ANTI EATING: REVIEW OF ORGANIC AND PSYCHOLOGICAL CAUSES OF VOMITING ...
ANTI EATING: REVIEW OF ORGANIC AND PSYCHOLOGICAL
CAUSES OF VOMITING
GISLA GNIECH and REETA SONAWAT
This article is concerned with disgust, nausea and vomiting. The origin of vomiting behaviour is generally
attributed to and classified into six major groups: a) Pathological and physiological, b) motion sickness,
c) chemical, d) physical, e) psychological and f) morning sickness during pregnancy. Whereas the
etiology of pathological and physiological, chemical and physical vomiting is well established, motion
sickness and morning sickness are less clear and may be caused by complex psychological factors.
Lost local orientation is believed to lead to motion sickness. Many psychological interpretations such as
unwanted pregnancies, negative daughter-mother-relationships, attention seeking motivations etc. are
found in the literature as causes for morning sickness.
Dr. Gisla Gniech is Professor, Dept. of Psychology, University of Bremen, Germany.
Dr. Reeta Sonawat is Reader, Dept. of Women and Child Development, Dr. Baba Saheb Ambedkar
National Institute of Social Sciences, Mhow, Madhya Pradesh.
Introduction and Problem
A healthy growing human body needs, besides other things, well selected food to
compensate for lost energy. In one of the main research fields of the first author,
namely the "psychology of eating" one is sometimes confronted with the organism's
aversions to special substances. As Rozin and Fallon (1987) pointed out, there are
four types of causes of rejection of food:
(1) Distaste is caused by sensory factors. A bad taste (especially bitter) and smell,
including a non-acceptable texture (Logue et al. 1981), motivates a person to a mild
form of rejection, e.g. black coffee in American culture, cheese in China, sometimes
uncooked fish.
(2) Danger is motivated by the anticipation of harmful effects, e.g. poisonous,
putrefied or allergy causing food. Eating such things is extremely dangerous.
(3) Inappropriate are foodstuffs which belong to the non-food area for humans
such as wood, rocks, sand, clothes, paper. These have little nutritional value, if any.
(4) Disgust is a mixture of sensory and idealistic aversions causing the rejection
of certain substances as food, e.g. faeces, blood, mucus and is closely linked with
nausea or vomiting.
Nausea and vomiting are anti-eating functions to protect the organism against
dangerous substances or situations. Harmful effects, on human beings, do not lie
exclusively in poisoned or putrid substances i.e. the biological dimension. There is
also psychic protection against aversive stimuli. Besides these functions, there are
many other reasons for nausea and vomiting.
In order to describe the phenomenon of vomiting and its causes, we first have to
give a definition. Vomiting or emesis is defined as the forceful expulsion of gastro-
intestinal contents through the mouth. It is accompanied by salivation, contraction

394 Gisla Gniech and Reeta Sonawat
of the pharynx and the muscular system, and is often preceded by the build up of
nausea. However, vomiting can occur in the absence of any premonitory nausea.
The person is able to exert temporary control over the vomiting, sufficient to ensure
that it is delayed until reaching the bathroom when the food just comes up, usually
in small quantities. There are internal (e.g. sickness) or external (e.g. being on a
ship) reasons for vomiting. Vomiting can have organic (e.g. physical, chemical,
physiological) or psychological reasons. The phenomenological description runs
from disgust through nausea (queasy feeling) to vomiting (spitting ingested food).
The frequency list of the subject index in literature on vomiting is found as follows:
(1) motion sickness,
(2) illness,
(3) eating disorders,
(4) psychological reasons and conditioned reflex,
(5) chemotherapy,
(6) special cases such as a. pregnancy,
b. early childhood,
c. infancy,
(7) others.
