Haphephobia

Haphephobia is a specific phobia involving the fear of being touched (and of touching others). The fear is so intense that it can trigger symptoms ranging from anxiety to nausea to hives. It is a rare condition that can be treated effectively with drug treatments, psychotherapy, and self-care.

What is haphephobia?

Haphephobia is a fear of being touched and is also described as a touch aversion or a phobia of touch. This fear goes beyond a fundamental dislike for being touched or touching others, though.^[1] As a specific phobia, there is marked fear and anxiety in response to a particular situation, object, or event,^[2] in this case, physical contact with other people.

For some people, the fear of being touched is specific to certain people or groups, like being touched or touching someone of another gender. For others, though, the fear of being touched extends to everyone, including colleagues, friends, and family members. In either case, the phobia of hugs and other forms of touching causes extreme distress and can significantly impact one’s ability to conduct activities of daily living.

Symptoms of haphephobia

As with any specific phobia, people with haphephobia experience physical and psychological symptoms. On the one hand, physical symptoms might include nausea, dizziness, or fainting. On the other hand, psychological symptoms can include anxiety, panic attacks, and depression.^[3]

The symptoms of the fear of being touched go much further, though. Other physical and psychological symptoms might include the following: ^[2,3]

• Shortness of breath or difficulty breathing
• Elevated heart rate
• Chest tightness
• Excessive sweating
• Hives
• Crying
• Hypervigilance when around other people
• Avoidance behaviors (e.g., refusing to touch others; isolating oneself from other people)
• Trouble with intimate relationships

The key to identifying haphephobia symptoms is not just in naming or labeling them. Instead, these symptoms must cause significant daily distress in a person’s life. More details about this component of haphephobia are discussed in the diagnosis section.

Causes of haphephobia

Like any phobia, the fear of being touched likely arises from a complex interaction of biological and environmental factors.

For example, some people with specific phobias like this have a genetic predisposition for developing haphephobia. Though the biological mechanisms for phobia development aren’t well understood, what is known is that the amygdala is a central player in the role of fear.^[4]

Evolutionarily, the amygdala is vital in warning us about danger. Part of its job is to serve as an early warning system for sights, sounds, smells, and other stimuli that might cause us harm. This triggers physiological fear responses, such as a racing heart and sweaty palms.

The other aspect of the amygdala’s job is to communicate with the cerebral cortex – the area of the brain responsible for higher-order thinking – to evaluate the nature of the danger. This “discussion” between the amygdala and cerebral cortex takes longer than the impulses that trigger the early warning system described above. But the cerebral cortex can determine whether the danger is real, what response is necessary, and whether fear is warranted.^[4]

Researchers believe that phobias like haphephobia partially result from a dysfunction of this amygdala-cerebral cortex communication. Even so, it’s only half of the equation, as the environment plays a crucial role in the development of phobias.^[4]

Let’s assume a parent physically abused you as a child. As a result of that abuse, you associate human touch with something bad, like physical pain and emotional abuse. It stands to reason that you would develop a fear of being touched in the context of those childhood experiences. This is just one example of an environmental cause, though. 

Risk factors and triggers

In addition to genetic and environmental factors, certain risk factors and triggers make someone more likely to develop haphephobia.

For example, a history of physical or sexual abuse is a significant risk factor for touch aversion.^[1] These types of abuse needn’t be recent, either. Sexual abuse as a child, bullying in grade school, or physical abuse at the hands of a parent or other authority figure can all be risk factors for the fear of being touched as an adult

A secondary risk factor for a phobia of touch is witnessing the reaction of a loved one with haphephobia. For example, a parent who was physically assaulted during a mugging might exhibit the symptoms of the fear of being touched when approached by their child for a hug. The parent’s resulting physical and psychological reaction might lead the child to develop a touch aversion themselves.^[5]

A third risk factor is one’s family history of mental health. A person with a parent who has an anxiety disorder, panic disorder, or another mental health issue is generally more at risk of developing a mental health issue themselves.

Triggers for haphephobia follow the same pattern. For example, a person abused by their domestic partner might experience heightened symptoms when their partner is in the same room. The symptoms might initially be specifically in response to the abusive partner but might generalize to others as time passes and if treatment is not undertaken.

Locations or events in which physical touch is more likely can also trigger haphephobia symptoms. Intimate events, like family reunions and weddings, might be avoided altogether, as the likelihood of handshakes, hugs, and other forms of touch are more likely. Even situations in which being near others (e.g., mass transportation) might also trigger symptoms.

