Medical Phobias: The Irrational Fear of Blood, Injections, and Injury
Hello, Human Pincushion
How a Phobia Can Jeopardize Your Health
Imagine being so fearful that you'd rather die than get stuck with a needle. No matter how hard you try, panic and a racing heart take control and make you want to bolt.
That is exactly what my brother-in-law faces with his needle phobia. His fear is so intense that it prevents him from getting the medical treatment he needs.
He has a common genetic disorder called hemochromatosis, which causes his body to build up toxic levels of iron.1 Regular blood donations would prevent continued storage of excess iron in his liver, heart, and pancreas. Controlled blood letting would thus reduce the associated risks of persistent iron overload, significantly decreasing his risks of cancer, heart arrhythmias, and cirrhosis.
Easy choice, right? Ditch the extra iron by toughing it out with the needle. However, his fear of needles outweighs his fear of dying.
That's the irrational part about phobias.
"You'll Feel a Little Sting"
Symptoms of Phobias
A phobia is an irrational fear of an object or situation that poses objectively little danger.
People with phobias experience the following symptoms, according to the American Psychiatric Association (APA):2
- feelings of terror, dread, panic, or horror
- automatic and uncontrollable reactions to a feared object or situation
- recognition that one's fear is disproportionate, considering the actual level of danger
- fast heartbeat
- shortness of breath
- trembling and
- an intense desire to escape the feared situation or object.
How a Phobia Develops
A Blood-Injection-Injury (BII) phobia involves fearing the sight, smells, pain, or even the thoughts connected with injections, injuries, or invasive medical/dental procedures.
This phobia is more prevalent among females, young people, and those in lower income brackets.3 It typically involves a genetic predisposition as well as learned fear.
Learning to Be Afraid
Typically, a person acquires their Blood-Injection-Injury phobia after one of the following occurs:
- a negative experience, such as a blood draw involving repeated needle pricks (i.e., because the phlebotomist could not find a good vein).
- having a panic attack in a specific situation, such as during a dental procedure.
- seeing something traumatic happen to someone else, such as a bloody car accident.
- observing a parent, sibling, or other person who was very scared of needles, or
- learning about something bad happening, such as neighborhood kids playing with contaminated drug syringes.
Fear of Blood, Injections, Injury: Different From Other Phobias
Early Onset, Long-Term Impacts
Phobias are the most prevalent type of anxiety disorder. The average age of onset for a person with a Blood-Injection-Injury phobia is between 8 and 9 years old.4
Although this phobia responds well to therapy, people often do not seek help, preferring instead to avoid medical and related settings. Unfortunately, however, if the phobia persists until adulthood, there is only a 20% likelihood that the person will achieve full recovery.5
Medical phobias interfere with normal functioning when individuals avoid activities such as the following because of their medical fears:
- obtaining routine vaccinations, sick care, and surgeries
- planning a family or
- taking a child, parent, significant other, or pet to the doctor.
Students who are training to be nurses and physicians may even struggle with squeamishness in response to needles, blood, and wounds.6 However, with repeated exposure, they are typically able to overcome their fears.
Does the Sight of Blood Makes You Woozy?
When Should I Seek Help for a Medical Phobia?
Phobias are the most common type of anxiety disorder, and often they do not interfere much with an individual's lifestyle. However, medical phobias are different. You may be able to avoid the annual flu shot, but sooner or later we will all need medical treatment.
Consider seeking treatment for your Blood-Injection-Injury fears if:
- Your level of fear or distress is excessive, unreasonable, and out of proportion to the level of real danger that exists.
- Your level of anxiety creates panic and disabling fear.
- You avoid medical treatment because of your fear (e.g., vaccines, check-ups, blood tests or treatment for a health problem).
- Your avoidance creates significant distress or interferes with your normal routine.
- You have struggled with your fear-related symptoms for six months or more.
Medical Phobias Are Different From Most Other Types
Medical phobias are different from other phobias in several respects:
Risk to Health
Continuing to avoid the object of one's fears -- medical treatment -- can potentially lead to one's demise. You cannot necessarily say that about most other fears (e.g., the fear of clowns, heights, or dogs).