We don't intend to discuss the physiological aspects of brain functions, especially
in the cortical eating center and in the hypothalamus, neither do we speculate
concerning the role played by the area in the vicinity of the parotid gland and the
labyrinthum. In general, no simple reasons for vomiting exist, since the somato-
psycho-social uniqueness of the human being is grounded on complex mecha-
nisms. Nevertheless, an attempt has been made to review and classify the field to
find more explanations for special cases of psychologically caused vomiting such
as motion sickness or morning sickness in early pregnancy. Until now these
phenomenon have been regarded by physicians as purely somatic (caused by
hormonal threshold) and by psychoanalysts as purely psychosocial (defence of the
pregnant state and growing foetus). The reason why morning sickness is so
interesting, in this field, is that the pregnant woman is a person supposed to be a
healthy basis for the growing organism. One condition of healthiness is eating and
not vomiting.
Literature review
In our review we go from the relatively simple organic reasons for vomiting to the
more complicated psychological causes.,
1. Organic disorders Pathological and physiological reasons
The act of vomiting is heralded by nausea when there is an initial reflux of duodenal
contents into the stomach. Retching then follows, involving a series of vigorous
contractions of abdominal, thoracic and diaphragmatic muscles with the glottis
closed, the gastric contents flow into the lower oesophagus. Finally, there is powerful
and sustained contraction of the abdominal muscles, the diaphragm descends,
causing a large rise in intra abdominal pressure leading to vomiting itself. A wide
variety of both gastrointestinal and other disorders may lead to vomiting. Vomiting

Anti Eating 395
which is delayed more than one hour after meals is said to be typical of peptic ulcer,
gastric carcinoma, gall bladder disease and intestinal obstruction. Early morning
vomiting is typically associated with pregnancy, alcoholism and metabolic distur-
bance such as uraemia (Morgan, 1985). A broad field of vomiting-causes lies in
infections (bacterial, parasitic, viral) and intoxications of spoiled food (Oliver, 1990).
Vomiting is a common sequel of gastric reduction procedures after surgical treat-
ment (e.g. for obesity). Systematic studies (Griffen et al., 1977; Halmi, 1980; Mason,
1981) support this fact and point out that it is a serious burden to many patients.
Mason (1981) reported that in the year following surgery 17 per cent of the members
of one cohort reported vomiting "frequently" and 53 per cent reported vomiting
"occasionally"; comparable figures for another cohort were 11 per cent and 39 per
cent. In another study by Mason (1981) patients reported vomiting more than twice
a week of whom 66 per cent continued vomiting after one month falling to 33 per
cent after 6 months, 18 per cent after a year and 10 per cent after two years.
Lilian et al. (1986) report of green vomiting. They observed 45 new borns (weight
more than 2000g) initially presumed normal with bilious vomiting in the first 72 hours.
Data indicated that approximately two infants per thousand show these symptoms.
2. Motion sickness
Nausea is the most commonly reported symptom of motion sickness. It is a
profoundly unpleasant, subjective experience related to the epigastric region, her-
alding the approach of frank vomiting. The act of vomiting automatically constitutes
a more severe case of motion sickness than one in which only nausea is present,
although the end result of this particular facet of the syndrome may well be more
serious, e.g. in survivors of sea or air disasters.
The term "nausea" is derived from the Greek word naus meaning a ship. Sailing-
induced rotation was believed to possess therapeutic power by early 19th century
psychiatrists and even in the later part of that century physicians still sent patients
on a voyage for the sole purpose of inducing vomiting. Motion sickness has long
been a cause of great concern, Cicero claimed that "he would rather be killed than
again suffer the tortures of nausea maris" (Marti-lbanez, 1954). Schwab (1943)
examined a large number of US naval staff members suffering from chronic sea
sickness. He divided these patients into type I and type II groups. The former were
those who became sick, not only at sea, but on a wide variety of other forms of
transport (one speaks of kinetosis). The type II individuals had little previous history
of motion sickness and only became seasick during severe weather conditions.
Psychologists have recently stated that the disturbance of the balance organs in the
ear, together with some stimulation of the vomiting centre in the brain are not the
only causes for sea-sickness. The reflexes of the visual system and a general
disturbed orientation also play an important role (Stadler, 1987).
