Safety Behaviors in Emetophobia: Identifying and Breaking Free

What Is a Safety Behavior?

A safety behavior is an action performed to prevent or reduce anxiety in a feared situation. In emetophobia, these behaviors aim to prevent vomiting or to provide reassurance about the possibility of vomiting.

The Safety Behavior Paradox

These behaviors seem to help in the short term:

• Immediate anxiety reduction
• Sense of control
• Avoidance of feared situation

But they harm in the long term:

• Maintain the belief that danger is real
• Prevent learning that fear is unfounded
• Reinforce and generalize the phobia
• Progressively limit daily life

Key principle: Every time you use a safety behavior and don’t vomit, your brain attributes this “success” to the behavior, not to the fact that the danger didn’t exist in the first place.

Main Categories of Safety Behaviors

1. Food Avoidance

Food avoidances are among the most common safety behaviors in emetophobia.

Systematically Avoided Foods

Rigid Food Rules

• Never eat food on the expiration date
• Refuse any food prepared by someone else
• Eat only thoroughly cooked foods
• Avoid restaurants or only order “safe” dishes
• Never try anything new

Food Checking Rituals

• Check expiration dates multiple times
• Smell foods before eating
• Visually inspect every food item
• Research online the risks of each ingredient
• Throw away still-good food “just in case”

2. Situational Avoidance

Avoided Places

Transportation:

• Airplane (can’t escape)
• Boat (possible seasickness)
• Bus and subway (potentially sick passengers)
• Car as passenger (motion sickness)

Public spaces:

• Restaurants (uncertain hygiene)
• Cinemas and theaters (stuck in middle of row)
• Concerts and crowded events
• Shopping centers
• Amusement parks

Healthcare facilities:

• Hospitals (gastroenteritis)
• Medical offices
• Waiting rooms

3. Checking and Reassurance Behaviors

Body Self-Monitoring

• Taking temperature multiple times daily
• Mentally scanning body for nausea
• Interpreting every gurgle as sign of illness
• Monitoring heart rate and breathing

Reassurance Seeking

From loved ones:

• “Do you think I look sick?”
• “Did that dish taste okay to you too?”
• “Do you think I’m going to vomit?”
• “Was the meat cooked enough?”

Online:

• Compulsive symptom searches
• Checking food product recalls
• Consulting health alerts
• Reading about food poisoning

”Just in Case” Preparation

• Always having a plastic bag on hand
• Knowing toilet locations everywhere
• Spotting emergency exits
• Always carrying anti-nausea medication

4. Subtle Avoidance Behaviors

These behaviors are often less obvious but equally problematic.

Mental Avoidance

• Avoiding saying words “vomit,” “nausea,” “vomiting”
• Changing channels if a vomiting scene appears
• Avoiding thinking about the possibility of vomiting
• Compulsive distraction to avoid focusing on sensations

Neutralization Behaviors

• Repeating reassuring phrases repetitively
• Mental rituals to “cancel” an anxious thought
• Touching a lucky charm
• Avoiding certain numbers or colors associated with illness

The Vicious Cycle of Safety Behaviors

How It Works

Situation perceived as risky
          ↓
    Intense anxiety
          ↓
Safety behavior
(avoidance, checking, fleeing)
          ↓
  Temporary relief
          ↓
"I didn't vomit THANKS TO my behavior"
          ↓
Reinforcement of belief that danger was real
          ↓
Maintenance and generalization of phobia

Concrete Example

Situation: Dinner invitation at friends’ house

Without safety behavior:

• I go → I eat normally → I don’t vomit → My brain learns it wasn’t dangerous

With safety behaviors:

• I decline the invitation (avoidance) → Relief → My brain concludes “I was right to avoid, it was dangerous”

OR

• I go but only eat bread (partial avoidance) → I don’t vomit → My brain concludes “I didn’t vomit BECAUSE I avoided other foods”

In both cases, fear is maintained or reinforced.

How to Identify YOUR Safety Behaviors

Self-Questionnaire

Answer honestly:

Food:

• Do you regularly avoid certain foods for fear of vomiting?
• Do you check expiration dates more than once?
• Do you refuse to eat at others’ homes or restaurants?
• Do you throw away still-good food “as a precaution”?

Social situations:

• Have you declined invitations for fear of vomiting?
• Do you avoid public transportation?
• Do you systematically locate toilets in every place?
• Do you avoid certain events (concerts, cinema, etc.)?

