Iatrophobia

What is iatrophobia?

Iatrophobia is an excessive fear of doctors and medical care, that can cause intense feelings of anxiety and panic attacks when anticipating or attending a doctor’s appointment ^[1].

Although not specifically mentioned in the Diagnostic and Statistical Manual of Mental Disorders, 5^th Edition (DSM-5), iatrophobia is considered a specific phobia, which is in part defined by an irrational and disproportionate level of fear or anxiety when faced with a certain stimulus ^[2].

Current research on iatrophobia is limited, partially due to the fact that many people do not report or seek help for phobias, particularly iatrophobia ^[3].

Several studies have explored the variety of reasons for the avoidance of medical help, which indicate that around a third of Americans have avoided going to the doctor for troubling symptoms ^[4]. However, the majority of this research discusses specific conditions, such as cancer, and involves several reasons other than iatrophobia, including low trust and financial concerns ^[5][6].

As such, further research is required to clarify the causes of and circumstances surrounding the development of iatrophobia ^[1].

Symptoms of iatrophobia

Symptoms of iatrophobia may vary from person to person, but can include ^[1][2]:

• Extreme anxiety and fear when planning, anticipating, or attending a doctor’s appointment.
• Symptoms of anxiety or a panic attack, such as sweating, shaking, racing heartbeat, difficulty breathing, dry mouth, and difficulty concentrating.
• Repeated avoidance of seeking medical advice for physical symptoms.
• Minimizing the severity of symptoms to others, insisting there is nothing wrong or that the symptoms are minor and they will clear up on their own.
• Declining to take prescribed medications or attending planned treatments.
• Looking online for diagnoses and answers rather than going to a doctor.
• “White coat hypertension” when being examined by a doctor, meaning that blood pressure is elevated when tested by a doctor compared to when being checked in a non-medical setting such as at home.

Causes of iatrophobia

The exact cause of iatrophobia is not known, but there are many theories relating to the risk factors of developing this fear or other specific phobias.

Genetics

Research shows that there is a strong familial link associated with the development of specific phobias. People with a specific phobia have been found to be significantly more likely to have a relative with an anxiety disorder, phobia, or both, suggesting that a heritability is likely ^[7].

Brain functioning

Research of the neurobiology of fear and specific phobias has found that some people may have a difference in the activation and function of the fear response in the amygdala, indicating that they could have an increased sensitivity to fear that may lead to the development of a phobia ^[8].

Previous conditions and health anxiety

Someone who has previously experienced a condition, either in childhood or adulthood, that required repeated treatments, involved a lot of pain, or disrupted certain areas of their life may develop a fear of becoming seriously unwell again and having to go through these negative experiences again ^[4].

Past experiences with doctors

Studies have found that many people who avoid going to the doctor do so because they have had negative experiences of doctors in the past, such as encountering bias related to their age, gender, weight, or ethnicity, or feeling dismissed when sharing their symptoms ^[1][4]. This can cause a lack of trust and lead to the development of severe fear and avoidance of doctors.

Discomfort with medical examinations

Someone may develop iatrophobia if they experience a fear of medical examinations, whether a physical examination or an in-depth discussion about their medical history. For example, someone may feel very uncomfortable about allowing a doctor to examine their breasts, rectum, or genitals, causing them to avoid seeking help for symptoms related to these areas ^[6].

Similarly, they might be afraid because of an experience of past physical or sexual abuse that contributes to a fear of being touched by others or be afraid of showing scars or marks on their body that might require them to divulge information to their doctor about a traumatic event ^[4]. Thus, iatrophobia may occur alongside a diagnosis of PTSD, or as the only disorder related to this event.

Diagnosing iatrophobia

Many people live with their fear and avoid the stimulus that causes it, thus contributing to many specific phobias going undiagnosed ^[3]. This is especially true of iatrophobia, as many people with this phobia will continue to avoid their doctor due to their fear and thus never receive a diagnosis.

If you think you have iatrophobia it is important to seek a diagnosis to receive appropriate treatment and prevent worsening physical and mental health. If you don’t feel able to go to your regular doctor, this consultation could take place over the phone or with a mental health professional, which may reduce your feelings of anxiety.

To diagnose iatrophobia, you will be asked questions about your symptoms relating to diagnostic criteria for a specific phobia from the DSM-5, which includes ^[2]:

• Anticipating or being faced with the stimulus (the doctor) causes intense feelings of anxiety, which may lead to prolonged or repeated avoidance.
• The associated symptoms cause distress and impair social and/or professional functioning.
• The level of fear and anxiety is disproportionate to the potential danger or outcome.
• These symptoms have persisted for at least 6 months.
• These symptoms cannot be explained by another condition, such as obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD), or social anxiety.

Treatment for iatrophobia

Due to the nature of iatrophobia, the first step to treating the condition is the development of a trusting therapeutic relationship, in which the individual feels heard and supported. Without this, symptoms may not be effectively managed and may worsen ^[1].

The effectiveness of treatment for certain kinds of specific phobias has not yet been well researched, so different phobias can potentially require different treatment. Treatment for phobias typically involves systematic exposure and desensitization, to gradually decrease the fear associated with the stimulus ^[9][10].

