxiety is biophysical, there since birth, part of the spectrum of ordinary human variation in brain functioning captured in the idea of neurodivergence. In my experience, mistaking neurodivergence for trauma ironically can create trauma for those who live with more biophysically-rooted forms of anxiety.