Blood-injection-injury type phobia

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Blood-injection-injury type phobia
Other namesBII

Blood-injection-injury (BII) type phobia is a type of specific phobia [1] [2] characterized by the display of excessive, irrational fear in response to the sight of blood, injury, or injection, or in anticipation of an injection, injury, or exposure to blood. [3] Blood-like stimuli (paint, ketchup) may also cause a reaction. [4] This is a common phobia with an estimated 3-4% prevalence in the general population, [3] though it has been found to occur more often in younger [1] [4] and less educated groups. [4] Prevalence of fear of needles which does not meet the BII phobia criteria is higher. [5] A proper name for BII has yet to be created.

Contents

When exposed to phobic triggers, those with the phobia often experience a two-phase response: [6] an initial increase in heart rate and blood pressure, followed quickly by bradycardia (decreased heart rate) and hypotension (decreased blood pressure). [6] [4] [3] [1] This diminishes cerebral blood supply, and will often result in a fainting response. [6] In an individual with BII phobia, expression of these or similar phobic symptoms in response to blood, injection, or injury typically begins before the age of ten. [1] Many who have the phobia will take steps to actively avoid exposure to triggers. [3] This can lead to health issues in phobic individuals as a result of avoidance of hospitals, doctors’ appointments, blood tests, and vaccinations, or of necessary self-injections in those with diabetes [6] [3] and multiple sclerosis (MS). [7] Due to frequent avoidance of phobic triggers, BII phobics' personal and professional lives may be limited. Some may feel that their phobia precludes them from joining a healthcare profession, or from getting pregnant. [4] The phobia is also able to affect the health of those who don't have it; a BII-phobic, for instance, may have difficulty providing aid to someone else in an emergency situation in which blood is present. [4]

Causes of BII phobia have yet to be fully understood. There is a body of evidence which suggests the phobia has genetic underpinnings, though many phobics also cite a traumatic life event as a cause of their fear. [1] The fainting response accompanying the phobia may have originated as an adaptive evolutionary mechanism. [8] [9]

Applied tension (AT), a method in which individuals alternately tense and relax their muscles while being exposed to a phobic trigger, is widely recognized as an effective form of treatment for BII phobia. While AT is generally the default treatment suggestion, methods of applied relaxation (AR) and exposure-only cognitive-behavioral therapy (CBT) have been found to be effective in diminishing phobic response in some instances. [6] Certain other strategies can be employed to temporarily alleviate symptoms associated with phobic response, such as coughing to increase cranial blood flow. [8] The acute symptoms associated with an episode of triggering are often fully resolved within a few minutes of stimuli removal. [4]

BII phobia does bear some similarity to other phobic disorders: specifically, dental phobia (commonly considered a sub-type of BII phobia) and hemophobia. [1] In each of these phobias, a biphasic fainting response is a common reaction to a trigger. [1]

Signs and symptoms

In a majority of specific phobias, affected individuals experience heightened anxiety when exposed to a phobic trigger. [2] While BII-phobics experience a similar reaction initially upon exposure, most ultimately respond to a trigger with a biphasic, or two-phase, fainting response. [3] [6] In the first phase, phobics often experience an anxiety reaction characterized by elevated heart rate and heightened blood pressure, as occurs in most other phobias. [6] This is the result of increased activation of the sympathetic nervous system. [2] However, with BII phobia, a second phase usually follows closely, in which the phobic individual experiences a massive dip in heart rate and blood pressure [4] [10] known as vasovagal response. [8] Stimulation of the vagus nerve, a part of the parasympathetic nervous system, is responsible for promoting the lowered heart rate and decreased blood pressure. [6] These physiological changes limit blood flow to the brain and can promote pre-syncope (lightheadedness, feelings of faintness) and syncope (fainting): [6] categorized in this instance as vasovagal fainting. [1] This second, fainting phase is not common to other phobias. [3]

A fainting response pattern is not seen in all individuals with BII phobia, but is found in a majority. [6] Up to 80% of those with BII phobia report either syncope or pre-syncope as a symptom when exposed to a trigger. [3]

Other symptoms that may evolve when exposed to phobic triggers include extreme chest discomfort, tunnel vision, becoming pale, [4] shock, vertigo, diaphoresis (profuse sweating), nausea, and in very rare cases asystole (cardiac arrest) and death. [3] Increase in stress hormone release (particularly of cortisol and corticotrophin) is typical. [3]