Body and health:

• Do you take your temperature regularly without medical reason?
• Do you often ask others if you look sick?
• Do you always carry anti-nausea medication?
• Do you completely avoid alcohol?

Mental:

• Do you avoid saying or writing the word “vomit”?
• Do you frequently search for information about food poisoning?
• Do you perform mental rituals to reassure yourself?

Results:

• 0-3 boxes checked: Few safety behaviors
• 4-8 boxes checked: Moderate safety behaviors
• 9+ boxes checked: Significant safety behaviors requiring targeted work

Strategies to Reduce Safety Behaviors

General Principle: Gradual Reduction

You don’t eliminate all safety behaviors at once. The approach is progressive:

1. Identify all safety behaviors
2. Rank from least to most anxiety-provoking
3. Start with easiest to abandon
4. Progress toward more difficult ones
5. Consolidate each step before moving to next

Progressive Abandonment Technique

Step 1: Awareness

• Identify a specific safety behavior
• Understand how it maintains your phobia

Step 2: Behavioral Experiment

• Choose a situation where you usually use this behavior
• Plan NOT to use it this time
• Predict what will happen (anxiety, vomiting?)

Step 3: Reality Testing

• Conduct the experiment without the safety behavior
• Observe what actually happens
• Compare to your predictions

Step 4: Learning Analysis

• “What happened?”
• “What did I learn?”
• “How does this change my belief?”

The “Anxiety Surfing” Technique

When you abandon a safety behavior, anxiety temporarily increases. The surfing technique involves:

1. Observing the rise of anxiety like a wave
2. Accepting that anxiety is present
3. Not fighting against it
4. Waiting for it to naturally subside (it always will)
5. Noticing that no catastrophe occurred

Mental image: You’re a surfer on the wave of anxiety. You don’t fight the wave, you let it carry you until it calms.

Common Mistakes to Avoid

1. Replacing One Behavior with Another

Example: Stopping anti-nausea medication but starting to carry a “lucky” bracelet

Solution: Identify all safety behaviors, including the most subtle

2. Abandoning Too Quickly or All at Once

Example: Eliminating all food avoidances in one day

Likely result: Excessive anxiety, failure, discouragement, return to old behaviors

Solution: Gradual progression and consolidation

3. “Testing” Situations Rather Than Exposing

Example: Going to restaurant “to see” if you can handle it, ready to flee at first sign

Problem: It’s not real exposure if escape route is prepared

Solution: Fully commit to the situation, without escape plan

Testimonial: The Liberation Process

“My safety behaviors had taken over everything. I only ate 10 different foods, I hardly went out anymore, I took my temperature 8 times a day, and I constantly asked my partner if they thought I was sick.

My therapist helped me identify them all — I had about thirty! We started with the easiest: stopping sniffing my food, then reducing temperature taking. Each abandonment was difficult at first, but anxiety always eventually came back down.

Today, 8 months later, I’ve eliminated the vast majority of these behaviors. I eat at restaurants again, I travel, I even tried oysters last month! I still have some avoidances to work on, but my life has completely changed.”

— Nathalie, 36

4-Week Action Plan

Week 1: Identification

• List ALL your safety behaviors
• Classify by category
• Rank by difficulty of abandonment
• Choose 1-2 easy behaviors to start

Week 2: First Abandonments

• Abandon the 1-2 chosen behaviors
• Note anxiety felt and its evolution
• Observe results
• Consolidate before continuing

Week 3: Progression

• Add 1-2 new behaviors to abandon
• Continue previous ones
• Analyze learnings
• Adjust if necessary

Week 4+: Consolidation and Advancement

• Continue gradual progression
• Target more difficult behaviors
• Maintain previous abandonments
• Celebrate progress

Conclusion: Breaking Free to Live Fully

Safety behaviors are at the heart of emetophobia maintenance. They create an illusion of control that paradoxically reinforces the phobia and considerably limits daily life.

Key messages:

• Safety behaviors maintain phobia despite their immediate reassuring effect
• They prevent the brain from learning that danger doesn’t exist
• Identifying them is the first step toward recovery
• Abandonment must be progressive and planned
• Temporary anxiety is normal and decreases with practice
• Each abandoned behavior is a victory toward freedom

Every safety behavior you abandon brings you closer to a life where your food, outings, and relationships are no longer dictated by fear. It’s demanding work, but the benefits are immense.

If you’ve identified many safety behaviors and your emetophobia significantly impacts your life, don’t hesitate to consult a specialized CBT therapist. Professional support can make all the difference.