The modern version of motion sickness is space or canal sickness. There have
reportedly been at least 16 cases of space sickness among astronauts and cosmo-
nauts during weightless flights. Astronaut Russell Schweickart, the lunar module
pilot of the Apollo 9 mission, in March 1969, suffered mild nausea from the beginning
of the flight and it terminated in frank vomiting when he attempted to don his space

396 Gisla Gniech and Reeta Sonawat
suit prior to entering the lunar module. Stewart (1985) administered a questionnaire
to 17 astronaut candidates to collect data on signs and symptoms of motion
sickness. Two experiences most frequently mentioned on the questionnaire were
disorientation and upset stomach. Vomiting during space flight may result from
elevated stromach pH, disorientation, or a combination of both factors. In experi-
ments in which subjects have been rotated at speeds ranging from two to ten
revolutions per minute on a rotating platform or a 'slow rotating room' the main
symptoms of canal sickness were found to be nausea and vomiting (Graybiel et al.,
1960,1967). Even in a large space platform nausea, vomiting and other symptoms
of canal sickness may ensue for the same reason. Using the Wesleyan University
elevator device, Crampton (1955) examined a number of physiological variables in
an attempt to find a reliable indicator for forthcoming nausea and/or vomiting. The
subjects were exposed to a symmetrical wave motion having an amplitude of 7.5 ft.
and a frequency of 15.6 cycles/min., where the mid-wave-velocity was 400 ft./min.
The principal finding was that the onset of pallor consistently preceded the report of
nausea, and nausea always preceded vomiting.
Ordy and Brizzee (1980) studied the susceptibility to motion sickness in 104 squirrel
monkeys, assessing the effect of combined vertical rotation and horizontal accel-
eration, phenotype, sex, morning and afternoon testing, and repeated test expo-
sures on incidence, frequency, and latency of emetic responses. The highest emetic
incidence (89 per cent with a frequency of 2.0 during 60 min. and a latency of 90
min. from onset of testing) occurred at 25 rpm and 0.5 Hz linear acceleration. The
results indicate that squirrel monkeys represent a suitable primate model for studies
of motion and space sickness.
Money and Cheung (1983) studied the effect of removal of the vestibular apparatus
of the inner ear in mongrel dogs. It was observed that the emetic response to certain
poisons was impaired. The authors concluded that the inner ear is part of the normal
mechanism for vomiting in response to poison, and that one of the physiological
functions of the inner ear is to facilitate the emetic response to poisons. It seems
likely that this mechanism, whereby the vestibular apparatus facilitates the emetic
response to poisons, is the basis of motion sickness.
3. Chemical causes of vomiting
Any consideration of vomiting due to functional causes must take into account the
basic physical and reflex mechanisms involved in the act of vomiting (Jewell, 1983).
In the floor of the fourth ventricle there is also a chemo-receptor trigger zone which
may activate the vomiting centre in response to metabolic disturbances or the emetic
effect of poison, drugs and pharmacological substances. Drug abuse is often
associated with vomiting. The central theme of research is alcohol, but other fields
are not neglected.
The therapeutic role of chemical drugs is of great importance. In some special cases,
secondary effects, such as vomiting, are observed (e.g. with cancer-chemotherapy).
For the health establishing effect these non-intended sequences are tolerated.
McClung et al. (1988) studied the effect of Ipecac. Ipecac is a natural product
composed of emetin, cephaeline, and psychotrine. Emetin is the strongest pharma-

Anti Eating 397
cological element which produces nausea, vomiting and diarrhoea. It has been used
since 1812 as an amebicide. The chronic administration of Ipecac can result in
unusual symptom complexes such as chronic diarrhoea, vomiting etc. Mescaline is
the active alkaloid of peyote and is chemically related to epinephrine. It was studied
in the 1950s and received much attention. Peyote has an intensively bitter taste and
often causes nausea and vomiting. In other cases the negative effects of chemical
substances are used as conditioning elements in behaviour-therapy. The drug
Antabuse, used in alcohol aversion therapy, causes a profound physical reaction,
including nausea, vomiting and other symptoms of massive autonomic arousal.