Neurological responses to phobic triggers include activation of the bilateral occipito-parietal cortex and the thalamus. [1] It has also been suggested that exposing a BII-phobic individual to a trigger will lead to decreased activity in the brain's medial prefrontal cortex (MPFC). [10] Diminished MPFC activity has been linked with impaired ability to control emotional responses. This lessened emotional control could contribute to a general lack of control over symptoms of anxiety arising when exposed to a phobic trigger. [10]

Complications

On the health of those with the phobia

The health of individuals with BII phobia can be jeopardized by the condition as a result of avoidance of phobic triggers. [6] As modern healthcare relies increasingly on injections, it can be difficult for phobics to receive the care they need, since situations involving injections, vaccinations, drawing of blood, etc. are usually avoided. [3] Avoidant behaviors can be especially detrimental to an individual's well-being if they are diabetic and require insulin injections, or experience another pathology or disease which requires treatment via self-injection, such as MS. [7] There may be inappropriate cessation of injection treatment by individuals with the phobia, potentially causing adverse events [7] or reducing treatment efficacy. [7]

Bodily injuries may also be sustained in the course of a fainting response to a phobic trigger. [8]

Comorbidity with other health conditions

Substantial rates of comorbidity with BII phobia have been demonstrated for the following:

In individuals with diabetes:

On the health of the broader population

BII phobia is able to affect the health of a broader population than just the community of individuals with the phobia. Someone with the phobia may, for instance, be unable to respond appropriately and/or offer assistance in an emergency event in which another person was injured or cut. [4]

Avoidance of vaccinations due to BII phobia may also prove detrimental to public health at large, as lowered rates of vaccination in a population tend to increase risk of infectious disease outbreak. [11]

Given BII phobics will very often avoid situations involving exposure to blood or needles, these individuals are likely to avoid donating blood. Public health benefit could result from helping them overcome their phobia, such that donation becomes a viable option. [8]

Limitations on personal and professional life

BII phobia may influence the personal and professional decisions of those with the condition. BII-phobic females may, for instance, choose not to get pregnant, as they fear the injections, vaccinations, and labor-induced pain associated with maternity. [4]

Those with the phobia may also be unable to pursue a profession in a health-related field, such as nursing, which would require repeated exposure to feared stimuli. [4] Phobic individuals may find their ability to complete medical school severely impaired. [1]

Dental phobia

Dental phobia is often considered a sub-type of BII phobia, as dental phobics generally fear the aspects of dentistry that are invasive (those commonly involving blood and injections). [1] Some individuals with dental phobia do, however, have fears which center mainly around choking or gagging during a dental procedure. [7]

As with many individuals with BII phobia, many dental phobics will attempt to avoid their triggers. [1] This can lead to refusal to seek dental care, potentially contributing to tooth decay and overall poor oral health. [1] [7] Individuals with dental phobia exhibit symptoms similar to those with BII phobia when exposed to a phobic trigger, including syncope and pre-syncope. [1]

Hemophobia

BII phobia is closely related to hemophobia (fear of blood), though the two are not the same condition. While the anxieties of BII-phobics tend to extend beyond the fear of blood to ideas of pain, needle breakage inside the body, or needle contact with bones, [7] hemophobics tend to be specifically concerned with exposure to blood. However, in both phobias, individuals experience similar symptoms when exposed to phobic triggers.[ medical citation needed ]

Causes

The cause of BII phobia is not yet well understood. Various studies indicate an underlying genetic cause, wherein certain genes make an individual more vulnerable to developing specific phobias. The contributing genes have not yet been identified. [1]

BII phobia has markedly strong familial aggregation — if present in a family, multiple members are likely to have the phobia. [1] This aggregation is stronger in BII phobia than in any other known phobic disorder: [2] upwards of 60% of those with the phobia have first-degree relatives who are also BII-phobics. [8] It is believed that this evidences the phobia's genetic underpinnings. One study estimated actual heritability of the phobia at 59%. [1]

Additionally, a majority of phobics attribute their fear to environmental factors. For instance, some sort of traumatic event involving blood, injury, or injection that conditioned them to fear those particular stimuli. Others self-report being conditioned by seeing another person react to the stimuli with a consistent pattern of fear. [1]

It has been theorized that exhibiting vasovagal response when exposed to blood was evolutionarily advantageous, and that this phobia is a vestige of an ancestral evolutionary mechanism. [8] [9] Fainting may have acted as a form of tonic immobility, [8] allowing primitive humans to play dead in a situation where blood was being spilled, perhaps helping them to avoid the attention of enemies. It has also been suggested that the drop in blood pressure associated with seeing blood — as with an individual seeing blood from their own wound — occurs in order to minimize blood loss. [8] [9]

