Fear of medical procedures

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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."

Contents

Classification

Fear of medical procedures can be classified under a broader category of "blood, injection, and injury phobias". This is one of five subtypes that classify specific phobias. [1] A specific phobia is defined as a "marked and persistent fear that is excessive or unreasonable, cued by the presence (or anticipation) of a specific object or situation." [2] [3] : 79  Often these fears begin to appear in childhood, around the age of five to nine. [1] It is normal to become squeamish at the sight of blood, injury, or gross deformity, [4] : 376  but many overcome these fears by the time they reach adulthood. Those who do not are more likely to avoid medical and dental procedures necessary to maintain health, jobs, etc. [3] : 82  [1] Research shows that when people encounter something that they have a specific phobia of many of them have a feeling of disgust [3] : 82  which makes them not want to come near or experience the object or situation which is disgusting to them. This feeling of disgust, especially in the blood, injection, and injury phobias may be passed down in families. [1] Women have been known to avoid becoming pregnant because it requires blood and medical examinations that they would rather avoid. [4] : 377  Also, most individuals who experience phobias have an increased heart rate upon encountering the thing they fear, but blood, injection, injury-phobic people also seem to have an increase of fainting after the initial speeding up of heart rate. Their heart rate will go up and then slow again, leading to nausea, sweating, pallor, and fainting. [4] : 377  This fainting can also lead to seizures, making life very difficult for those who have this fear. [4] : 378  However, only 4.5% of individuals who have this phobia as a child will have this fear their entire lifetime. [3] : 82  Additionally, procedural anxiety is frequently recognized in people who need to take part in medical procedures regularly. Due to their constant exposure to these procedures, patients may attend their treatments with recurrent experiences of significant anxiety, sometimes associated with previous negative experiences. [5] For those who do experience this phobia in an extreme manner, specific coping treatments have been found to help them. Biological treatments, such as medications used for other anxiety ailments, are generally found to be inappropriate for fear of medical procedures or other specific phobias. Psychological treatments are the treatment of choice because they are more accurate at addressing the problem. Some of these treatments used especially for fear of medical procedures include exposure-based treatments, eye movement desensitization and reprocessing, and applied tension to react against fainting. [3] : 82 

Fear of surgery

Fear of surgery or other invasive medical procedure is known as tomophobia. Fear of surgery is not a fear experienced often, but is still just as harmful as other phobias that are more common. Since surgery is not a common occurrence, the fear is based on inexperience or something that is out of the ordinary. [6] Surgery is a strong stressor that can trigger physiological reactions such as tachycardia, hypertension, hyperventilation, hyperthermia, muscle tension, sweating, and psychological reactions such as fear, anxiety, and acute panic attacks. [6] This fear is one of those categorized under all fears of medical procedures that can be experienced by anyone, all ages, and have little need for actual psychological treatment, unless it is uncharacteristically causing the patient to react in a way that would be harmful to his or her health. [7]

Children

Fear of surgery is common among young children. Christine Gorman, of Kids and Surgery, states "Surgery is scary enough for adults. But imagine what goes through the mind of a three-year-old when he sees a doctor or nurse all suited up and wearing a surgical mask: "It's a monster! It's got big eyes and no mouth! It's taking me away from Mommy and Daddy." No wonder half of all children from ages of 2 to 10 show evidence of distress—from bed-wetting to nightmares—for at least two weeks after their operation. Some of them remain traumatized even six months later." [7] This statement shows that the fear that comes when young children go into surgery can be a serious matter because they are still traumatized by the effects for weeks after the surgery has taken place. Being scared of surgery has led to "eating disorders, sleep disturbances, regression to earlier levels of behavior, depression, and somatization such as loss of voice after tonsillectomy." [8] Many children see surgery as a form of punishment [7] and, since they sometimes can't see what they did "wrong", the fear is escalated, leaving greater chance for a longer effect on the psychological and emotional feelings of the child. Many ways have been tried to help children overcome this fear, including their parents and doctors simply telling them that the surgery won't hurt, or sedatives given by the doctor to minimize the feelings of anxiety later. [7] There are certain types of treatments that have been proven to be better methods than others. Some hospitals allow parents to come into the surgery room and stay with the child, calming them until the anesthetic has taken effect. This is noted to keep anxiety down for both the parent and the child. [9] If the child can enter the surgery calmly, there is much less of a chance that they will have many complications after the surgery due to fear. Other ways to treat the fear of surgery for children include having a doctor explain to them what the surgery is going to do and acting out the operation on a doll or stuffed animal. [7] This makes the surgery something less scary and able to be understood in the child's mind. When the surgery is understood by the child, the fear of the unknown is less of a factor of how scared the child will be, and how much that will impact their reaction to the surgery. [10]

Adults

Children are not the only ones to express fear of surgery, or have after effects that can affect the mental and physical well-being of the person. Adults most fear the pain they expect to receive from the surgery. "The Roche Pain Management Survey polled 500 Americans, 27% of whom had surgery during the previous five years. Of those who had surgery, 77% reported pain afterwards, with four out of five of those saying they experienced moderate to extreme pain. 70%, indicated they experienced pain even after receiving medication; 80% reported they received pain medication on time, although 33% had to ask for it; and 16% had to wait for medication." [11] Unlike children, adults seem to have less fear of the surgery itself, but rather fear of the effects of surgery.

