Fear of Heart Disease

Which condition comes first

A study drawing on twenty household surveys conducted in eighteen countries separated anxiety and depression into two families, fear disorders and distress disorders, and asked which of them precedes heart disease.

The prevalence figures were close: 13.3 per cent for fear disorder and 14.0 per cent for distress disorder in the total sample. Most people had one or the other rather than both, 7.7 per cent pure fear and 8.5 per cent pure distress, and where both were present the fear had usually come first, in 3.8 per cent of the sample.

The finding is in the comparison. Against people with neither, respondents with a pure fear disorder had the highest odds of developing heart disease afterwards, at 1.8 with a confidence interval from 1.5 to 2.2. Against people with a pure distress disorder, they were still at significantly increased risk, at 1.3.

That is not a study of cardiophobia specifically, and the catalogue does not report it as one. What it establishes is that fear, as a class of disorder, is associated with later heart disease more strongly than depression is, which places a fear of heart disease in an awkward position: the anxiety is about an outcome that anxiety is a risk factor for.

How many cardiology patients are panicking

The 2008 encyclopedia of phobias records a second figure from the other end of the same problem. Cardiac symptoms are among the most frightening and most prominent features of panic disorder, and people consulting physicians about the cardiovascular symptoms of panic may constitute as many as one third of all cardiology patients.

If that is even approximately right, it describes a speciality in which a large minority of the caseload has arrived at the wrong door. The symptoms are real, the distress is real, and the organ being examined is not where the problem is.

It also explains why a fear of heart disease is so hard to reassure. A person having palpitations is not imagining them.

What the case description shows

The one case description available comes through the literature on nosophobia, the general fear of contracting a disease, which lists cardiophobia among its primary forms:

• HIV
• tuberculosis
• sexually transmitted infection
• cancer
• COVID-19

It describes a woman with a fear of heart disease who avoided food containing cholesterol, which is ordinary, and who avoided people she thought were at risk of a heart attack, which is not.

Heart disease is not contagious. Avoiding somebody who might have it protects nobody from anything, and the behaviour is the clearest evidence in the sources that what is being enacted here is a contamination logic rather than a risk calculation.

Where cardiophobia is filed

The tenth revision of the International Classification of Diseases lists nosophobia under the hypochondriacal disorders, defined by a persistent preoccupation with the possibility of having at least one serious and progressive physical disorder. The description used there is that the fear is unfounded, that medical examination and reassurance is often sought and sometimes avoided instead, and that checking behaviours are common.

Cardiophobia has no listing of its own. It is a subtype of a subtype, and its name survives because the organ is specific enough to be worth naming.