Fear of Drowning

Why the fear predicts the drowning

The Frontiers in Psychology paper that built a measure for it opens with the claim in one line: fear of water is the strongest predictor of no or low swimming competency. The barriers to learning that get listed alongside it are the material ones, meaning pool access, the cost of lessons, hair care, discomfort at being seen in a swimsuit, and a family history of injury in the water. Fear of drowning outranks them.

That ordering is what makes the fear different from an ordinary phobia of an object. Avoiding a spider costs nothing that protects a person from spiders. Avoiding water removes the one competence that lowers the risk of drowning, so the avoidance and the danger point in the same direction. Some people never learn because they will not go near the water at all. Others attend the lessons and still cannot learn, because floating asks for a relaxation the fear does not permit.

The scale of the incompetence is measured, country by country, and is larger than the phobia rates could account for:

• 14.5 per cent of five to seventeen-year-olds in Germany were unable to swim, in an interview and examination survey published in 2016
• roughly half of British children aged seven to eleven could not swim twenty-five metres, in a 2013 figure from the Amateur Swimming Association
• 7 per cent of Slovenian twelve-year-olds cannot swim fifty metres and are classed as non-swimmers
• nearly 64 per cent of African American children, 45 per cent of Hispanic children and 40 per cent of Caucasian children have little or no swimming ability, in 2017 figures from the USA Swimming Foundation

Where the fear is not evenly distributed

That last line has a literature of its own. In 2011 the Journal of Black Studies published a study by Carol C. Irwin, Richard L. Irwin, Timothy D. Ryan and Joris Drayer, under the title The Legacy of Fear, examining whether fear of drowning was itself a variable behind limited swimming ability in minority children.

It found significant racial differences in the fear, and one group standing out inside them: adolescent African American girls were more likely to report fearing drowning while swimming than any other group in the sample. The responses of parents and caregivers differed on the same lines, which matters because a parent's fear of the water is one of the recorded reasons a child does not get taught. The paper sets that against drowning rates for African American children that run, in some age bands, at three times the rate of their white peers.

A fear that is transmitted, that reduces the skill, and that concentrates in the population already drowning most is not a phobia in the clinical sense at all. It is closer to what this catalogue elsewhere calls a fear that is correct about its object and wrong about what to do.

What the fear of water questionnaire measures

Until recently there was no instrument for the thing. In 2020 a group at the Faculty of Sport in Ljubljana, Fatmir Misimi, Tanja Kajtna, Samir Misimi and Jernej Kapus, published the Fear of Water Assessment Questionnaire, built so that a swimming teacher rather than a clinician could identify who was afraid before the lessons started.

The construction was ordinary psychometrics and the numbers are unusually clean for this catalogue. Two thousand and seventy-four people answered a forty-item draft. Exploratory factor analysis reduced it to twenty items in three factors, accounting for 31.69 per cent of the variance, with a Cronbach's alpha of 0.831. A discriminant function analysis then correctly classified 98.2 per cent of participants into the fearful and unafraid groups.

Where the fear comes from is less settled than how to measure it. The same paper sets the traditional account, a bad experience such as a fall into deep water or a frightening lesson, against the non-associative position, in which the fear appears without any aversive event because it was available from the start. Both are given weight, and the aquaphobia prevalence quoted alongside them, between 2 and 3 per cent of the general population, is far too small to cover the number of adults who cannot swim.

How drowning actually proceeds

The event the fear is about is quieter than its depiction. The World Health Organization's 2005 definition calls drowning the process of experiencing respiratory impairment from submersion or immersion in liquid, a wording that does not require death, medical treatment, or any water in the lungs, and the same consensus retired the older vocabulary of wet, dry, active, passive, silent and secondary drowning.

A person who cannot swim can struggle at the surface for twenty to sixty seconds before going under. Drowning people are often unable to wave, shout or speak, which is why lifeguarding manuals treat the absence of noise as the signal rather than the reassurance. Non-fatal drownings are estimated at two to four times the number of fatal ones, and the highest rates worldwide are among children under five.

Two neighbouring fears in this catalogue keep their own objects. Galeophobia fears an animal in the water rather than the water's own behaviour, and kayak angst describes hunters who feared drowning in a panic whose cause was the loss of the horizon rather than the sea.

Why no diagnosis carries the word

There is no entry for a fear of drowning in any diagnostic manual. What the manuals carry is the specific phobia, and the water version of it is aquaphobia, which is where the fear of drowning gets filed when it reaches a clinic at all. The 2015 reference on phobias makes the relationship explicit: the core of water fear is harm rather than water, and it presents most often as a fear of drowning, including in people who swim competently.

That is the whole of the taxonomic position. The fear is real, it is measurable, it is unevenly distributed, and it is studied hardest by people whose job is teaching swimming rather than treating anxiety. It appears in the medical record mainly as what somebody feared before an incident, not as what was diagnosed after one.