Treatments

Individuals typically seek therapeutic treatment for BII phobia in a bid to alleviate symptoms that arise when exposed to a phobic trigger. Therapists may use a combination of physical and psychological measures, such as cognitive-behavioral-therapy and applied tension (AT), in order to aid in extinguishing the individual's fear response. [6]

Early studies of methods to combat vasovagal fainting found that certain leg exercises and that individuals making themselves angry over imagined scenarios could increase blood pressure, thus elevating cerebral blood flow and preventing fainting upon exposure to a phobic trigger. A later study tested applied muscle tension as a way of preventing fainting when an individual with a fear of injuries was exposed to triggering visual stimuli. Lars-Göran Öst expanded upon this research, having BII-phobic individuals engage in applied muscle tension while shown blood stimuli. Those who were trained in the technique showed notable symptom improvement over the course of five one-hour treatment sessions. [8]

An AT treatment program most often involves an individual being instructed to clench their arm, leg, and chest muscles in 10 to 15 second intervals [6] as they are systematically exposed to triggers of increasing likeness to real blood or needles. [8] This program is designed to increase heart rate and blood pressure, counteracting vasovagal response. [8] [6]

The method of applied tension remains popular — it is the most common BII phobia treatment suggestion, and has been found to be highly effective in a majority of BII-phobics. However, exposure-only cognitive-behavioral therapy (CBT) can also be effective, as can the method of applied relaxation (AR). [6]

CBT is a technique which promotes fear extinguishment by way of gradual, repeated exposure to feared stimuli. BII-phobics may be given pictures of needles or blood, asked to illustrate needles or scenes with blood, or to speak about their phobic triggers. This systematically progresses to the point of the individual directly confronting a phobic stimulus: being given a needle, witnessing blood being drawn, etc. As exposure continues, it is expected that the phobic response will become less pronounced, and symptoms less debilitating. [12]

While AT targets the phobia’s physiological response, aiming to raise blood pressure and directly prevent fainting, AR focuses mainly on helping an individual avoid the phobia’s associated anxiety. A phobic will learn progressive relaxation techniques to help to calm themselves upon exposure to a trigger. [6]

Temporary alleviation of symptoms

Drinking water before a triggering experience such as blood donation has been indicated to aid in prevention of a fainting response. Water will increase sympathetic nervous system activation, raising blood pressure and combating vasovagal response. [8]

Certain physical maneuvers also have the capacity to temporarily boost blood pressure, alleviating symptoms of pre-syncope like lightheadedness by boosting blood flow to the brain. These include the phobic individual crossing their legs, making tight fists with both hands, or engaging muscles of the trunk or arms. [13] Coughing, which can similarly increase cranial blood flow, can also be useful as a coping mechanism to avoid pre-syncope and syncope. [8]

Symptoms of a phobic response are generally able to be fully alleviated within a few minutes simply by removing the phobic trigger. [4]

Epidemiology

BII phobia is one of the more common types of phobia — it is estimated to affect about 3-4% of the general population. [3]

Onset of the phobia generally occurs in middle childhood, before the age of ten. [1] There are more reports of incidence of the phobia in younger individuals [4] [1] and those with low education levels. [4] Some studies suggest that women also experience the phobia more frequently, however results are mixed concerning relative prevalences of the phobia between the sexes. [1]

Related Research Articles

<span class="mw-page-title-main">Phobia</span> Anxiety disorder classified by a persistent and excessive fear of an object or situation

A phobia is an anxiety disorder, defined by a persistent and excessive fear of an object or situation. Phobias typically result in a rapid onset of fear and are usually present for more than six months. Those affected go to great lengths to avoid the situation or object, to a degree greater than the actual danger posed. If the object or situation cannot be avoided, they experience significant distress. Other symptoms can include fainting, which may occur in blood or injury phobia, and panic attacks, often found in agoraphobia and emetophobia. Around 75% of those with phobias have multiple phobias.

Specific phobia is an anxiety disorder, characterized by an extreme, unreasonable, and irrational fear associated with a specific object, situation, or concept which poses little or no actual danger. Specific phobia can lead to avoidance of the object or situation, persistence of the fear, and significant distress or problems functioning associated with the fear. A phobia can be the fear of anything.

