This is a topic that’s really close to my heart because I went through a period of time where I wanted to puke while I was in college. Literally driving up to the building made this nausea start to creep up. If I was even a few minutes late, my heart would start to race and I would get all nervous about whether or not I should even go inside. We’ll talk more about that in a bit but let’s focus on you right now.
If you clicked on a title like this, you must be dealing with some big physical feelings around being at school or going to school. That has to be hard. Let’s break down some possibilities and see if we can start to figure this mystery out for you!
The Climate Caveat
Before I jump into all of the possibilities here, I want to let you know that there are a lot of reasons to feel nauseated right now with the current climate in the US. Fear and concern around COVID-19, racial injustices, and cruelty toward marginalized communities can account for physically feeling sick, especially if you are part of a vulnerable population. If you don't have a history of feeling ill when it comes to school, you may want to sit with this for a moment and consider if it may be a result of the current state of the world or if it's truly related to school itself. Sick feelings over these issues are completely typical so please know you are not alone if this is the case.
Have you talked with your doctor?
Now I’m not a medical professional myself, but I know that there are plenty of reasons that someone might feel sick like that - regardless of whether or not it’s a school day. Before we get too deep into the possible psychological (mental) reasons, I recommend checking in with your doctor to see if something physical is going on to cause the nausea. A quick google search of “why am I nauseous” lists a huge amount of possible reasons, so it can help to get all of those ruled out from the start! Or, maybe, the doctor will be able to pinpoint exactly what’s causing this and you can move forward with some treatment and experience quick relief.
If you’ve checked with a doctor and they’ve determined there’s not a physical ailment causing this, then let’s proceed and dig a little deeper here on the mental side of things.
When are you noticing that puking feeling?
Does this start as soon as you pull up to the building, whether you’re driving yourself or on a bus? (Or maybe right as you’re logging in, if you’re doing virtual class?) Or does it actually start when you wake up and realize that it’s a school day? Maybe it starts even earlier - like the night before, when you’re sitting around and realize you have class the next day?
If you don’t yet know when that feeling begins to crop up, that’s okay. But this week, try to notice when you feel it coming on. As a therapist, I was trained to look for patterns, so that’s my advice to you: look for patterns! Is there a certain thought about school that makes you feel sick? Does it happen right as you check your backpack to make sure your homework is complete? Do you finish your food and your stomach starts to churn? (If it’s that last one then, again, I do recommend talking to a doctor!) It can be helpful to write things down to figure out what’s causing this feeling - you could even make a little chart like this:
You just briefly detail what’s going on throughout the day and then mark an X near any time you feel sick. And, remember, we’re looking for patterns. Do you see one on that chart??
What is the pattern?
On a chart like the one above, the pattern may not be immediately clear -- but without talking to the person who created that, I would guess that they are feeling the most pukey any time they have to deal with a transition at school, like going to a different class period or course. It also looks like waking up late (being off of their routine) made them feel nauseous.
If you notice some patterns on your own chart and find that there’s not a physical ailment causing it, we might be working with some feelings of anxiety.
Can anxiety seriously make someone want to puke?
Anxiety, worry, and nervousness are powerful things and yes, they can seriously make us want to throw up sometimes. A brief explanation of this is that when we start to get really nervous, our brain goes into “fight, flight, or freeze” mode. A surge of energy (adrenaline) rushes through us and our body physically responds. For some people, they get the urge to throw up. Most of us end up feeling shaky or dizzy with our heart rate and/or blood pressure elevating. Sometimes it can even make us irritable or aggressive (hence the “fight” response.) Other times, we might just clam up and get sweaty (the “freeze”) or try to hide or run from the thing that’s spiking this feeling in us (the “flight.”)
So what do you do if there is a pattern and it might be anxiety?
First, let’s try to look at what sort of pattern there is. Whatever seems to be triggering (or causing/bringing about) the anxiety is what we want to plan around. So check your chart and let’s go through some of these possibilities:
Are you only getting anxious in class periods where you have to speak in front of the group or read out loud?
