Faux-Nausea From Anxiety Vs. True Nausea

People can feel nauseous when they get nervous. I'm one of them. My anxiety often hits me in the stomach, and this article is coming from a place of personal experience.

There are a few ways nausea, anxiety-induced or not, bothers people:

• It just feels unpleasant and distracting for its own sake.
• It can set off fears that you're going to throw up, which will be uncomfortable and embarrassing in one way or another.
• It can lead to worries that others will notice how pukey you feel and judge you harshly for it. You could be afraid they'll simply notice how quiet and pale you look, or that they'll catch on because you're not able to perform some task that's expected of you, like carrying on a conversation or eating your meal at a restaurant.

A vicious cycle can come into play where someone gets nervous, starts to feel nauseous, then gets even more nervous about how their queasiness may humiliate them, which makes their stomach feel worse, and so on.

"Faux-nausea"

I've noticed in some cases when someone feels pukey due to nerves they're not truly nauseous, in the sense that their stomach has been upset due to some outside force and there's a decent possibility they might need to throw up. Instead their anxiety creates a bunch of tense, unpleasant sensations in their body that feel like nausea, but their actual GI tract is fine. They're not at much risk of puking. It may emotionally feel like that's a possibility. They may have all kinds of scary thoughts about barfing everywhere and being mocked, but physically it's not likely.

I know dividing the feelings you can get when you're nervous into "faux-nausea" and "true nausea" is an arbitrary distinction. It's not something to take too literally or try to poke holes in. It's just to make the point that sometimes the "nausea" you feel when you're worried and jittery is different from what's going on when you've, say, accidentally eaten some spoiled food and your body has to eject it from the system.

Some people who tend to feel queasy when they're nervous already sort of know this. They're still scared of and upset by their anxiety-induced pukiness, but they also recall that on the handful of occasions where they threw up due to having a stomach virus or whatnot, the nausea had a different quality to it. It's hard to describe exactly how it differed, but it came on faster. It had more of a clean, matter of fact inevitability to it. It felt like there was really something amiss in their stomach that needed to come up.

To get to the point, realizing the "nausea" you feel when you're anxious often doesn't represent a true risk of throwing up, and is instead a bunch of unpleasant, but harmless inner sensations, can take away a lot of its power to scare and control you. You can switch your mindset from, "I feel a bit pukey... Oh no! Oh no! What if I get sick?" to, "Ugh, my stomach feels weird. It's not fun to go through, but it's not going to amount to anything. I can put up with it and carry on. "

Who this article may help

Some people may have read everything above and are thinking, "That's nonsense. I actually do throw up when I get anxious. The nausea I feel is 100% real." I don't think the ideas in this piece will apply to everyone.

I think viewing your anxious stomach upset as "faux-nausea" could be helpful and empowering if:

• You mostly get dull, lingering nausea-like sensations when you're nervous. They rarely or ever get more intense, where you may start retching or feel like you're going to puke at any moment.
• You've never actually thrown up from nerves, or it's only happened a handful of times when you were extremely panicked.
• You wouldn't like it if you barfed, but if it happened you know you'd manage okay. Like most people, you'd find it a little painful, and a bit embarrassing and inconvenient, but it wouldn't be the end of the world. More importantly, you're willing to push your luck a bit as you try to get a handle on your faux-nausea.

Trying to think of your nervous pukiness as not a big deal won't make sense if these points describe you:

• You get extremely uncomfortable nausea sensations when you get anxious, where it really does feel like you could hurl at any time.
• You puke from your nerves fairly often, at least often enough that any time you feel nauseous there's a realistic possibility you could spew.
• You're really afraid of throwing up. That's the worst possible outcome and you'd do anything to avoid it. You may or may not consider your fears to be irrational, but you can't help but have them anyway. You may even have full blown Emetophobia, a phobia of vomiting.

If you're terrified of puking then you're probably not willing to entertain the idea that you only have "faux-nausea" when you're anxious. It would feel risky and negligent to dismiss it that way. What if it really could lead to a disaster? You believe you need to be alert and on guard to that possibility at all times.

On the other hand, if you recognize yourself in the descriptions of faux-nausea you might be thinking, "Yeah, that's right. I feel 'nauseous' when I'm anxious fairly often, but I can't remember the last time I actually threw up from it. It may make more sense to change the way I look at it."

