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Tomophobia: I Fear Doctors, Blood, and Needles. Now What?

Tips to face your medical fears.

Tomophobia: the fear or needles and medical procedures
(Shutterstock: I AM NIKOM)

One thing about COVID-19 is that people who have avoided doctors for years are having to face their fears of the medical system.

I have been listening to Chris Cuomo speak about his illness. “I have never given blood in my life, and we both know why,” he recently stated on his show to CNN’s Dr. Sanjay Gupta. “It’s because I’m a wuss.”

He went on to say, “that, of course, could complicate the process just a little. The likelihood that I faint is like 110%. If they want the blood, I’m going to give it to them because that is the best thing I’ve heard of so far in terms of what I can do to help as someone who was sick.”

That left me thinking about why people faint from a very small medical procedure like giving blood.  This is something I’ve given people advice and prescriptions for, including anxiety medication for the smallest medical procedures.   

This phobia which is often overlooked—and infrequently talked about—is called tomophobia. Tomophobia is the fear of medical procedures. It is most commonly the fear of needles, especially among children. Let’s take a look at some of the facts:

  • Everyone has some fear of medical procedures. However, if you have a specific phobia, you likely experience an exaggerated sense of dread or panic. When faced with the extreme fear of medical procedures, you might have tomophobia. These irrational fears must interfere with personal relationships, work, and school, and prevent someone from enjoying life. One’s functioning must be impaired to meet the criteria of a specific phobia.  
  • The characteristics of the “blood-injection-injury” phobia includes the fear of seeing blood, becoming injured, or receiving an injection or other invasive medical procedure. The highest prevalence of “blood-injection-injury” phobia is found in females in their reproductive age (3.3%), while the prevalence in women over age 50 is 1.1%. Prevalence rates in men range from 0.7 to 0.8%.  
  • The symptoms of tomophobia include situation-induced panic attacks when medical procedures need to be performed, such as intense anxiety or anger. Children may scream or run out of the room. For adults, it may cause avoidance of going to the doctor or getting other potentially lifesaving procedures because of their fear.  
  • Tomophobia may be caused by people who have vasovagal syncope.Vasovagal syncope is when your body overreacts to triggers due to the overwhelming response of the autonomic nervous system mediated by the vagus nerve. This might cause you to have a really intense heart rate, a drop in blood pressure, or you may pass out or faint from pain. 
    • For these people, passing out might cause trauma for them if they hit their head or feel very uncomfortable. So, then they develop a fear of this happening again and then a fear of medical procedures. It also might be part of an anxiety disorder in which they have panic attacks in response to many types of anxieties, not just fear of medical procedures alone. 
    • Or, it might be caused by someone who had had iatrogenic trauma which means someone who was accidentally injured by a medical procedure in the past. That person therefore fears that the medical system may do more harm than good. For example, someone who had a needle injury that caused bad cellulitis (infection of area of skin)  and great pain might have fear of these procedures in the future. 
  • For these people, passing out might cause trauma for them if they hit their head or feel very uncomfortable. So, then they develop a fear of this happening again and then a fear of medical procedures. It also might be part of an anxiety disorder in which they have panic attacks in response to many types of anxieties, not just fear of medical procedures alone. 
  • Or, it might be caused by someone who had had iatrogenic trauma which means someone who was accidentally injured by a medical procedure in the past. That person therefore fears that the medical system may do more harm than good. For example, someone who had a needle injury that caused bad cellulitis (infection of area of skin)  and great pain might have fear of these procedures in the future. 

So, what can you do about it? Tomophobia can be diagnosed by a clinical interview by a psychologist or psychiatrist. 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. 

Exposure means using systematic desensitization techniques, starting with just visualization of the feared stimulus (visualizing in their mind getting an injection). This also includes watching a video of someone getting an injection, seeing and holding a needle, holding a needle up to the skin, or actually getting an injection if it was fear of needles.  

Another option is eye movement desensitization and reprocessing (EMDR). EMDR therapy is an interactive psychotherapy technique used to relieve psychological stress. During EMDR therapy sessions, you relieve the phobia and speak about it in brief doses while the therapist directs your eye movements until you feel calm.article continues after advertisement

When it comes to fainting, I have two recommendations: laying down or applied tension. Laying down for blood draws instead of sitting up can prevent fainting and may help. Applied tension is a simple technique to increase blood pressure back to normal levels so you do not faint. This is how you do it:

  1. Sit down somewhere comfortably. 
  2. Tense the muscles in your arms, upper body and legs, and hold this tension for 10-to-15 seconds, or until you start to feel the warmth rising in your face. 
  3. Release the tension and go back to your normal sitting position. 
  4. After about 20-to-30 seconds, go through the tension procedure again until you feel the warmth in your face.
  5. Repeat this sequence so that you have practiced the tension five times.

During these uncertain times, there is a lot of anxiety and fear about the unknown. And, many people are forced to face their fears of medical procedures and needles. Always consult with a professional if you are experiencing any of these symptoms and need help. New York State has set up free online counseling using this hotline (I have signed up to offer my services for free as have many others): 1-844-863-9314. Always reach out and get help. You are not alone. 

This article was originally posted on Psychology Today where Dr. Lea Lis is a regular contributor.

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