Therapy

• Behavioral therapy: Therapy such as cognitive behavioral therapy (CBT) can help to change emotional responses and behaviors that have been conditioned as a response to fear, by providing skills to tolerate distress, reducing extreme fear responses, and teaching helpful coping strategies ^[3][11].
• Exposure and Response Prevention: ERP is a type of CBT, initially designed to treat OCD but also effective in trauma and anxiety disorders, in which the individual is exposed to the stimulus that creates anxiety and taught to recondition their response, thereby preventing negative emotions and behaviors ^[9].
• EMDR: Eye movement desensitization and reprocessing (EMDR) is a specialized therapy, used to treat trauma. EMDR uses gradual exposure to anxiety-provoking stimulus to desensitize the individual, increase distress tolerance, and reduce emotional responses ^[12].
• Virtual reality therapy: Virtual reality therapy is a new treatment that allows for exposure to a distressing stimulus through virtual reality, as a way to gradually desensitize the individual in a safe environment, eventually leading to real exposure to the trigger once they have an increased tolerance ^[3][13].
• Other therapies: Interpersonal therapy, family therapy, and other forms of therapeutic intervention may also be useful, in which the individual can receive support and validation, with the aim to reduce negative emotions associated with their phobia ^[11].

Medications

Although there are no approved medications for the treatment of a specific phobia, a medication may be prescribed to help manage the symptoms, including ^[3][11][14]:

• Antidepressants: Selective serotonin reuptake inhibitors (SSRIs) such as citalopram and sertraline, serotonin and norepinephrine reuptake inhibitors (SNRIs) such as venlafaxine, and tricyclic antidepressants (TCA) such as clomipramine, are sometimes prescribed to treat a specific phobia to help alleviate feelings of anxiety.
• Antihistamines: Antihistamines, such as hydroxyzine, can be prescribed to treat symptoms of anxiety disorders.
• Anxiolytics: Benzodiazepines such as diazepam are often used as a short-term treatment of anxiety disorders and phobias but due to their potential for abuse and dependence, are not recommended for use as a long-term treatment.
• Beta-blockers: Beta-blockers, such as propranolol, can be used to treat the physical symptoms of acute anxiety, such as rapid heartbeat, and can be helpful in managing the symptoms of a specific phobia.

It is important to always take your medication exactly as prescribed, as taking too much, intentionally skipping doses, or abruptly stopping a medication can cause serious adverse effects and can worsen your mental and physical health.

Self-care for iatrophobia

If you have iatrophobia, you may be able to reduce some of your symptoms by ^[1][11][15]:

• Taking someone to appointments: Asking a friend or family member to attend a doctor’s appointment with you may help to reduce feelings of anxiety and improve communication.
• Writing down symptoms: If you experience anxiety during a doctor’s appointment you may struggle to clearly communicate your symptoms, increasing the chances of misdiagnosis, so you may find it useful to write down what you want to say before the appointment, and either read from this or give it to the doctor.
• Phone consultation: Initially speaking with a doctor over the phone about your symptoms may help to reduce anxiety about the appointment, thus improving communication and allowing for a therapeutic relationship to begin prior to meeting in person for a thorough medical examination.
• Talking to others: Speaking with friends and family or with a professional may lessen the impact of your anxieties and potentially reduce irrational ideas and fears.
• Relaxation exercises: Calming activities, such as breathing exercises, meditation, or yoga, are often effective in reducing feelings of anxiety and can also be useful in managing acute symptoms of a panic attack or severe emotional responses that occur in triggering situations.
• Support groups: Some people find attending a support group in person or online can improve understanding and acceptance of a specific phobia and reduce feelings of distress by sharing experiences with others.
• General wellbeing: Eating healthily, ensuring you get enough sleep, engaging in regular exercise, and taking care of your general wellbeing can make managing symptoms of anxiety easier, by improving and maintaining physical and mental health.

Frequently asked questions about iatrophobia

How common is iatrophobia?

The prevalence of iatrophobia is not known, due to a lack of research and reporting of the condition. However, research suggests that between 1-10% of the population has a debilitating phobia. Studies also show that females are much more likely to be diagnosed with a specific phobia than males ^[16].

Research suggests that around a third of the population avoid seeking medical advice for their symptoms, although this is due to a variety of reasons and not just because of iatrophobia ^[4][6].

What is the outlook for people with iatrophobia?

With appropriate diagnosis and treatment, iatrophobia can be effectively managed. However, left untreated, these symptoms may worsen, and avoidance of doctors will likely continue, which could result in symptoms of a serious condition going unnoticed, undiagnosed, and untreated, with potentially severe or fatal consequences ^[1][4].

Is iatrophobia linked to any other phobias?

People with a specific phobia commonly experience other phobias. Iatrophobia may be linked to the presence of other phobias such as ^[1][17]:

• Carcinophobia: fear of having cancer
• Cardiophobia: fear of having heart disease
• Hemophobia: fear of blood
• Hypochondria: fear of becoming unwell, also referred to as illness anxiety disorder
• Mysophobia: fear of germs
• Nosocomephobia: fear of hospitals
• Trypanophobia: fear of needles