Can a panic attack make you throw up?

Your heart is racing, your mouth is watering and your stomach is churning. For many people, the worst part of a panic attack is feeling like they’re about to be sick, and some people do throw up.

Can panic attacks cause vomiting?

Yes. Feeling sick, or stomach distress, is one of the 13 recognised symptoms of a panic attack. Most people with panic feel nauseous rather than actually being sick, but vomiting can happen, especially with very strong anxiety, when you’ve eaten recently, or when you’re already run down.

Why panic makes you feel sick

During a panic attack, your body’s fight-or-flight response is in charge:

• Digestion is paused, as blood moves away from your stomach to your muscles. Food sitting in your stomach can make you feel queasy.
• Your stomach muscles tense, creating a churning or clenched feeling.
• Fast breathing and swallowing air can make nausea worse.
• Your gut becomes more sensitive to normal feelings.

What helps in the moment

• Breathe slowly through your nose, with a longer out-breath. Fast mouth breathing tends to make nausea worse.
• Get fresh air. Open a window or step outside if you can.
• Sip cold water slowly, or hold something cold to your wrists or the back of your neck.
• Stay still, sitting upright, with your eyes on something steady in the distance.
• Loosen tight clothing around your waist.
• Remind yourself: “This is panic. Feeling sick is part of it, and it will pass.”

Afterwards

If you were sick, rinse your mouth, sip water slowly to replace fluids, and eat something plain when you feel ready. Rest, and give your body time to settle.

When the fear of being sick is the problem

For some people, the fear of vomiting is the main thing that sets off panic. They might avoid eating out, travel, crowds, alcohol or people who are ill, and constantly check how their stomach feels. This is called emetophobia, and it’s more common than many people realise.

The cruel twist is that anxiety itself causes nausea, which then seems to confirm the fear. CBT that gently helps you face the feared situations, and the feeling of nausea itself, is very effective for emetophobia, and for panic.

How Breatheasy can help

When panic brings on nausea, Breatheasy can help you ride it out. Tap “I’m feeling anxious” and Luma walks you through it: rate how strong it feels, breathe slowly as your phone pulses gently, ground yourself with 5-4-3-2-1, then see how far the anxiety came down. Slow, steady breathing is one of the best ways to settle an anxious stomach. It works without internet, and it’s always free. Breatheasy is coming soon to iPhone and Android.

When to see a doctor

See a doctor if you’re often sick when anxious, if nausea is stopping you eating properly, or if fear of being sick is shrinking your life. Get help urgently if you’re vomiting blood, can’t keep any fluids down, have severe stomach pain, or show signs of dehydration, like feeling dizzy, passing very little urine or feeling very weak.

If panic attacks keep happening, our guide to anxiety and panic attacks explains what helps.

Sources

• Panic disorder, NHS
• Feeling sick (nausea), NHS
• Panic attacks and panic disorder, Cleveland Clinic