Milano and Kornfeld in 1980 said "Any operation is a destructive invasion of the body and therefore frightens many patients". [12] : 1339  Some operations seem to invoke more fear from patients than others. Aged persons who require cataract surgery often fear the procedure, even though success is very likely. The fear of going blind because of the surgery is more apparent in women, who over all fear surgery more than men. [12] The cataract is a disease that attacks the lens, causing it to swell until sight becomes obscured. [12] : 1339  Operation is recommended when the disease begins to hamper everyday activities. [12] : 1340  Even though becoming blind was the only option without the surgery, over 25% of the patients were afraid of becoming blind as a result of the surgery: 34% feared the failure of the operation. [12] : 1342  Ritva Fagerström, concerning the fears of cataract operation said, "These fears are understandable as the condition of the retina was not known in advance," [12] : 1334  Two women out of 75, taking part in a study dealing with the fear of cataract operation felt that the experience of the first operation was so bad that they would not agree to have the second eye operated on. [12] : 1345  If a patient had this fear, understandable, and did not go through with the surgery, the blindness that would follow would keep them from being able to do normal things, easily leading them into situations of depression, or other dangerous situations which would be destructive to their overall health. Ways to overcome this fear are specific to the individual. Fear of surgery can be harmful to the patient if not taken care of properly before the surgery. Preoperative education and counseling, the aim of which is to provide the patient with reliable and accessible information, has been found to have a huge positive impact on reducing the fear and anxiety associated with surgery. [6] Often adults seem to become less fearful when given more information about the surgery, those who will be performing it, or the things to expect during recovery; 69% said that they had received much information and half of the patients trusted the ophthalmologist to do his best. [12] A well-conducted preoperative information session should consider patient needs and the specificity of their age. Sufficient time should be devoted and allow them to asking questions. The type of information that is given and the way it is communicated are also important. People who are more knowledgeable about the procedure and those who accept the proposed treatments are usually less stressed. [6] It has been established that older people prefer traditional methods of surgical education, while younger patients are eager to use multimedia (computer-animated videos), while both age-specific populations still prefer direct contact with the operating physician in easing the psychological distress associated with fear of surgery. [6]

Fear of dental work

Fear of surgery is not the only fear based on medical procedures that can be harmful to the health of those who experience it; fear of dental work can also be dangerous if taken to an extreme. Dental fear has been ranked fifth among the most common fears. (DeJongh, Morris, Schoemakers, & Ter Horst, 1995) [13] Those who start with dental fear when they are young and continue with it into adulthood can have total avoidance of all dental work, causing problems for their health. [14] Fear of dental care is often diagnosed using a fear measurement instrument like Corah's Dental Anxiety Scale or the Modified Dental Anxiety Scale.

Children

Dental fear in children varies from 3%-21% depending on age and method used to measure dental fear. [14] "A very young child may find the smells of a dental surgery and the sounds of the equipment working very overwhelming" says H.R. Chapman and N. C. Kirby-Turner. [14] Such overwhelming situations can make a child afraid and if the fear is not corrected, it can become harder to get the child to participate in dental procedures.

Some forms of treatment for children who do experience dental fear include allowing the family to come into the room with them to allow the child to see that the other members of the family are not scared, allowing the child to have time to explore the room and the equipment used on them, under the supervision of the dentist, to become familiar with the things surrounding them. [14] Other methods include tell-show-do, positive reinforcement, distraction, nonverbal communication or even general anesthesia and conscious sedation. [15]

Adults

When fear of dental work is not overcome in childhood it is very likely to continue into adulthood, causing a total avoidance of dental visits, which can lead to poor hygiene and lack of proper care for their teeth. Both age and gender have huge differences in how people express and deal with their fear of dental work. Overall women express a fear of dental procedures more than men. [16] Although dental anxiety is shown to be lower in men than in women, men expect more pain from the procedure. [16] This expectance of pain leads many to miss appointments and be unwilling to seek professional help for simple things like toothaches. These simple things can lead to larger problems resulting in decaying teeth and poorly cared for gums. Age also makes a difference in how dental work is dealt with. Dental fear in young adults (ages 18–23) is significantly higher than fear in adults (ages 26–79) [13] showing that over the years, with maturity the fear of dental work decreases. Still many are making appointments and breaking them or not making them at all, leading to a deterioration of their dental condition. [13]