Do you get that sick feeling at transitional times, like the example above?
Do you want to puke when you’re in a class that has a certain other person (or group of other students) in it?
Is that feeling only coming around when you’re in a class with a certain staff member?
Are you getting teased, bullied, or harassed during the times you marked with an X?
Are you feeling sick only during courses where you’re not feeling confident in understanding or completing the work?
Are you only feeling like puking at school when something challenging happened at home that morning with your family, friends, or roommates?
Do you have concerns around public health and safety? (Are there certain classes where you’re more worried about catching illness due to a lack of safety precautions?)
Do you feel like puking at school only on Mondays after partying over the weekend?
I won’t be able to cover all of the different reasons for why you might be feeling ill at different times during the school day, but hopefully those give you a starting point to reflect on your own habits and patterns. If any of those rang true for you, hopefully you’ll find some ideas below that you can take action on right away - I want you to feel better!
Do you want to throw up based on who else is in the room or based on class content?
If it’s purely based on others that are in the class, there are a few steps you can take. If there’s bullying, seek out a trusted staff member to lodge a complaint and see what options they can give you for other ways to get that class credit (switching classes? Taking it online?) There are so many resources online for how to handle getting harassed that I won’t recreate them here, but please do some more research on how to deal with this situation - no one deserves to feel unsafe while they’re trying to learn.
If there’s a conflict with the teacher or a support staff, please take similar actions. Many schools (colleges included) will assign a school counselor or social worker to students; take this topic to them and advocate for action to be taken. Hopefully the conflict can be resolved through conversation. If not, usually there is more than one teacher assigned to a certain topic - and if there isn’t, then ask if they can be creative in lessening the amount you have to physically be around this teacher. And, again, if there is harassment, please make it known to a trusted staff member. Sometimes this can be hard to do on your own - there is no shame in bringing a family member or friend along with you to ask for changes or to report something.
If the content of the course is too confusing or challenging, that could be making you feel nervous or sick. It can be hard to be stuck in a class where we’re lost or falling behind. If you think this might be causing nausea for you, please reach out to your counselor/advisor or the teacher directly and let them know. It can feel embarrassing to have to admit that but, truly, it takes a brave person to ask for help and to put themselves out there to tell staff they’re struggling.
Is the nausea coming from your weekend or nightly routine?
Sometimes our own habits can cause us to get sick. If you spend the weekend being extremely social, indulging in certain drinks or foods, or partaking in substances that affect your body and mind, you may find that it’s hard to bounce back on Monday. If you’re hoping to change that sick feeling, you may need to re-evaluate how you spend your time and figure out if there are ways to balance enjoying yourself and still making sure you feel okay for class. A quick way to start on a different path is to cut something down by one. So if you drink two energy drinks every Sunday, a first step could be to try drinking only one next Sunday. Does it make a difference in how you feel on Monday? What if the following Sunday you cut back further and split an energy drink with someone? Track your sick feelings and look for patterns again after you make changes - you might be surprised at what you notice!
It could be that your sleep routine is off and it makes you feel groggy and ill; there are ways to buckle down and make sure you’re getting enough relaxation and sleep at night. A lot of studies show that turning off screens (phone, tablet, computer, TV, etc.) an hour before bed can lead to a more restful night. This takes a lot of self-control and maybe even setting a timer so you can be sure your screens are off on time… but it makes a big impact! Doing other relaxing things before bed can help too. I recommend picking one or two, trying them for a week, and continuing to track that sick feeling. (For some, YouTube videos on guided meditation or relaxation yoga tend to be a good starting place!)
Are transitions difficult?