Becoming more tolerant of your faux-nausea

Just making the mental shift to seeing yourself as having faux-nausea when you're nervous can be helpful on its own. It can take some of the air out of the physical sensations to realize they're not as risky as you previously assumed they were. Though adjusting your mindset will likely drop your fear a bit, to really change your relationship to this symptom you probably need to face it down more.

The main way to do this is to gradually get used to your inner faux-nauseous sensations. Right now you're probably a bit scared of them. You get spooked when they come on and probably try to make them go away. And if you can't do that then you grit your teeth and reluctantly try to gut them out.

It takes time and effort, but you can get to a point where you can calmly allow the faux-nausea feelings to be there without getting too upset. They may still feel uncomfortable, but that's all they'll be. They won't also set off a spiral of worries about embarrassing yourself, or trigger a bunch of safety behaviors as you try to settle your stomach. You'll be able to think of the physical discomfort from your faux-nausea the same as you would a sunburn, doesn't feel the best, but not worth thinking much about otherwise.

Steps for getting used to your faux-nausea

The ideas I'll cover below are geared toward dealing with faux-nausea, but draw on established Exposure Therapy and mindful observation principles which can be used for all kinds of bothersome somatic anxiety symptoms.

Learning to allow your faux-nausea to be there

The way to start building up your tolerance to your faux-nausea is to become more curious and observing of it:

Preparation and mindset

• Begin at a time where you feel some mild anxious faux-nausea, and you're on your own and can take some time to explore it (e.g., you're hanging around at home and thinking about a scary presentation you have to give in a few weeks).
• Make yourself physically comfortable.
• Try to put yourself in a neutral, observing, curious, scientific-data-gathering mindset.
• Try to frame your false alarm faux-nausea as arising from one or more uncomfortable involuntary inner sensations, rather than as this vague, scary, awful feeling you have to avoid at all costs. That's really all it is. Your nerves are causing various physical changes in your head, throat, and torso that feel a lot like nausea, but aren't really.
• If the thought of exploring your faux-nausea makes you too uneasy, tell yourself you only have to do it for a few minutes, then you can get up and try to calm yourself down, or have some ginger tea or whatnot. Though once that time is up, ask if you could do another few minutes, or if you'd be willing to come back for another short round after the break.
• Know that if you suddenly find yourself getting super freaked out and unsettled you can stop. The idea is to lean into some mild to moderately uncomfortable feelings, not punish yourself by enduring something truly tortuous.

Being with your faux-nausea

• To start, try just sitting with the unpleasant feelings and quietly, peacefully putting up with them as best you can, no different than if you had your hand in a bucket of cold water.
• If it helps you to stay present and hang in there, feel free to take some slow, relaxing breaths, but try to only do it as a means of staying with your faux-nausea, not to lower it.
• Next, see if you can move from only tolerating the sensations to more actively observing them for a while. Don't try to change or get rid of them. Just watch what they do in your body. See if they move around, randomly become weaker or stronger, or switch to a different set of feelings. Try to stay detached and see how things unfold.
• Try fleshing out exactly how certain sensations show up. Pay attention to what's going on and answer questions like the ones below. Your responses don't have to be perfect or even make logical sense. Just see what comes to mind.
  • How much space in your body does the sensation take up?
  • Does it have solid or fuzzy boundaries?
  • Does it feel light and airy, or heavy and dense?
  • Does it feel still and steady, or bubbling and pulsing?
  • Does it feel hot, cold, or neutral?
  • If it had a color, what would it be?
• Get even more curious. Really tune into your inner sensations and try to figure out what's happening in your body to bring them about. Your body can create a variety of faux-nauseous sensations, each caused by a different mix of muscle contraction, tension, breath holding, and so on:
  • Are you slightly tensing or sucking in your abs?
  • Are you unintentionally holding your breath and making yourself feel tense or woozy?
  • Are you tensing certain muscles in your throat or mouth to create a bit of a gagging sensation?
  • Are you tensing up your torso while slowly exhaling to create an uncomfortable sense of your guts shifting around?
  • Are you taking quick, shallow breaths and getting a little lightheaded?
• If a set of faux-nauseous sensations seem really uncomfortable as a whole, ask yourself where specifically in your body is it the most painful? Often when you zero in on the worst spot it doesn't feel that bad by itself.
• If you really want to go the extra mile, see if you can increase the sensations. For example, press or lie on your stomach, or get up and walk around if you feel dizzy.