<span class="mw-page-title-main">Claustrophobia</span> Medical condition

Claustrophobia is the fear of confined spaces. It can be triggered by many situations or stimuli, including elevators, especially when crowded to capacity, windowless rooms, and hotel rooms with closed doors and sealed windows. Even bedrooms with a lock on the outside, small cars, and tight-necked clothing can induce a response in those with claustrophobia. It is typically classified as an anxiety disorder, which often results in panic attacks. The onset of claustrophobia has been attributed to many factors, including a reduction in the size of the amygdala, classical conditioning, or a genetic predisposition to fear small spaces.

<span class="mw-page-title-main">Reflex syncope</span> Brief loss of consciousness due to a neurologically induced drop in blood pressure

Reflex syncope is a brief loss of consciousness due to a neurologically induced drop in blood pressure and/or a decrease in heart rate. Before an affected person passes out, there may be sweating, a decreased ability to see, or ringing in the ears. Occasionally, the person may twitch while unconscious. Complications of reflex syncope include injury due to a fall.

<span class="mw-page-title-main">Fear of needles</span> Phobia of injections or needles

Fear of needles, known in medical literature as needle phobia, is the extreme fear of medical procedures involving injections or hypodermic needles. This can lead to avoidance of medical care and vaccine hesitancy.

Systematic desensitization, or graduated exposure therapy, is a behavior therapy developed by the psychiatrist Joseph Wolpe. It is used when a phobia or anxiety disorder is maintained by classical conditioning. It shares the same elements of both cognitive-behavioral therapy and applied behavior analysis. When used in applied behavior analysis, it is based on radical behaviorism as it incorporates counterconditioning principles. These include meditation and breathing. From the cognitive psychology perspective, cognitions and feelings precede behavior, so it initially uses cognitive restructuring.

Heliophobia is the fear of the Sun, sunlight, or any bright light. It is a type of specific phobia.

Phobophobia is a phobia defined as the fear of phobias, or the fear of fear, including intense anxiety and unrealistic and persistent fear of the somatic sensations and the feared phobia ensuing. Phobophobia can also be defined as the fear of phobias or fear of developing a phobia. Phobophobia is related to anxiety disorders and panic attacks directly linked to other types of phobias, such as agoraphobia. When a patient has developed phobophobia, their condition must be diagnosed and treated as part of anxiety disorders.

Cynophobia is the fear of dogs and canines in general. Cynophobia is classified as a specific phobia, under the subtype "animal phobias". According to Timothy O. Rentz of the Laboratory for the Study of Anxiety Disorders at the University of Texas, animal phobias are among the most common of the specific phobias and 36% of patients who seek treatment report being afraid of dogs or afraid of cats. Although ophidiophobia or arachnophobia are more common animal phobias, cynophobia is especially debilitating because of the high prevalence of dogs and the general ignorance of dog owners to the phobia. The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) reports that only 12% to 30% of those with a specific phobia will seek treatment.

In psychology, Desensitization is a treatment or process that diminishes emotional responsiveness to a negative, aversive, or positive stimulus after repeated exposure. Desensitization can also occur when an emotional response is repeatedly evoked when the action tendency associated with the emotion proves irrelevant or unnecessary. The process of desensitization was developed by psychologist Mary Cover Jones and is primarily used to assist individuals in unlearning phobias and anxieties. Desensitization is a psychological process where a response is repeatedly elicited in circumstances where the emotion's propensity for action is irrelevant. Joseph Wolpe (1958) developed a method of a hierarchal list of anxiety-evoking stimuli in order of intensity, which allows individuals to undergo adaptation. Although medication is available for individuals with anxiety, fear, or phobias, empirical evidence supports desensitization with high rates of cure, particularly in clients with depression or schizophrenia. Wolpe's "reciprocal inhibition" desensitization process is based on well-known psychology theories such as Hull's "drive-reduction" theory and Sherrington's concept of "reciprocal inhibition." Individuals are gradually exposed to anxiety triggers while using relaxation techniques to reduce anxiety. It is an effective treatment for anxiety disorders.

Exposure therapy is a technique in behavior therapy to treat anxiety disorders. Exposure therapy involves exposing the target patient to the anxiety source or its context without the intention to cause any danger (desensitization). Doing so is thought to help them overcome their anxiety or distress. Procedurally, it is similar to the fear extinction paradigm developed for studying laboratory rodents. Numerous studies have demonstrated its effectiveness in the treatment of disorders such as generalized anxiety disorder, social anxiety disorder, obsessive-compulsive disorder, post-traumatic stress disorder (PTSD), and specific phobias.