In many instances, someone with a fear of being touched doesn’t even have to be in these situations – the mere thought of the potential of touch is often enough to trigger symptoms and elicit avoidance responses.

Diagnosing haphephobia

A mental health professional relies on various sources of information when making a diagnosis. There will likely be an intake interview to get a broad understanding of the presenting issue (e.g., to determine when, where, and why the symptoms arise), and psychological assessments (e.g., personality tests, depression inventories) might be used to get a clearer picture of what’s going on and to rule out other potential causes of the symptoms.

Additionally, mental health professionals rely on the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) to further refine their focus. The diagnostic criteria for specific phobias are summarized as follows: ^[6]

• The fear is persistent, typically lasting at least six months
• The fear is both excessive for the situation and unreasonable
• The fear is triggered by the presence of a specific situation or object or the anticipation of a fear-inducing situation or object
• An anxiety response is nearly always triggered when exposed to the feared stimuli
• The feared stimuli are consistently avoided at all costs or otherwise endured with significant distress and anxiety
• The fear and avoidance associated with the phobia cause significant interference in one’s daily routine, school or work functioning, social activities, and relationships, or there is marked distress related to having the phobia
• The person understands that their fear is out of proportion with the threat
• Other mental health issues, such as panic disorder, post-traumatic stress disorder, obsessive-compulsive disorder, social phobia, etc., do not better explain these symptoms

Haphephobia treatment

Treating a phobia of hugs and other touch uses various approaches, like psychotherapy and medication. You can also employ many self-help strategies to help manage the daily symptoms associated with this phobia.

Haphephobia therapy

Exposure therapy is a common approach for treating the fear of being touched. Essentially, exposure therapy involves the slow and systematic introduction of the feared element in a highly controlled environment.^[2]

For example, a patient with haphephobia might first simply discuss their fear of being touched in the context of therapy. The next step might be to sit on the same couch with a friend or a loved one. After that, the patient might be asked to rest their hand on the sofa next to their loved one’s hand. This process would proceed to greater and greater instances of touch until the patient experiences touch without fear.

Cognitive-behavioral therapy (CBT) is another highly successful option for treating the phobia of touch. CBT focuses on the maladaptive thought patterns associated with phobias and seeks to reframe those negative or distorted cognitions as a vehicle for changing behavior.^[3]

CBT relies on various techniques to bring about cognitive and behavioral change, including the following:

• Journaling helps track one’s mood, identify triggers, and reflect on how one’s thought patterns influence one’s behavior.
• Role-playing can assist clients in identifying maladaptive thought patterns while also practicing exposure to the phobia.
• Thought recording is done to track one’s thoughts and observe the associated feelings, behaviors, anxieties, and so forth.

Other therapy options include couples, family, or group therapy,^[5] all of which provide greater emotional support and understanding from loved ones. In some cases, flooding (which involves prolonged, immediate exposure to touch) is effective in breaking the barrier of anxiety and fear, too.^[3] Virtual reality therapy is yet another option that allows exposure to the stimulus without the risk of actual physical touch.

Haphephobia medications

Medications might be used in conjunction with psychotherapy but are not a viable option on their own as no medication fully treats the phobia or its underlying issue.^[2] 

Having said that, anti-anxiety medications like benzodiazepines might be prescribed to help manage the symptoms associated with the fear of being touched, although they’re typically not used as a first line of treatment due to the risk of dependency.

Antidepressants like fluoxetine and beta blockers like propranolol might also be prescribed to help lessen symptoms before an event that might provoke symptoms,^[2] such as starting a new job and having anxiety about shaking people’s hands when greeting them for the first time.

All medication options should be discussed with your doctor.

Self-help strategies for haphephobia

In addition to seeking professional help, people with touch aversion can control their situation more by employing various self-help strategies. For people with haphephobia, practicing mindfulness can be extremely helpful in minimizing symptoms. Breathing exercises can also work well for maintaining a certain level of calm in the face of anxiety about being touched.

Other options include the following:^[7]

• Physical exercise can help alleviate stress associated with the fear of being touched.
• Muscle relaxation techniques involve activating and then relaxing specific muscles, which teaches people they have more control over their body than they think.
• Eating well will help keep you more physically fit and emotionally balanced.
• Avoiding drugs and alcohol is also helpful in staying grounded and having a clear mind for doing the hard work of managing the phobia.