Behavioral treatment of psychogenic vomiting in the context of social phobia

A case of psychogenic vomiting in the context of social phobia was treated by a combination of exposure in vivo, social skills training, and cognitive modification. The intervention was not directly aimed at the vomiting, but at aspects of the patient's behavior hypothesized to be instrumental in maintaining it; deficits in prosocial behaviors and associated anxiety. Change was assessed on the basis of patient's records of daily frequency of: vomiting; performance of treated behaviors; and associated anxiety within a single-case multiple baseline design. Change occurred only with the introduction of treatment and not before it, ruling out effects of time or mere contact. Clinically, the vomiting was virtually eliminated after 7 weeks, and the anxiety was substantially reduced in most previously feared (and avoided) social situations; except for a 2-week depressive spell, this outcome has been maintained for an available 2-year follow-up. A general improvement in the patient's personal, social, and vocational life has also occurred.