This Is Why Being Anxious Makes Some People Puke

A few weeks ago, Marissa De La Cerda, a 21-year-old writer from Chicago, was hitting the deadline to turn in an article for her internship when a source she spoke to for the story began calling and texting her, telling her that he didn’t want the story to run anymore.

“I was sitting at a restaurant with my friend and I started to have an anxiety attack because I was nervous about what my supervisor would say and about all these other factors,” she tells me. “I felt the pit of anxiety in my stomach and I threw up. Not a lot, but still—I just couldn’t handle the anxiety.”

De La Cerda, who was diagnosed with an anxiety disorder at age 15, says she’s experienced anxiety-induced nausea and vomiting since she was around 12 or 13 years old. “I remember just always feeling very anxious and getting this pit of anxiety in my stomach that would eventually result in me feeling like I had to puke or actually puking,” she says.

It’s a feeling I can personally relate to. During the first week of my freshman year of college, I drank nothing but water and ate only packages of instant miso soup, in an attempt to quell my near-constant nausea and urge to vomit. That feeling of being on the verge of being sick wasn’t because I was "cool" enough to be binge drinking at frat parties—but because the acute anxiety I was going through was enough to make me feel like puking 24/7, especially if I tried to eat anything solid. On one hand, starting college was exciting. On the other, I had just moved clean across the country, and my stomach was churning at the thought of so much change.

I didn’t end up vomiting that week but, for better or worse, Marissa and I are intrinsically linked by our anxious puke urges. But which comes first, the chicken or the egg? A 2002 study published by the Center for Advancing Health that looked at 62,000 participants in Norway with gastrointestinal issues (like nausea and heartburn) found that those who had major complaints of nausea were more likely to experience anxiety and even depression. In fact, 41 percent of those who suffered from nausea were found to also have an anxiety disorder.

More from Tonic:

Drew, a 33-year-old who lives in Brooklyn (and who asks that his last name not be used in this article since the upcoming mentions of cannabis could compromise his job), tells me that as a kid in Minnesota, he would get really excited and anxious about going to the Mexican restaurant Chi-Chi’s for his birthday—so much so that when he got there, he’d cram down three tacos, and immediately throw it all up. “If you were to name a restaurant operating in the Twin Cities in the mid-to-late '90s, there’s a fair chance I puked in it,” he says.

Joking that he’s “had a stomach ache since the third grade,” Drew adds that growing up, he never ate breakfast or lunch because he was so anxious at school over being away from home and being in new situations with new people that it killed his appetite. Later on, his stomach pains got so bad that he mistook them for an ulcer and went to his college health clinic, where he was diagnosed with hypothyroidism. “Once I started getting treated for that and also started seeing a therapist, the nausea and anxiety abated a bunch, but I still get it when I’m really stressed,” he says.

While nausea and vomiting can be experienced along with hypothyroidism, they aren't generally thought to be common symptoms, and are usually rarely caused by the condition, says psychotherapist Ken Goodman, who's a spokesperson with the Anxiety and Depression Association of America (ADAA). This implies, as Drew thought, that the stomach issues are more likely associated with anxiety.

For Drew, Marissa, myself, and the other estimated 40 million Americans who experience anxiety, it’s common to feel nausea, as well as other physical symptoms, Goodman says. “[Physical symptoms] range from nausea to lightheadedness, a racing heart, pressure in your chest, and labored breathing,” he adds. “[Anxiety] can make you feel like you’re having an out-of-body experience.”

Goodman—who also founded Quiet Mind Solutions, an anxiety-combatting audio guide—says that for some of us, anxiety can manifest as nausea and vomiting because of the connection between the brain and the gut. Whenever you go through emotional distress, it’s reflected somehow, whether you get panic attacks, clam up and shut down, or, like me, feel deeply unsettled in the pit of your stomach. Anxiety can often take shape in the form of gut issues, he says, and heighten any gastrointestinal problems you might already have.

“Any stomach distress, like ulcers or irritable bowel syndrome—that’s all exacerbated by anxiety,” he says. “Anxiety can cause your body to tighten up anywhere between the mouth, the windpipe, and all the way down [to the gastrointestinal tract], so it can feel like you can’t breathe, or you’re getting sick.”

Plus, anxiety causes you to go into fight-or-flight mode, in which your body responds to a perceived threat by ringing the alarm to the hypothalamus, an area of the brain that then releases hormones that prime you to either run from the danger or fight against it. And those hormones, according to Goodman, can send some of us running to the bathroom to retch. “Adrenaline and cortisol are hormones that are released [during fight-or-flight] that can cause some people to feel lightheaded, and cause other people to feel nauseous,” Goodman says.

For those people who do have the anxious voms, relief can be found in different ways. Drew says his nausea and throwing up subsided as he treated his anxiety in therapy, but it didn’t go away completely, and he still had to find other ways of treating the symptoms.

“I used to self-medicate with weed and had great success reducing nausea and increasing my appetite, but unfortunately over time, it also started increasing my anxiety,” he says. “Now, there are CBD gummies everywhere, and I’ve found that helps with relaxation and nausea without the added anxiety.”

De La Cerda has had useful experiences in therapy that have helped to curb both her nausea and anxiety altogether. “Therapy has taught me a lot of skills to help combat some of the stronger symptoms and when I feel like I’m going to puke, I just try really hard to remain present and breathe.” Goodman says that if you’re vomiting every time you’re anxious, and it’s interfering with your life (or just getting plain annoying), talking to a doctor or mental health professional might be a good way to start addressing the problem—even if it doesn’t go away completely.

“If you experience nausea with your anxiety, that might be something that will continue,” he says. “But the frequency of the vomiting might decrease, and you may have better control over it.” Either way, it’s normal for your body to experience symptoms of anxiety, whether it’s anxious vomiting, anxious pooping, or nervous, excessive sweating. And as I’ve learned, understanding why your body is reacting the way that it does can go a long way in making those symptoms a little less scary, and in helping you manage them.

“Nausea is very common, and like all symptoms of anxiety, it should never prevent you from doing what you want to do,” Goodman says.

Sign up for our newsletter to get the best of Tonic delivered to your inbox.