An everyday danger exists in possible food poisoning. Oliver (1990: 75f) listed
as main sources: fish and shell-fish toxins, mushroom toxins, miscellaneous
chemicals such as heavy metals, monosodium glutamate etc. The predominant
symptoms of foodborn diseases are nausea, vomiting, diarrhoea, cramps and
fever (Oliver, 1990: 7).
4. Physical causes of vomiting
The quantity of things eaten can be so high that the stomach repulses the swallowed
stuff. This is a rare example of a physical cause of vomiting. More often one can
observe an actively initiated vomiting in cases of "uncontrolled' eating. There are
three fields of uncontrolled eating, namely eating disorders, consumption of poi-
soned or spoiled food, or accidental swallowing of hard inedible things such as safety
pins, buttons, screws by children. Self-induced vomiting (Fairburn, 1980) is widely
discussed in the context of eating disorders especially bulimia nervosa (Palmer,
1979). Fingers, rolled up sheets of paper, or handles of tooth-brush etc. are stuck
down the throat. These actions are either self-induced in order not to get fat (these
cases are psychologically caused and defined later) or used by helpers to get rid of
the swallowed noxious material.
5. Psychological reasons of vomiting
Very few studies deal with vomiting as a psychic phenomenon. The concept of
vomiting due to physio-psycho-social causes has long been recognised only for
childhood and pregnancy. But the view that psychological factors may play a
paramount role in vomiting is not a new one. Hurst (1919) wrote about a seven year
old child who developed hysterical vomiting. Brady (1986) presented the case of a
21 year old female displaying psychogenic nausea and vomiting.
In the following section we list examples for explanations from learning-, motiva-
tional- and social-psychological theories such as conditioning, attribution, and
body-image for the discussed problem.
a. Classically conditioned response
Learned taste- and food-aversions are linked with the subjective feeling of indispo-
sition after the "consumption of food which is accompanied by vomiting. The
connection of illness and substance is (even after only one contingency) very
effective. Seligman and Hager (1972, Introductior) call this phenomenon anecdoti-
cally "Sauce Beamaise-Phenomenon" and attribute this to a biological prepared-

398 Gisla Gniech and Reeta Sonawat
ness against a bodily danger (Seligman, 1970). The "internal malaise" (opposed to
peripheral pain, Pelchat and Rozin, 1982: 341) is a strongly affective reaction. The
sequence is as follows: Consumption of a stuff, that is spoiled by poison, bacterially
infected, contaminated by X-Rays etc. against which the body shows repellent
reactions. Taste and smell will be experienced as aversive and the food will be
avoided in future situations. Retching eliciting stimuli such as allergic substances
(Kaufman, 1954), chemotherapeutic strategies in cancer treatment and behavioural
therapeutic strategies have a special function.
Aversive conditioning is an effective strategy in extinguishing unaccepted behaviour
(Rachman and Teasdale, 1969). In general two aversive stimuli are used: Electric
shock and/or chemical induced vomiting. Lamon et al. (1977) pointed out that
"nausea" is "the optimal aversion stimulus in aversion therapy with alcoholics".
Nausea and vomiting in anticipation of chemotherapy often develop in patients
undergoing cancer treatment. The first proposal by Leventhal et al. (1988) is that
postchemotherapy nausea and vomiting (anxiety and secondary nausea occurring
later in time) are unconditional responses. These UCRs then become conditioned
to various stimuli in the chemotherapy environment and thereby take the form of
conditioned responses. In a study by Weddington et al. (1984) deep-muscle-
relaxation-hypnosis controlled these conditioned reactions in 6 female patients aged
24-56 years. Anticipatory emesis recurred when hypnosis was not used. During a
subsequent session in which hypnosis was reinstated, anticipatory emesis was
again controlled (Redd et al., 1982). Nesse et al. (1980) discussed nausea in cancer
chemotherapy and suggested that pretreatment nausea is a classically conditioned
response. A 52 year old woman had no symptoms before her first treatment session
but showed severe nausea and vomiting 12 hours after each injection. Another
woman aged 20 years had become "hypersensitive to the smell of the clinic". The
nausea persisted upto her most recent visits which were only follow-ups. The clinic
building did have a distinctive odour, but it was not nauseating except for the
patients. A controlled study of leukemic children showed that they developed a
conditioned taste aversion to a specially flavoured ice cream after it was paired with
chemotherapy treatment (Bernstein, 1978).
