Severe vomiting in a diabetic woman. Psychological considerations.

A 50-year-old diabetic woman experiencing 20 episodes of vomiting each day was admitted to the hospital. When vigorous medical management failed to control the vomiting, psychiatric consultation indicated that psychological factors, especially displaced anger and an early childhood history of gastrointestinal sensitivity, combined with autonomic neuropathy and uremia to produce the symptom. A multimodal treatment regimen including continued medical management, supportive psychotherapy, relaxation training and mental imagery exercises effected a dramatic improvement.