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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. The term phobia, which comes from the Greek word for fear (φόβος, fobos), denotes a number of psychological and physiological conditions that can range from serious disabilities to common fears to minor quirks. ... A medical procedure is a course of action intended to achieve a result in the care of patients, used by medical or paramedical personnel. ... Injection has multiple meanings: In mathematics, the term injection refers to an injective function. ... Different bevels on hypodermic needles. ...

Overview and incidence

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. The Diagnostic and Statistical Manual of Mental Disorders, published by the American Psychiatric Association, is the handbook used most often in diagnosing mental disorders in the United States and other countries. ... The Diagnostic and Statistical Manual of Mental Disorders, published by the American Psychiatric Association, is the handbook used most often in diagnosing mental disorders in the United States and other countries. ... Specific phobia is a generic term for any kind of anxiety disorder that amounts to an unreasonable or irrational fear related to exposure to specific objects or situations. ... Inoculation, originally Variolation, is a method of purposefully infecting a person with smallpox (Variola) in a controlled manner so as to minimise the severity of the infection and also to induce immunity against further infection. ...

It is estimated that at least 10% 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.

Evolutionary basis

According to Dr. James Hamilton, author of the pioneering paper on needle phobia, it is likely that the form of needle phobia that is genetic has some basis in evolution, given that thousands of years ago humans who meticulously avoided stab wounds and other incidences of pierced flesh would have a greater chance of survival. James Hamilton, 5th Duke of Abercorn (born 4 July 1934) is a Northern Irish peer and politician, and currently Lord Steward of the Household. ... This article is about the general scientific term. ... This article is about evolution in biology. ... Survival may refer to: Survival skills Survival kit Survivalism Survival, a studio album by Grand Funk Railroad Survival (album), a Bob Marley reggae album Survival (Doctor Who), an episode of Doctor Who Survival (television), a British wildlife television program Survival International a charity Survival Festival, Australia This is a disambiguation...

Types

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

Vaso-vagal

Although most specific phobias stem from the individual themselves, the most common type of trypanophobia, affecting 50% of trypanophobes, is an inherited reflex. Approximately 80% of trypanophobes report that a relative within the first degree exhibits the same disorder. For other uses, see Reflexive (disambiguation). ...

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 vasovagal syncope, or fainting due to a decrease of blood pressure. Vasovagal syncope is the most common cause of syncope, also known as fainting. ... A sphygmomanometer, a device used for measuring arterial 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. Perspiration (also called sweating or sometimes transpiration) is the production and evaporation of a fluid, consisting primarily of water as well as a smaller amount of sodium chloride (the main constituent of table salt), that is excreted by the sweat glands in the skin of mammals. ... For other uses, see Nausea (disambiguation). ... Pallor is a reduced amount of oxyhemoglobin in skin or mucous membrane, a pale color which can be caused by illness, emotional shock or stress, avoiding excessive exposure to sunlight, anaemia or genetics. ... Tinnitus (pronounced or ,[1] from the Latin word for ringing[2]) is the perception of sound in the human ear in the absence of corresponding external sound(s). ... Panic attacks are sudden, discrete periods of intense anxiety, fear and discomfort that are associated with a variety of somatic and cognitive symptoms[1]. The onset of these episodes is typically abrupt, and may have no obvious trigger. ...

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 may cause death.^{[citation needed]} For other uses, see Death (disambiguation). ...

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. Desensitization is a method to reduce or eliminate an organisms negative reaction to a substance or stimulus. ...

Associative

Associative Trypanophobia is the second most common type of trypanophobia, affecting 30% of needle phobics. 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. Specific phobia is a generic term for any kind of anxiety disorder that amounts to an unreasonable or irrational fear related to exposure to specific objects or situations. ... Psychological trauma is a type of damage to the psyche that occurs as a result of a traumatic event. ...

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. This article is about the sleeping disorder. ... A panic attack is a period of intense fear or discomfort, typically with an abrupt onset and usually lasting no more than 30 minutes. ...

Treatments that are effective for this form of trypanophobia include cognitive therapy, hypnosis, and/or the administration of anti-anxiety medications. This article is about Becks Cognitive Therapy. ... For other uses, see Hypnotized (song). ...

Resistive

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 20% 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

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. Hyperalgesia is an extreme sensitivity to pain, which in one form is caused by damage to nociceptors in the bodys soft tissues. ...

This form of trypanophobia affects around 10% 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. Anesthesia or anaesthesia (see spelling differences) has traditionally meant the condition of having the perception of pain and other sensations blocked. ...

