Fear of Disease

Why nosophobia has a different name for each disease

The disease supplies the prefix and the structure repeats underneath:

• HIV infection produces AIDS phobia, sometimes called HIV serophobia
• pulmonary tuberculosis gives phthisiophobia
• sexually transmitted infections give syphilophobia or venereophobia
• cancer gives carcinophobia
• heart disease gives cardiophobia
• COVID-19 gave coronaphobia
• the common cold and influenza have their own sufferers

The Greek root is nosos, meaning disease, on the usual phobos.

What nosophobia looks like from outside

The ICD-10 files nosophobia among the hypochondriacal disorders, which are marked by a persistent preoccupation with having one or more serious and progressive physical illnesses. The preoccupation is described as unfounded, which is doing a great deal of work in that sentence.

Two behaviours dominate. The first is checking, and it is specific to whatever disease is feared: a body searched for lesions that might be the Kaposi's sarcoma of AIDS, or for the spots that might be a skin cancer. The second is avoidance, and it grows strange fast. One case study describes a woman with cardiophobia who kept away from foods containing cholesterol, which is at least intelligible, and also kept away from people she judged to be at risk of a heart attack, which is not. Medical examination and reassurance are often sought and sometimes avoided outright, and the same person may do both in a month.

Where nosophobia is thought to come from

The psychodynamic account concerns medical students, and Hunter and colleagues set it out in a study of them. Whatever weaknesses, sensitivities or peculiarities a student brought with them meet the stresses of a training built around bodies, disease and death. Students then start matching: this patient to a remembered relative, this presentation to something in their own history, this symptom to a patient they lost. Emotional investment in the people on the ward is what turns the escalating worry into a shape borrowed from memory.

The media account is older and blunter. A poor grasp of how a disease actually works, assembled from newspaper coverage and uninformed talk, is enough to generate the fear. The dated cases carry the argument. The reviewed literature tracks feared diseases against how prevalent each was in the coverage at the time, and the fit is close.

The family account is the strangest of the three. One study found that people with nosophobia were significantly more likely than controls to be younger siblings. The proposed explanation is that a younger sibling is raised by an older family and therefore sees more illness and death among ageing relatives. Younger siblings also report more coddling and overprotection, particularly from mothers who show distress at injury and sickness while supplying care and attention as the reward for it. Children in that study tended to report the same fears their mothers had, and significantly more of them described themselves as sickly or low in vitality as children. Both routes damage the same thing: confidence in the body's ordinary health.

Why reassurance stops working on nosophobia

Older writing treated medical reassurance as a comfort, and it is certainly what gets asked for. More recent sources say the fear tends to survive the examination and the reassurance both, and some evidence suggests that over the long run the reassurance makes things worse. That finding shaped the treatment.

A 1988 behavioural pilot study produced statistically significant improvements in fear and in the damage done at home and at work, with follow-up showing some patients still well a median of five years later; a 1991 study using similar methods replicated it. The methods went at the behaviour directly:

• exposure to what was feared
• satiation, in the form of writing out the fears in full detail
• paradoxical intervention, such as exercising in order to bring on the heart attack

Reassurance-seeking was blocked at the source, by telling family and doctors not to entertain the requests.

Cognitive therapy has worked where the behavioural route failed. In one case study a patient who could not stop avoiding and ritualising was worked through the evidence for his belief that he had AIDS, and the belief fell from 95 per cent to 30.

Where nosophobia ends and hypochondriasis begins

There is a long-running confusion about where nosophobia ends and hypochondriasis begins, made worse by definitions such as the ICD-10's, which treats the first as a subsection of the second. The transient version that appears during medical training has collected an unusual number of names for one phenomenon: nosophobia itself, medical student's disease, hypochondriasis of medical students, and the frankly unserious medicalstudentitis. Some authors have argued that what students get is a distinct thing and should not be filed with the rest of it.