As you continue to tune into your faux-pukey sensations, they'll sometimes start to dissipate on their own. Anxious sensations often do that, provided you can calmly sit with them and let them run their course, rather than throwing fuel on the fire by freaking out about them. Though it doesn't always work that way. Some symptoms won't go away until you address their deeper roots. However, even if they don't dissolve at that moment, you're still building up your ability to tolerate them.

Practicing and improving over time

If you're up to it, do this exercise several times a week for a few months. Over time you'll get better and better at tolerating more and more flavors of faux-nausea. You'll also get more skilled at tuning into your inner world of bodily sensations and identifying where exactly the faux-nauseous feelings are coming from ("Hm, this time it's because I'm subtly closing the top of my throat"). Over time challenge yourself to sit with and tolerate stronger and stronger versions of your faux-nausea.

Facing your fears of faux-nausea in the the outside world

You can build up a lot of tolerance by sitting with your faux-nausea at home, but try to graduate to doing the above practices out in the real world, like if you find yourself feeling pukey at work or while sitting around with friends.

If certain situations tend to make you faux-nauseous and afraid of embarrassing yourself try putting yourself in them, and being with the feelings that come up. Some people get queasy in standard scary situations, like going to a party where they only know one person.

It's also common for someone who struggles with faux-nausea to feel nervous in settings that may naturally unsettle their stomach a little. What they're doing doesn't bother their stomach enough to make them throw up, but it makes them a tad bloated or unsteady, and then the anxious faux-nausea and the fears of "What if I do puke this time?" join the mix. Some examples are:

• Eating spicy, greasy, or filling foods
• Drinking soda or beer and feeling gassy
• Being a passenger in a car, if you're prone to car sickness
• Being on a boat, if you get seasick
• Flying, if you get airsick
• Riding a rollercoaster or spinny carnival ride
• Being in a hot environment
• Physically exerting yourself

People who get faux-nausea also tend to fear situations where they feel trapped, and they couldn't easily get to a toilet if they suddenly had to throw up:

• Sitting in a middle seat in a crowded theater
• Getting a haircut
• Taking a long distance bus trip
• Driving in heavy traffic
• Flying on a plane, when passengers are required to stay in their seats

They may also be afraid of eating with other people. Their faux-nausea may make them feel like they have no appetite, but they don't want to draw attention to themselves by not touching their food.

Whatever the fear, the idea is to be in these settings, let the faux-nausea come up, and experience firsthand you can tolerate it, and that nothing will go wrong. If you're afraid of situations where your stomach is already bothered, you want to learn you can handle the original uncomfortable sensations, like being full, and that any additional faux-nausea won't send you over the edge. You can also realize that you can successfully do things that seem like they'll make your stomach worse, like eating that greasy pizza with your friends. Remember this is faux-nausea you're dealing with, so your stomach isn't actually at risk. It just feels like it is.

Again, the key is to do all this gradually. Some of these situations may really frighten you, so work up to them over time.

Process upsetting nausea-related memories

Many people who fear they'll barf and embarrass themselves have had moments in their childhood where they were nauseous and something bad did happen. Maybe they threw up in front of their third grade class and got scolded by the teacher, or got seasick on a family boat ride and were made fun of by their relatives. They didn't fully work through the tough emotions of shame and fear it brought up at the time, and now when they feel queasy as an adult their old worries of being humiliated get triggered. It adds an extra dimension of threat to their present day faux-nausea.

Processing any memories that feed into your anxiety and faux-nausea can reduce its intensity. This article explains how to do that:

How To Emotionally Process The Upsetting Memories That Fuel Your Social Anxiety And Insecurities

If all goes well you can eventually get to a point where you'll be able to gracefully put up with most of your faux-nausea. It just won't seem like a big deal to you any more. No one's perfect, and every so often you may get really nervous and get a wave of strong pukiness you have trouble managing, but it will stand out as an exception.

You may find a lot of your anxious faux-nausea goes away for good once you lose your fear of it. Some of it may have been sustained by that vicious cycle I mentioned earlier, where getting nervous about your symptoms amplifies them. However, other faux-nausea may be a symptom of anxiety you have for other reasons, and won't go away until you address those causes. But at least in the meantime the faux-nausea won't bother you as much and give you even more to feel bad about.

Related articles:

Learning To Simply Tolerate Your Anxiety
How To Face Your Bigger Social Fears Gradually