Vicarious

Whilst witnessing procedures involving needles it is possible for the phobic present to suffer the symptoms of a needle phobic attack without actually being injected. Prompted by the sight of the injection the phobic may exhibit the normal symptoms of vascal vagal syncope and fainting or collapse is common. While the cause of this is not known, it may be due to the phobic imagining the procedure being performed on themselves. Recent neuroscience research shows that feeling a pin prick sensation and watching someone else's hand get pricked by a pin activate the same part of the brain ^[1]

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. The English suffixes -phobia, -phobic, -phobe (of Greek origin) occur in technical usage in psychiatry to construct words that describe irrational, disabling fear as a mental disorder (e. ...

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, the sight of the needle physical or on a screen, examination rooms, hospitals, white lab coats, hospital gowns, doctors, dentists, nurses, the antiseptic smell associated with offices and hospitals, the sight of a person who physically resembles the patient's regular healthcare provider, or even reading about the fear.

Treatment

As well as the specific methods recommended for a case of 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 inoculations.

• 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. Any therapy that endorses relaxation methods is usually ineffective against trypanophobia as this encourages a drop in blood pressure that only enhances the vasovagal reflex.

• Laughing Gas - This will provide sedation and reduce anxiety for the patient, along with some mild analgesic effects.

• Inhalation 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.

Ethyl chloride is a chemical compound once widely used in producing tetraethyl lead, a gasoline additive. ... Iontophoresis is a non-invasive method of propelling high concentrations of a charged substance, normally medication or bioactive-agents, transdermally by repulsive electromotive force using a small electrical charge applied to an iontophoretic chamber containing a similarly charged active agent and its vehicle. ... For other uses, see Nitrous oxide (disambiguation). ...

In popular culture

Like other phobias, Trypanophobia has also played a part of popular culture in either TV Shows, Films, and even some celebrities have admitted to having this phobia. Here are some examples:

• Late Night host, Conan O'Brien has self-declared a fear of needles (Cited from Late Night on October 11, 2005 when offered a flu shot).
• Trypanophobia was the main theme in the Ed, Edd n Eddy episode, This won't hurt an Ed, where Eddy learns that Kevin has trypanophobia, not knowing everyone else also has a fear of needles. Edd, Jonny, and Plank are the only ones who don't have trypanophobia.
• Monk (TV series), Adrian Monk, the title character, has this problem among his list of phobias
• Gerard Way, lead singer and frontman of the platinum album band My Chemical Romance, said in an interview that he is severely afraid of needles.
• In The Suite Life of Zack and Cody, it was revealed that Moseby is afraid of needles when the staff gets a blood test.
• In the film SLC Punk!, Heroin Bob has a very prominent case of trypanophobia. This led to a cut on his hand getting infected to the point where he had to be quarantined.
• Snoop Dogg has stated on his television show "Snoop Dogg's Father Hood" that he has been afraid of needles since the age of 4.
• Goku from Dragon Ball Z suffers from Trypanophobia as said in an episode.
• Emily Ellison suffers from Trypanophobia as she stated at a sleepover.

Conan Christopher OBrien (born April 18, 1963) is an Emmy Award-winning American television host and comedian, best known as host of NBCs Late Night with Conan OBrien. ... Late Night is shorthand for several different things: Late night television - generally United States programming airing after 11:30pm EST Late Night, a long running variety program that has aired on NBC immediately following The Tonight Show since 1982. ... Ed, Edd n Eddy is a Canadian/American animated television series created by Danny Antonucci and produced by a. ... Monk is an Emmy and Golden Globe winning U.S. television show about the private detective Adrian Monk (Tony Shalhoub). ... Adrian Monk is the protagonist of the television series Monk, portrayed by Tony Shalhoub. ... The term phobia, which comes from the Ancient Greek word for fear (φόβος, fobos), denotes a number of psychological and physiological conditions that can range from serious disabilities to common fears to minor quirks. ... Gerard Arthur Way (born April 9, 1977) is the front man, lead vocalist and co-founder of the band My Chemical Romance; he is also elder brother to the bands bass player, Mikey Way. ... My Chemical Romance are an American rock band formed in 2001. ... The Suite Life of Zack and Cody, is an American childrens television series that airs on the Disney Channel. ... Information Nickname(s) Mr. ... SLC Punk! (1998) is an independent film directed by James Merendino; SLC is an acronym for Salt Lake City. ... Son Goku , Goku in most English versions) is the protagonist who first appears in the Dragon Ball manga created by Akira Toriyama, more popularly followed by an anime series. ... DBZ redirects here. ...

References

1. ^ Vicarious responses to pain in anterior cingulate ...[Cogn Affect Behav Neurosci. 2004] - PubMed Result

• James Hamilton (1995). "Needle Phobia - A Neglected Diagnosis". Journal of Family Practice 41. 
• DK Lamb's Needle Phobia Information Site
• Jerry Emanuelson's Needle Phobia
• Dental Fear Central's Needle phobia in the context of dentistry