If you’re pretty sure your chart is similar to the example above, you might have a hard time with transitioning from one activity or location to the next. This is true for a lot of students. If you can pinpoint where the challenge is (location? Activity? Teaching style?), then you can request accommodations from your teachers. I would start with speaking to a counselor about what you’re realizing regarding your challenges with transitions and see if they have any recommendations right away. This may take some playing around with your schedule and practicing tolerating transitions before you notice your nausea decreasing.
Does public speaking make you want to puke or are you worried about what others think of you?
Like I was saying way earlier in this article, even being a few minutes late to class made me want to puke… if I knew I had to go in late AND speak in front of a class? My “freeze” response would be full force and I’d just sit in my car, avoiding that college class and feeling even more anxious because then I’d be missing the day’s lesson and end up behind. So if you’re experiencing those fight, flight, or freeze symptoms in response to going into class to speak or read in front of others, you are not alone.
There are a few things to try in the heat of the moment when you find out you have to present or speak in front of the class. It helps if you practice these things somewhere safe and calm beforehand so that your body and mind can remember how to do them when it’s crunch time. Here are 3 quick suggestions to get you started:
Breathing exercises: you can google these and get a ton of results for different techniques and styles. “Square breathing” and “cookie breathing” are my go-to suggestions during therapy sessions because they’re really easy to remember. “Cookie breathing” is where you think of the most delicious cookie you’ve ever smelled baking in an oven (or, really, any super delicious food that brings happy memories for you) and then you sloooowly inhale as if you’re taking in all that goodness. “Square breathing” relies on an external cue: you find something square and you breathe in as your eyes move across the top of it, exhale as your eyes move down one side, inhale as your eyes scan the bottom of it, and exhale while your eyes look over the final side of the square. (If you’re a visual learner, you may want to look those up on YouTube.)
Unclenching your core: there’s this thing called the Polyvagal Theory and the very short version of it is that there’s a nerve that can either speed up or slow down your heart. You can use it to help your heart chill out by “unclenching your core.” Basically, as you sit, tighten any muscle that’s pressing against your chair and seat. Then release all tension from those muscles. If you notice yourself tightening back up as you stand to go speak or while you’re talking, just keep trying to monitor those muscles and relax them as soon as you notice the tightness.
Progressive muscle relaxation: this one is a little more challenging to do on the fly but it’s similar to the last idea. This involves more of your body though. I recommend practicing this at home while playing a guided progressive muscle relaxation video in the background (the script will help tell you what to squeeze and what to release.) Once you have a daily routine of doing this, you'll start to memorize the script and it will be easier to do it in class on the spot.
My favorite part about those suggestions? No one really knows what you’re doing - most of those things are happening internally and on such a small physical scale that other students aren’t going to be like “what the heck?” They likely won’t even notice you’re doing anything at all.
Are things hard at home?
Sometimes we get nervous about what happened at home earlier in the day or what might happen when we return home after school. When we’re worried about those things, even though we may like school or feel safe at school, it can get our brains and bodies running on overdrive. This can definitely make us feel sick. Certain stuff that happens at home is outside of our control but it can help to have an outlet to get those anxious feelings out of our minds and bodies. That outlet might be talking to a trusted friend or adult, seeking a professional to talk to (school counselor, social worker, therapist in the community, etc.), journaling, creating art or music based on your experiences, etc. If things are dangerous at home or you often feel unsafe, I encourage you to speak to a professional or staff member at your school and to ask for help.
What if you’ve tried to make those changes and you still feel like puking at school?
If you have seen a doctor and ruled out a physical ailment, narrowed down when you’re feeling sick, noticed the patterns, and have tried to adapt to overcome them and you’re still feeling like throwing up, you may want to seek some extra help. There are a lot of therapists in our community that really love helping teens and young adults handle anxiety around school! Many of us have even been in similar positions ourselves.
If you’re interested in working with me, I would love to meet you to see if we’re a good fit. If you’re looking to work with someone else, I recommend searching for your zipcode on PsychologyToday and reading about other therapists in the area that specialize in working with anxiety and people in your age group.