Blood-injection-injury phobias are the only type of phobias where fainting can occur. People with medical phobias have typically inherited a tendency to faint in response to fear, something called a vasovagal reflex.7When presented with what scares them, people with medical phobias experience a racing heart, followed by a quick drop in blood pressure. This produces dizziness, nausea, ringing in the ears, and fainting.
Up to half of people with a needle phobia and up to 75% of those with a blood phobia tend to respond by fainting.8 There have been rare documented cases of people dying as a result of vasovagal fainting following needle sticks.
Role of Disgust
Most phobias are considered fear disorders. However, psychological research within the last two decades suggests that both a fear of spiders and a fear of blood-injection-injury may actually be "disgust disorders."
People who experience these phobias are more disgust sensitive than others. These two phobias, particularly blood-injection-injury phobias, are driven at least in part by the emotion of disgust -- the desire to escape contamination or infection.9
Open Wide for the Dentist
Reader Experience Poll
Does fear of needles, blood, or injury prevent you from doing any of the following?
Medical Phobias: You Are Not Alone
Medical phobias are common, with up to 10% of the general population suffering from needle and injection phobia alone.10 Another 10% of people display fear of needles/injections that falls short of a full-blown phobia.11
One research study of 1,500 people found that 19.5% of healthy adults and 30.1% of patients with chronic illness reported a fear of blood and/or injury from injections.12
Medical phobias are a special hazard for people who already suffer chronic illness. Unfortunately, self-injections, blood tests, and invasive medical procedures are a normal part of diagnosing and treating many such illnesses. Examples of chronic illnesses include rheumatoid arthritis, multiple sclerosis, diabetes, and chronic renal failure.
When it comes to self-injected medications, pain and fear of needles are the two major reasons for non-compliance with doctor's orders. Up to half of all prescribed medications are not taken as directed, and 20% of prescriptions are not even filled.13
Sooner or Later, We Will All Need Medical Treatment
Examples of Blood-Injection-Injury Phobias
Medical phobias include a variety of subtypes:
Hemophobia (fear of blood)
Trypanophobia (fear of needles and injections) - Approximately 80% of people with a needle phobia report having a first-degree relative with the same phobia.
Tomophobia (fear of surgery and invasive medical interventions)
Dental Phobia: Fear of the dentist includes fear of extractions, receiving anesthetic injections, and fillings. People with this fear tend to have poorer dental health compared to those without the phobia. They also suffer greater interference with sleep patterns, lower levels of energy, often avoid certain foods, and have poorer social relationships.
Iatrophobia (fear of doctors) - People who fear doctors could have some reason to distrust them. In a 2011 survey of 1,900 physicians, doctors admitted to the following behaviors within the previous year:
- 11% - lying to a patient or a patient's guardian
- 20% - not fully disclosing a mistake because of fear of a lawsuit
- 55% - describing a patient’s prognosis in a more positive manner than warranted.14
Leeches and Maggots in Medicine: Don't Try This at Home
If you're afraid of needles, what about an alternative therapy? Say, something that wriggles, squirms and sucks your blood ... or eats you alive?
Leeches Are an FDA-Approved Medical Device
Reader Opinion Poll
If your doctor recommended using medical maggots or leeches, would you do it?
Leeches and maggots became approved as medical devices by the US Food and Drug Administration (FDA) in 2004. Under US law, a medical device is any non-pharmacological item that is intended to diagnose, treat, cure, prevent, or alleviate a disease or medical condition.
Hirudotherapy, or the use of medicinal leeches for blood letting, has been practiced since ancient times.
Leech saliva is comprised of more than 30 various proteins that together numb pain, decrease swelling and keep blood flowing. Leeches therefore are used to alleviate blood clots, relieve pressure on veins, and treat some types of osteoarthritis.
Maggot debridement therapy uses live, sterilized maggots to remove dead tissue and kill bacteria.15 It was a popular form of treatment in the early 1900s before antibiotics became popular in the 1940s with the advent of penicillin.
Depending on the size of the wound, hundreds of maggots are applied for up to three days. The wound is then sealed with a special gauze dressing. Maggot therapy is used to help heal ulcers, gangrene, skin cancer, and burns.
Conquer Your Medical Phobia
5 Reasons to Donate Blood
Here are some facts from the American Red Cross:
- 1 pint of blood can save up to 3 lives.