b. Motivation and emotion
Three phenomenal aspects describe emotional and motivational states: a) physical
arousal, b) expression or reaction, c) special subjective feelings. Strong affective
responses are sometimes accompanied by gastrointestinal reaction up to nausea
and vomiting. Patients with vomiting symptoms, had significantly greater anxiety,
depression and somatic sub-scale than patients with dieting symptoms. Tylden
(1968) saw vomiting as a physiologically-based, response to the high level of stress
they were experiencing. Children often vomit when they are anxious, i.e. when they
cannot fight or flee or express their feelings in words. Often these anxieties are
caused by fear of their parents anticipated loveless behaviour. There is an intensi-
fication of normal adolescent anxieties related to secondary sexual development
and changes in body size and shape. This intensified anxiety may be produced by
some of the physical changes that accompany a disease and its treatment including
nausea and vomiting (Kellerman and Katz, 1977). Similarly 50 per cent of Hill's

Anti Eating 399
(1968) patients' vomiting began as a recurrent reaction to stress in childhood.
Episodic intense or severe anxiety may undoubtedly be accompanied by nausea
and vomiting in certain individuals. A regular relationship between the occurrence
of psychogenic vomiting and the experience of stress has been emphasized by
Rosenthal et al. (1980). Clarke et al. (1987) presented the case report of a 40 year
old insulin-dependent, diabetic woman with day and night time vomiting that was
associated with anxiety. Concerning hostility Anon (1968) explored organic and
psychological causes for intractable vomiting emphasizing the difficulty in making
diagnostic distinctions.
Leibovich (1973) described the clinical picture of the psychogenic disorder of
vomiting. This term is applied when vomiting is the result of an emotional disturbance
or of a more profound psychic upset and only when no organic pathology is found.
Vomiting was even seen as the effect of eating at the time when strong emotional
arousal occurred. Rosenthal et al. (1980) claimed that patients who vomit have
difficulty in handling anger. Inability to resolve their aggression results in vomiting
as if by a displacement mechanism, which allows indirect expression and avoidance
of unwanted feelings, vomiting leads in some way to relief of unpleasant feelings.
Hill (1968, 1972) also implies that hostile feelings may lead to vomiting. Cellesi and
Giordano (1972) studied four 5-10 year old victims of nervous vomiting and identified
similar psychodynamic factors, family situations, and personalities in each case.
c. Personal and social problems
The discrepancy between individual motives and cultural demands often lead to
severe conflicts in behaviour. Vomiting can be expressed as a symptom of an
extreme tension between personal and social claims. Some cases may serve as
examples: Rosenthal et al. (1980) emphasised that patients with history of vomiting
lack assertiveness, find it difficult to limit demands which are placed upon them and
exhibit a variety of conflicts in managing their lives and relationships. Further patients
with psychogenic vomiting were reported to be passive, disliked confrontation, and
showed poor assertiveness. Psychoanalytic reports emphasise immature sexuality
and fear of heterosexuality as causal mechanism in psychogenic vomiting (Cleghorn
and Brown, 1964). Hill (1968) emphasised the pathogenic effects of being entrapped
in a hostile relationship, others point to the problem faced by women who are forced
into a passive compliant social role which grossly limits their assertiveness auto-
nomy (Rosenthal et al., 1980; Knapp, 1967). An everyday observation, of mother-
child-relationship as regards, eating, gives hints for social conflicts in this field too.
The mother who is rigid in terms of the amount of food she believes should be eaten
as well as the appropriate time in which to do so is likely to find herself faced with
an unhappy infant who is forced to vomit because it has been overfed or has waited
too long or cried too hard and is unable to eat when the "magic hour" finally arrives.
