Fear of Injury

Which condition each dictionary describes

Merriam-Webster's medical dictionary gives traumatophobia as an excessive or disabling fear of war or physical injury, usually resulting from experiences in combat. That is a description of a veteran, and it dates the word: it belongs to the vocabulary that preceded post-traumatic stress disorder.

The English Wikipedia gives something else. It treats traumatophobia as another name for injury phobia, files it under the blood, injection and injury subtype introduced in the DSM in 1994, and describes an abnormal fear of sustaining an injury. That is a description of a patient avoiding a procedure.

The Greek does not settle it. Trauma means a wound, which covers both a wound received in a war and a wound received on an operating table, and the two readings have simply grown apart in different books.

What the injury reading covers

On the Wikipedia account the reaction fires on exposure to blood, to an injury or to an injection, and the symptom list is the standard panic one:

• breathlessness and palpitations
• heavy sweating and a dry mouth
• nausea and shaking
• an inability to speak or think clearly
• a fear of dying or losing control, and detachment from reality
• in some cases a full anxiety attack It notes that dental phobia is a separate condition and not a form of this one, and that one study found it commoner in women.

The consequence given is the one that matters: people with the fear avoid medical procedures that could save their lives. Treatment is behavioural and cognitive, usually behavioural, and the method described is repeated exposure to blood, injury and injections until the reaction diminishes. Hypnotherapy is listed as an option.

Why the numbers belong to the cluster

No figure exists for traumatophobia under its own name. The blood-injection-injury phobia it is filed with is estimated at 3 to 4 per cent of the general population.

A survey published in the journal Depression Research and Treatment in 2014 interviewed 3,261 people in the Indian subcontinent, 1,648 men and 1,613 women, using a twenty-one item questionnaire with a reported internal consistency of 0.972. Its central finding was a sex difference: prevalence, and the fainting that goes with it, was slightly more than double in women. Avoidance of hospital visits was similar in both.

Two secondary findings are worth keeping. Depression was highly comorbid, while obsessive-compulsive disorder and social anxiety disorder were not. And the frequency among relatives did not behave: it was higher in first and third degree relatives than in second degree relatives, which is not the gradient a simple heritable trait produces.

Why fainting makes this cluster different

The blood-injection-injury type is the one specific phobia with its own physiology. The response is diphasic: the heart rate and blood pressure rise and then fall, and the person faints. Every other phobia in the manual produces arousal and this one produces collapse, which is why it is grouped separately and why the standard advice about exposure has to be modified for it.

The survey's authors add a practical warning. The harm caused by the phobia rises sharply when another medical problem arrives alongside it, because that is the point at which avoiding a hospital stops being inconvenient.