- Less than 5% of the population donates blood, although more than 1 in 3 will require blood or blood products at some time in their lives.
- A trauma victim—someone who has been hurt in a fire or car accident, for example—can require as many as 100 pints of blood. That victim could be your friend, neighbor, or family member.
- Blood shortages would not exist if all eligible donors stepped up to donate blood (4-6 times per year).
- Blood donation provides men an added benefit because men are at increased risk for hemochromatosis, or iron overload. This is a potentially deadly condition. Simply by donating blood three times a year, they can reduce their iron overload and their risk for heart attack by as much as 50%.
Calm Down: Applied Tension Is Effective For Relaxation
1Mayo Clinic Staff. "Overview - Hemochromatosis - Mayo Clinic." Mayo Clinic. Accessed January 18, 2016. http://www.mayoclinic.org/diseases-conditions/hemochromatosis/home/ovc-20167289.
2American Psychiatric Association. "Let's Talk Facts: Phobias." Psychiatry.org. Accessed September 5, 2013. http://www.psychiatry.org/mental-health/lets-talk-facts-brochures.
3Pull, Charles B. "Recent Trends in the Study of Specific Phobias." Curr Opin Psychiatry 21, no. 1 (2008): 43-50. http://www.medscape.com/viewarticle/568313.
4Beidel, Deborah C., and Candice A. Alfano. "Child Anxiety Disorders: A Guide to Research and Treatment, 2nd Edition." Google Books. Accessed September 5, 2013. http://books.google.com/books?id=MWF2TIoYqZwC&dq=average+age+of+onset+BII+phobia.
5Marcdante, Karen. "Nelson Essentials for Pediatrics: Anxiety and Phobias." Inkling for Web. Accessed September 5, 2013. https://www.inkling.com/read/nelsons-essentials-pediatrics-karen-marcdante-6th/chapter-17/anxiety-and-phobias.
6 Neurenbeurg, C. (2011, May 23). Afraid of needles? Why some faint at the very sight. Retrieved from http://bodyodd.nbcnews.com/_news/2011/05/23/6697692-afraid-of-needles-why-some-faint-at-the-very-sight.
7Helpguide.org. "Phobias and Fears: Symptoms, Treatment, and Self-Help." Last modified August, 2013. http://www.helpguide.org/mental/phobia_symptoms_types_treatment.htm.
8Nierengarten , Mary Beth. "Multispecialty." Medscape. Last modified March 17, 2009. http://www.medscape.com/viewarticle/589716.
9Çavuşoğlu, M, and G. Dirik. "Fear or disgust? The role of emotions in spider phobia and blood-injection-injury phobia." National Center for Biotechnology Information. Accessed September 5, 2013. http://www.ncbi.nlm.nih.gov/pubmed/21638233.
10Anxiety UK. "Injection Phobia and Needle Phobia: A Brief Guide." Last modified 2010. http://www.thesf.org.uk/documents/Emotional-Health/Needle-Phobia-web.pdf.
11Healthopedia. (2018). Trypanophobia: Fear of Needles and Injections - Causes, Symptoms and Treatment. Retrieved from https://www.healthtopia.net/disease/mental-health/phobia/trypanophobia-causes-symptoms-treatment.
12Kose, S, and A. Mandiracioglu. "Fear of blood/injection in healthy and unhealthy adults admitted to a teaching hospital." International Journal of Clinical Practice 61, no. 3 (2007): 453-7. Accessed September 3, 2013. http://www.ncbi.nlm.nih.gov/pubmed/17313613.
13 Fung, Brian. "The $289 Billion Cost of Medication Noncompliance, and What to Do About It." The Atlantic. Last modified September 11, 2012. http://www.theatlantic.com/health/archive/2012/09/the-289-billion-cost-of-medication-noncompliance-and-what-to-do-about-it/262222/.
14 LiveScience.com. "1 in 10 Doctors Admit Lying in the Past Year." Last modified February 8, 2012. http://www.livescience.com/18383-doctors-lie-patients.html.
15Youn, Anthony. "Gross, sure -- but maggots have medical benefits." CNN. Last modified September 12, 2012. http://www.cnn.com/2012/09/12/health/youn-maggot-therapy.
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