The most severe symptom of epidemic vomiting is found in eating disorders,
especially the syndrome of "bulimia nervosa" (Russel, 1979; Halmi, 1985; Gilbert,
1986). One of the first explanations of this phenomenon stems from a feminist's
perspective (Boskind-Lodahl, 1976) and focuses on real or perceived rejections as
the source of the eating disorder as a consequence of appearance and body
preoccupation (Slade, 1985). Bulimia nervosa can be described as follows: Uncon-

400 Gisla Gniech and Reeta Sonawat
trolled binge-eating attacks remind to the woman that body-weight might increase
and her figure might no longer fit with the expectations of society of a beautiful
woman. So some (mostly physical) techniques such as purgation and vomiting
(Lacey and Gibson, 1985) or chewing and spitting out (Mitchell et al., 1988) are used
to get rid of the foodstuff eaten or being eaten. Bulimia nervosa may become a self
perpetuating vicious circle of daily binge eating and vomiting. In a recent detailed
report of 35 patients with bulimia nervosa Fairburn and Cooper (1984) described
regular spitting out, regurgitation and rumination of food in 37.1 per cent cases. 579
women who fulfilled self-report diagnostic criteria for bulimia nervosa were thereby
identified. They had grossly disturbed eating habits and half vomited at least daily.
6. Pregnancy
Approximately 50 per cent of normal women living in industrialised societies expe-
rience nausea and vomiting during the first 10 to 12 weeks of pregnancy (Fair-
weather, 1968). Wolkind and Zajick (1977) interviewed 96 out of 105 women
attending an antenatal clinic in London in an attempt to understand why it is that
only 50 per cent of women have such experiences. No physiological theory alone
can answer all the questions raised by the phenomenon. Psychological theories
have, however, been advanced in an attempt to explain: firstly, why half the women
do not experience the symptoms and secondly, why in some women the symptoms
do occur and continue beyond the first trimester of pregnancy. Dilorio (1985)
investigated the incidence and characteristics of nausea and vomiting among 78
pregnant teenagers (aged 17-19 years). Data from a 15 item questionnaire indicate
that 56.8 per cent of the subjects experienced nausea and vomiting.
In general, vomiting takes place in the morning so that it is called "morning sickness
during pregnancy". The scientific term is "hyperemesis gravidarum". Medical and
psychological explanations compete in this field. The medical explanation of hypere-
mesis gravidarum points out the alteration of the hormone threshold (this is also
seen by Davenport et al. (1972) concerning cyclic vomiting in puberty, i.e. at the
beginning of the menstruation cycle of girls). Pregnant women experience many
changes bodily, especially as regard the internal secretion. They become heavy, fat
and clumsy. Blood flow from the legs to the heart is slower than normal. Feet and
legs swell up. Breathing becomes more difficult, since the lungs cannot dilate
normally. The pressure on the stomach causes pain. The symptom "hyperemesis
gravidarum" is medically interpreted as being caused by endocrinological changes
and by the pressure of the growing foetus on the inner organs. Vomiting can also
be seen as biological protection mechanism to withhold even very small amounts
of dangerous, toxic substances from the foetus since the first phases of development
are highly sensitive to disturbances of any kind. This could explain why "morning
sickness" is observed especially during early pregnancy. A physiological specula-
tion concerning morning sickness during pregnancy lies in its resemblance to motion
sickness. Perhaps the altered body-state with the growing belly causes an unstable
sensation in the inner ear. This might be generalised to the parotid gland and could
give a feed-back to the vomiting centre in the brain.
Concerning the psychological explanations, Glatzel (1973) pointed out that, in
pregnancy, women develop special appetites ("picae gravidorum") and aversions

Anti Eating 401
to one food or another without material explanation. The reasons for the changes
of hyperphagia to aphagia are still unknown. Glatzel (1973) himself stresses a
psychological background in form of anxious defence and emotional phantasies
concerning pregnancy and the growing child. We have to mention here that there
is nearly no systematic empirical evidence on the appetite and vomiting behaviour
of pregnant women. Molinski (1972) as well as Hertz and Molinski (1980) explained,
from the psychological standpoint, that the vomiting behaviour of a pregnant women
is a defence mechanism against the child and/or the man. But this is unconscious
and has to do with a problematic mother-daughter-relationship. Another explanation
of vomiting during pregnancy may be that the woman wants to show the new state.
