Trypanophobia

Trypanophobia is the extreme and irrational fear of medical procedures involving injections or hypodermic needles. It is occasionally referred to as aichmophobia, belonephobia, or enetophobia, names that are technically incorrect because they simply denote a “fear of pins/needles” and do not refer to the medical aspect of trypanophobia. The name that is in common usage is simply needle phobia, while the correct scientific term is trypanophobia.

The condition was officially recognized in 1994 in the DSM-IV (Diagnostic and Statistical Manual, 4th edition) as a specific phobia of blood/injection/injury type. Phobic level responses to injections cause sufferers to avoid inoculations, blood tests and in the more severe cases, all medical care.

It is estimated that at least ten percent of American adults are trypanophobic, and it is likely that the actual number is larger, as the most severe cases are never documented due to the tendency of the sufferer to simply avoid all medical treatment.

Types of Trypanophobia
Although trypanophobia is defined simply as an extreme fear of medically related shots/injections, it appears in several varieties.

Vaso-Vagal Trypanophobia
Although most specific phobias stem from the individual themselves, the most common type of trypanophobia, affecting fifty percent of trypanophobes, is an inherited reflex. Approximately 80 % of trypanophobes report that a relative within the first degree exhibits the same disorder. People who suffer from vaso-vagal trypanophobia fear the sight, thought or feeling of needles or needle-like objects. The primary symptom of vaso-vagal trypanophobia is vaso-vagal syncope, or fainting due to loss of blood pressure. The physiological changes associated with this type of trypanophobia also include feeling faint, sweating, nausea, pallor, tinnitus, panic attacks and initially high blood pressure and heart rate followed by a plunge in both at the moment of injection. In this case, the patient is more likely to react passively as opposed to aggressively. Although most phobias are dangerous to some degree, trypanophobia is one of the few that actually kills. In cases of severe trypanophobia, the drop in blood pressure caused by the vaso-vagal shock reflex causes death. The best treatment strategy for this type of trypanophobia is desensitization or the progressive exposure of the patient to gradually more frightening stimuli, allowing them to become desensitized to the stimulus that triggers the phobic response.

Associative Trypanophobia
Associative Trypanophobia is the second most common type of trypanophobia, affecting thirty percent of needle phobes. This type of trypanophobia is the classic specific phobia in which a traumatic event such as an extremely painful medical procedure or witnessing a family member or friend undergo such, causes the patient to associate all procedures involving needles with the original negative experience. This form of trypanophobia causes symptoms that are primarily psychological in nature, such as extreme unexplained anxiety, insomnia, preoccupation with the coming procedure and panic attacks. Treatments that are effective for this form of trypanophobia include cognitive therapy, hypnosis, and/or the administration of anti-anxiety medications.

Resistive Trypanophobia
Resistive Trypanophobia occurs when the underlying fear involves not simply needles or injections but also being controlled or restrained. It typically stems from repressive upbringing or poor handling of prior needle procedures i.e with forced physical or emotional restraint. This form of trypanophobia affects around twenty percent of needle phobes. Symptoms of this form of trypanophobia include combativeness, high heart rate coupled with extremely high blood pressure, violent resistance, avoidance and flight. The suggested treatment for this form of trypanophobia is psychotherapy, teaching the patient self-injection techniques or finding a trusted healthcare provider.

Hyperalgesic Trypanophobia
Hyperalgesic Trypanophobia is another form of trypanophobia that does not have as much to do with fear of the actual needle. Patients with this form of trypanophobia have an inherited hypersensitivity to pain, or hyperalgesia. To them, the pain of an injection is unbearably great and many cannot understand how anyone can tolerate such procedures. This form of trypanophobia affects around ten percent of needle phobes. The symptoms of this form of trypanophobia include extreme explained anxiety, and elevated blood pressure and heart rate at the immediate point of needle penetration or seconds before. The recommended forms of treatment for this type of trypanophobia include some form of anesthesia, either topical or general.

Comorbidity and Triggers
Trypanophobia, especially in its more severe forms, is often comorbid with other phobias and psychological ailments, for example, Iatrophobia, or an irrational fear of doctors, is often seen in needle phobic patients.

A needle phobic patient does not need to physically be in a doctor's office to experience panic attacks or anxiety brought on by trypanophobia. There are many triggers in the outside world that can bring on an attack through association. Some of these are blood, injuries, examination rooms, hospitals, white lab coats, hospital gowns, doctors, dentists, nurses, the antiseptic smell associated with offices and hospitals, or even the sight of a person who physically resembles the patient's regular healthcare provider.

The Evolution of Trypanophobia
It is suspected that the geneticly linked forms of trypanophobia date from early human history. In early time periods, genes that predisposed a person to avoid physical injuries such as piercing, stabbing or other skin penetration would be more likely to survive, given that in those days, death from bleeding, hemorrhaging or subsequent infection of a wound, were far more common than they are today. Over time, the complex bundle of symptoms that comprise a vaso-vagal shock response were hard-wired into the genetic makeups of certain humans, and these symptoms are still expressed today in the form of vaso-vagal trypanophobia.

Treatment of Trypanophobia
As well as the specific methods recommended for trypanophobia that is clearly of one of the four types, there are other treatments available, some more effective than others. As not every trypanophobic patient falls clearly into one of the four categories and there are both hybrid phobias and phobias of other, as yet unnamed classifications, it is best to research all available treatment options before coming to a decision as to which one will be effective in a particular case.


 * Local anesthetic injections - This form of treatment is readily available and economically sensible. However, it provides only superficial pain control and it is completely impractical to treat needle phobia with an injection.


 * Ethyl Chloride Spray [and other freezing agents] - Easily administered, but provides only superficial pain control.


 * Topical Anesthetic Creams - This form of treatment is painless and portable but takes a long time to become effective and is messy.


 * Jet Injectors - Jet Injectors work by introducing substances into the body through a jet of high pressure gas as opposed to by a needle. Though these eliminate the needle, some people report that they cause more pain.  Also, they are only helpful in a very limited number of situations involving needles i.e insulin and some innoculations.


 * Iontophoresis - Iontophoresis drives anesthetic through the skin by using an electric current. It provides effective anesthesia, but is generally unavailable on the commercial market and is also inconvenient to use.


 * Behavioral Therapy - Effectiveness of this varies greatly depending on the person and the severity of the condition. Generally, it has limited efficacy in treating needle phobic patients and tends to be expensive.


 * General Anesthesia - This will eliminate all pain and also all memory of any needle procedure. On the other hand, it is a very extreme solution, as it is not covered by insurance in most cases and most physicians will not order it.  It can be risky, cost a great deal of money and require a hospital stay.