Treatment for this medical fear is similar to that of the treatment of adults who fear surgery. Explanations of what is going on can help, also dentists speaking to patients with less embarrassing wording (such as calling what they have a phobia or treating them like a child while discussing their problem) to encourage them to express and cope with their dental fear. [16]

Fear of doctors and fear of needles

Two of the most common fears of medical procedures are the fear of doctors and the fear of needles. These simple fears, when not overcome by patients, either by themselves or with medical help, can cause great problems in the future for their health.

Fear of doctors

People of all ages deal with fear of doctors (iatrophobia). Children often express fear by trying to hide from doctors when their parents take them in for checkups or by trying to avoid going to the doctor by not telling their parents when they don't feel well. This fear as a child can be easily treated in much the same way that doctors deal with children in surgery. An explanation or example (like seeing the doctor check an older sibling, or a stuffed animal) can help a child feel more comfortable with what the doctor will do for them.

Fear of doctors for adults can be extreme. Avoidance of visiting a doctor can lead to problems with not only short term but also long-term health. There is a medical condition called white coat hypertension that deals with the raising of high blood pressure while in the presence of doctors. [17] Such high blood pressure is not good for health considerations, so this fear leads to more complications in health aspects of life for those who deal with it.

Fear of needles

The fear of needles (also known as trypanophobia) is sometimes a complex condition that can result in poor health outcomes, even death, when the avoidance of needles prevents individuals from seeking basic medical attention. [18] Pre-school children are the most prone among children to be unwilling to cooperate and to express a variety of negative reactions, which are usually triggered by anticipated pain. These responses coincide with their ability to efficiently describe the intensity and areas on their body that they feel pain. In response, healthcare facilities are increasingly employing Certified Child Life Specialists and/or skilled nurses to promote effective coping for children undergoing medical experiences within a medical setting using psychosocial activities. Current vaccine recommendations in children may vary from country to country, but their number does not exceed 30 world-wide. [19] Interestingly, toddlers display a drop in vaccination coverage and compliance to scheduled doctor visits when compared to infants. Vaccinations are a common cause of distress in the toddler age group, but the success of every vaccination program relies on high immunization rates. [20] Needle-associated pain is the key factor that children fear when visiting a doctor's office, regardless if they are having a shot or not. [21] Although even healthy children experience fear and anxiety with frequent medical procedures involving needles such as blood draws or immunizations, some individuals who fear needles may refuse to receive shots that are mandatory, thus leading to greater risk of getting certain diseases, and many avoid treatment for serious medical conditions. Needle phobia is unique in the fact that it is a phobia that is documented to have resulted directly in the deaths of a few patients. [18]

In order to mitigate the effects of fear of needles in children, many treatment and distraction techniques have been evaluated in their ability to reduce report of pain, distress, and physiological responses to stress. Play-based distraction strategies such as bubble blowing, interaction with a robot, engagement with desired toys/electronic devices, engagement with a trained hospital support clown, illusion kaleidoscopes, reading developmentally books, have been found to benefit pre-schoolers in terms of coping with needle-related medical procedures. [21] Virtual reality (VR) technology has been used to manage the pain and anxiety associated with medical procedures in both children and adults, enabling researchers or clinicians to modify multimodal input stimuli to make patients feel "present" in the projected environment. [22] Immersive VR technology provides a visual and auditory distraction experience, allowing medical professionals to efficiently reduce the pain patients report undergoing painful procedures by completely distracting attention from the stimulus. [5]

In the New England Journal of Medicine, Lountzis and Rahman published an article about a 34-year-old woman who had a growth on her fingers that doctors were unable to completely remove because of her fear of needles. [23]

Related Research Articles

<span class="mw-page-title-main">Phobia</span> Anxiety disorder defined 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.

<span class="mw-page-title-main">Anxiety disorder</span> Cognitive disorder with an excessive, irrational dread of everyday situations

Anxiety disorders are a cluster of mental disorders characterized by significant and uncontrollable feelings of anxiety and fear such that a person's social, occupational, and personal function are significantly impaired. Anxiety may cause physical and cognitive symptoms, such as restlessness, irritability, easy fatiguability, difficulty concentrating, increased heart rate, chest pain, abdominal pain, and a variety of other symptoms that may vary based on the individual.

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.

Sedation is the reduction of irritability or agitation by administration of sedative drugs, generally to facilitate a medical procedure or diagnostic procedure. Examples of drugs which can be used for sedation include isoflurane, diethyl ether, propofol, etomidate, ketamine, pentobarbital, lorazepam and midazolam.