Blood phobia is an extreme irrational fear of blood, a type of specific phobia. Severe cases of this fear can cause physical reactions that are uncommon in most other fears, specifically vasovagal syncope (fainting). Similar reactions can also occur with trypanophobia and traumatophobia. For this reason, these phobias are categorized as blood-injection-injury phobia by the DSM-IV. Some early texts refer to this category as "blood-injury-illness phobia."

Ailurophobia is the persistent and excessive fear or hatred of cats. Like other specific phobias, the exact cause of ailurophobia is unknown, and potential treatment generally involves therapy. The name comes from the Greek words αἴλουρος, 'cat', and φόβος, 'fear'. Other names for ailurophobia include: felinophobia, elurophobia, gatophobia, and cat phobia. A person with this phobia is known as an ailurophobe.

<span class="mw-page-title-main">Dental fear</span> Medical condition

Dental fear, or dentophobia, is a normal emotional reaction to one or more specific threatening stimuli in the dental situation. However, dental anxiety is indicative of a state of apprehension that something dreadful is going to happen in relation to dental treatment, and it is usually coupled with a sense of losing control. Similarly, dental phobia denotes a severe type of dental anxiety, and is characterised by marked and persistent anxiety in relation to either clearly discernible situations or objects or to the dental setting in general. The term ‘dental fear and anxiety’ (DFA) is often used to refer to strong negative feelings associated with dental treatment among children, adolescents and adults, whether or not the criteria for a diagnosis of dental phobia are met. Dental phobia can include fear of dental procedures, dental environment or setting, fear of dental instruments or fear of the dentist as a person. People with dental phobia often avoid the dentist and neglect oral health, which may lead to painful dental problems and ultimately force a visit to the dentist. The emergency nature of this appointment may serve to worsen the phobia. This phenomenon may also be called the cycle of dental fear. Dental anxiety typically starts in childhood. There is the potential for this to place strains on relationships and negatively impact on employment.

<span class="mw-page-title-main">Thalassophobia</span> Fear of the sea or large open water

Thalassophobia is the persistent and intense fear of deep bodies of water such as the sea, oceans, or lakes. Though very closely related, thalassophobia should not be confused with aquaphobia which is classified as the fear of water itself. Thalassophobia can include fear of being in deep bodies of water, fear of the vast emptiness of the sea, of sea waves, aquatic creatures, and fear of distance from land.

<span class="mw-page-title-main">Syncope (medicine)</span> Transient loss of consciousness and postural tone

Syncope, commonly known as fainting, or passing out, is a loss of consciousness and muscle strength characterized by a fast onset, short duration, and spontaneous recovery. It is caused by a decrease in blood flow to the brain, typically from low blood pressure. There are sometimes symptoms before the loss of consciousness such as lightheadedness, sweating, pale skin, blurred vision, nausea, vomiting, or feeling warm. Syncope may also be associated with a short episode of muscle twitching. Psychiatric causes can also be determined when a patient experiences fear, anxiety, or panic; particularly before a stressful event, usually medical in nature. When consciousness and muscle strength are not completely lost, it is called presyncope. It is recommended that presyncope be treated the same as syncope.

According to the DSM-IV classification of mental disorders, the injury phobia is a specific phobia of blood/injection/injury type. It is an abnormal, pathological fear of having an injury.

Most people have a fear of medical procedures at some point in their lifetime, which can include the fear of surgery, dental work, doctors, or needles. These fears are seldom diagnosed or treated, as they are often extinguished into adulthood and do not often develop into phobias preventing individuals from seeking medical attention. Formally, medical fear is defined as "any experience that involves medical personnel or procedures involved in the process of evaluating or modifying health status in traditional health care settings."

Falling-out is a culture-bound syndrome reported in Latin America and the Caribbean and usually brought on by stress.

Myrmecophobia is the inexplicable fear of ants. It is a type of specific phobia. It is common for those who suffer from myrmecophobia to also have a wider fear of insects in general, as well as spiders. Such a condition is known as entomophobia. This fear can manifest itself in several ways, such as a fear of ants contaminating a person's food supply, or fear of a home invasion by large numbers of ants. The term myrmecophobia comes from the Greek μύρμηξ, myrmex, meaning "ant" and φόβος, phóbos, "fear".

References

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