Since in the first few months nothing can be seen she builds up a morning ritual to
reassure herself that she is pregnant and has some stable signs for it. This ceremony
is well accepted (since vomiting in normal life is negatively evaluated). Perhaps the
attention seeking component is high. However, these theoretical standpoints have
not been proved yet.
Some case studies may set spot-lights in the field: Prospective data on 86
pregnant women (mean age 25.9 years) were analysed to investigate the
relationships between the pregnancy symptoms of nausea and vomiting and
various demographic, social, and psychological factors (Fitzgerald, 1984). No
significant differences were discovered along demographic or social dimensions
between subjects reporting no nausea and those showing severe nausea during
the first trimester of pregnancy. Subjects showing both nausea and vomiting
during the first trimester reported significantly more (a) unplanned, undesired
pregnancies and (b) negative relationships with their own mothers than first
trimester groups experiencing nausea alone or no symptoms. Also those with
continuing nausea and vomiting in the third trimester, when compared with those
having no symptoms, tended to have reported (a) significantly more psychologi-
cal/psychiatric problems in the first trimester and (b) were significantly more
negative in the assessment of their own maternal relationship. Palmer (1973)
attempted to detect female vomiters in a sample of 138 women under prenatal
care. He found that the vomiters tended to be of low body height and from low
income societies. Tylden (1968) concluded that vomiting and hyperemesis are
expressions of stress in a susceptible group of pregnant women. Hyperemesis
is more likely to occur in women who have had repeated severe stresses and
many previous illnesses, particularly gastrointestinal and gall bladder diseases.
Barrucand (1968) interviewed 24 women, collected their MMPI-data and others
on the uncontrolled vomiting during the first 3-4 months of pregnancy. The most
common dominant factor (22 cases) was their emotional immaturity, primarily
associated with a mother relationship. The subjects' youth was stressed. Many
were first born, had marked social isolation and self-centered vital interests. The
pregnancies were almost always unwanted. Fear of adult life was nearly con-
stant, often observed in 'abusive mother-dependent daughter' situations.
Summary
Vomiting is a defence mechanism against body-damaging influences. It can be
caused physically, chemically, spontaneously or be self induced as a consequence

402 Gisla Gniech and Reeta Sonawat
of some noxious events. The oral defence mechanism runs from disgust through
nausea to vomiting.
Disgust is described as an emotion that has the following characteristics (Rozin and
Fallon, 1987): (a) a characteristic facial expression, (b) an appropriate action
(removing oneself), (c) a physiological expression (nausea and later vomiting), (d)
an emotional state (revulsion). Disgust as Raulff (1982) has stated is a person
centered protection against diffuse, slimy secretion (as excrements, fish etc.) and
putrescence, decomposed organisms (as mould and mushrooms, cheese, haut
gout etc.) and might be dissolved by gastrosophic actions (Raulff forgot black and
poisoned stuff). Nausea is feeling queasy. It is to be observed during commotion,
migraine, abuse, gastrointestinal and digestive disorders, appetite disorders and
strong emotional stimulation. Vomiting is the strongest expression of the aversive
defence mechanism. There are some drugs which initiate vomiting and drugs that
depress nausea and vomiting. In general, a person feels relief after vomiting. One
gets rid of a harmful and dangerous substance. There are plenty of reasons for
vomiting (mostly physical disorders). Interesting are the so called unknown reasons
(migraine, early morning sickness and even sea-sickness).
Though mainly considered to be an organic reaction with biological roots there are
some white spots on the map of explanation that are filled with psychological
interpretations. Psychological reasons for vomiting are in general caused by aver-
sive conditioning. Disgust, nausea and vomiting are sometimes protective. One may
interpret these mechanisms as guardian symptoms of the organism against serious
damaging influences in general.
The anti-eating function of vomiting provides a poor rationalisation for motion
sickness and morning sickness during pregnancy. Up to now, these symptoms
cannot simply be explained by common theories. Motion and morning sickness are
more or less "terra incognita" on the landscape of nausea and vomiting.
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