<span class="mw-page-title-main">Abnormal psychology</span> Sub-discipline of psychology

Abnormal psychology is the branch of psychology that studies unusual patterns of behavior, emotion, and thought, which could possibly be understood as a mental disorder. Although many behaviors could be considered as abnormal, this branch of psychology typically deals with behavior in a clinical context. There is a long history of attempts to understand and control behavior deemed to be aberrant or deviant, and there is often cultural variation in the approach taken. The field of abnormal psychology identifies multiple causes for different conditions, employing diverse theories from the general field of psychology and elsewhere, and much still hinges on what exactly is meant by "abnormal". There has traditionally been a divide between psychological and biological explanations, reflecting a philosophical dualism in regard to the mind-body problem. There have also been different approaches in trying to classify mental disorders. Abnormal includes three different categories; they are subnormal, supernormal and paranormal.

<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">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, including vaccine hesitancy.

<span class="mw-page-title-main">Clown Care</span>

Clown Care, also known as hospital clowning, is a program in health care facilities involving visits from specially trained clowns. They are colloquially called "clown doctors" which is a trademarked name in several countries. These visits to hospitals have been shown to help in lifting patients' moods with the positive power of hope and humor. There is also an associated positive benefit to the staff and families of patients.

Pseudodysphagia, in its severe form, is the irrational fear of swallowing or, in its minor form, of choking. The symptoms are psychosomatic, so while the sensation of difficult swallowing feels authentic to the individual, it is not based on a real physical symptom. It is important that dysphagia be ruled out before a diagnosis of pseudodysphagia is made.

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.

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.

Dental anesthesia is the application of anesthesia to dentistry. It includes local anesthetics, sedation, and general anesthesia.

<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.

Social anxiety is the anxiety and fear specifically linked to being in social settings. Some categories of disorders associated with social anxiety include anxiety disorders, mood disorders, autism spectrum disorders, eating disorders, and substance use disorders. Individuals with higher levels of social anxiety often avert their gazes, show fewer facial expressions, and show difficulty with initiating and maintaining a conversation. Social anxiety commonly manifests itself in the teenage years and can be persistent throughout life, however, people who experience problems in their daily functioning for an extended period of time can develop social anxiety disorder. Trait social anxiety, the stable tendency to experience this anxiety, can be distinguished from state anxiety, the momentary response to a particular social stimulus. Half of the individuals with any social fears meet the criteria for social anxiety disorder. Age, culture, and gender impact the severity of this disorder. The function of social anxiety is to increase arousal and attention to social interactions, inhibit unwanted social behavior, and motivate preparation for future social situations.

Blood-injection-injury (BII) type phobia is a type of specific phobia 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. Blood-like stimuli may also cause a reaction. This is a common phobia with an estimated 3-4% prevalence in the general population, though it has been found to occur more often in younger and less educated groups. Prevalence of fear of needles which does not meet the BII phobia criteria is higher. A proper name for BII has yet to be created.

<span class="mw-page-title-main">Social anxiety disorder</span> Anxiety disorder associated with social situations

Social anxiety disorder (SAD), also known as social phobia, is an anxiety disorder characterized by sentiments of fear and anxiety in social situations, causing considerable distress and impaired ability to function in at least some aspects of daily life. These fears can be triggered by perceived or actual scrutiny from others. Individuals with social anxiety disorder fear negative evaluations from other people.

While needle phobia is not age-specific, it is more common in children than in adults. The latest research from all fields indicates that needle-fear is predominant among children fears with some research claiming that up to 93% of children experience [needle-related] stress." Many studies have been performed investigating psychosocial methods of helping children cope with their fear. Current research in this area has investigated several types of non-invasive treatments to aid children in their needle phobia. These can be categorized into distraction techniques and other methods. These techniques offer safer, cheaper alternatives to drug or anesthetic treatments.

Separation anxiety disorder (SAD) is an anxiety disorder in which an individual experiences excessive anxiety regarding separation from home and/or from people to whom the individual has a strong emotional attachment. Separation anxiety is a natural part of the developmental process. It is most common in infants and little children, typically between the ages of six to seven months to three years, although it may pathologically manifest itself in older children, adolescents and adults. Unlike SAD, normal separation anxiety indicates healthy advancements in a child's cognitive maturation and should not be considered a developing behavioral problem.

<span class="mw-page-title-main">Pain management in children</span> Medical condition

Pain management in children is the assessment and treatment of pain in infants and children.

Masklophobia is a specific phobia used to classify a general and in some cases an irrational fear of masks, people in costumed clothing and mascots which is common among toddlers and young children. The common cause for masklophobia is not known. Coulrophobia can sometimes be associated with masklophobia.

References

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