Belonephobia

Belonephobia or fear of needles is the extreme fear of medical procedures that involve injections or hypodermic needles. This can lead to avoidance of medical care, including the vaccine controversy.

It is occasionally called aichmophobia, although this term can also refer to a more general fear of sharp objects.

Etymology

The word "belonephobia" comes from the Greek βελόνη belóne 'needle' and the scientific Latin suffix -phobia, and this from the ancient Greek -φοβία -phobía 'phobia, fear'. The person who suffers from it is "belonephobic, -ca", or "belonephobic, -ba". The variant "belonophobia" is incorrect due to its little use and because it is not recognized by specialized documents in Spanish, probably due to the influence of cognates such as the German Belonophobie, although it was mentioned by the Fundación del Español Urgent.

Summary and incidence

The condition was officially recognized in 1994 in the DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, 4th edition) as a specific phobia of the blood-injection-injury type (BII phobia). Phobic-level responses to injections cause patients to avoid inoculations, blood tests, and, in the most severe cases, all medical care.

It is estimated that at least 10% of American adults have a fear of needles, and the true number is likely higher, since the most severe cases are never documented due to the patient's tendency to avoid all treatment doctor. The diagnostic criteria for BII phobias are more strict, with an estimated prevalence of 3-4% in the general population, and this also includes blood-related phobias.

The prevalence of fear of needles has been increasing, with two studies showing an increase among children from 25% in 1995 to 65% in 2012 (for those born after 1999). The University Professor of Augusta, Amy Baxter, attributes this increase to an increase in the administration of booster shots around age 5, which is old enough to remember and young enough to be more likely to trigger the formation of a phobia.

Evolutionary basis

According to Dr. James G. Hamilton, author of the pioneering article on needle phobia, it is likely that the genetic form of needle phobia has some basis in evolution, given that thousands of years ago humans Those who meticulously avoided stab wounds and other incidences of pierced flesh would have a greater chance of survival.

The discussion of the evolutionary basis of needle phobia in Hamilton's review article refers to the vasovagal type of needle phobia, which is a subtype of blood-injection-injury type phobia. This type of needle phobia is uniquely characterized by a two-phase vasovagal response. First, there is a brief acceleration of heart rate and blood pressure. This is followed by a rapid drop in both heart rate and blood pressure, sometimes leading to unconsciousness.

Other medical journal articles have discussed additional aspects of this possible link between vasovagal syncope and developmental fitness in blood injection injury phobias.

A theory from evolutionary psychology that explains the association with vasovagal syncope is that some forms of fainting are nonverbal signals that developed in response to increased intergroup aggression during the Paleolithic. A non-combatant who has fainted indicates that he is not a threat. This could explain the association between fainting and stimuli such as bleeding and injuries.

Types

Although needle phobia is defined simply as an extreme fear of injections or medically related injections, it appears in several varieties.

Vasovagal

Although most specific phobias come from individuals themselves, the most common type of needle phobia, affecting 50% of those affected, is a hereditary vasovagal reflex reaction. Approximately 80% of people with a fear of needles report that a relative within the first degree has the same disorder.

People who suffer from vasovagal needle phobia fear seeing, thinking, or feeling needles or needle-like objects. Physiological changes associated with this type of phobia also include feeling faint, sweating, dizziness, nausea, paleness, tinnitus, panic attacks, and initially high blood pressure and heart rate, followed by a drop in both at the time of onset. injection. The main symptom of vasovagal fear is vasovagal syncope or fainting due to a decrease in blood pressure.

Many people who experience fainting during needle procedures report not having a conscious fear of the needle procedure itself, but rather a great fear of the vasovagal syncope reaction. People become more fearful of the side effects of low blood pressure caused by the thought of a needle.

A study in the medical journal Circulation concluded that in many patients with this condition (as well as patients with a broader range of blood/injury phobias), an initial episode of vasovagal syncope during a needle procedure may be the primary cause of needle phobia rather than any basic fear of needles. These findings reverse most commonly held beliefs about the cause-and-effect pattern of needle phobics with vasovagal syncope..

Although most phobias are dangerous to some extent, needle phobia is one of the few that actually kills. In cases of severe phobia, the drop in blood pressure caused by the vasovagal shock reflex can cause death. In Hamilton's 1995 review article on needle phobia, he was able to document 23 deaths as a direct result of vasovagal shock during a needle procedure.

Historically, the best treatment strategy for this type of needle phobia has been desensitization or progressive exposure of the patient to gradually more frightening stimuli, allowing them to become desensitized to the stimulus that triggers the phobic response. In recent years, a technique known as "applied tension" It has become increasingly accepted as an often effective means of maintaining blood pressure and avoiding the unpleasant and sometimes dangerous aspects of the vasovagal reaction.

Associative

Associative fear of needles is the second most common type and affects 30% of people with needle phobia. This type is the classic specific phobia in which a traumatic event, such as an extremely painful medical procedure or witnessing a family member or friend undergo it, causes the patient to associate all procedures involving needles with the original negative experience.

This form of needle fear causes symptoms that are primarily psychological in nature, such as unexplained extreme anxiety, insomnia, worry about the upcoming procedure, and panic attacks. Effective treatments include cognitive therapy, hypnosis, and/or the administration of anti-anxiety medications.

Resistive

Resistive fear of needles occurs when the underlying fear involves not only needles or injections, but also control or restriction. It usually comes from a repressive upbringing.^{[citation needed]} or poor handling of previous needle procedures (e.g., forced physical or emotional restraint).

This form of needle phobia affects around 20% of affected people. Symptoms include combativeness, high heart rate along with extremely high blood pressure, violent resistance, avoidance and flight. The suggested treatment is psychotherapy, which may include teaching the patient self-injection techniques or finding a trusted healthcare provider.

Hyperalgesic

The hyperalgesic fear of needles is another form that does not have much to do with the fear of needles themselves. Patients with this form have an inherited hypersensitivity to pain or hyperalgesia. For them, the pain of an injection is unbearably great and many cannot understand how anyone can tolerate such procedures.

This form of fear of needles affects approximately 10% of people with needle phobia. Symptoms include extreme explained anxiety, and elevated blood pressure and heart rate at the immediate point of needle penetration or seconds before. Recommended forms of treatment include some form of anesthesia, whether topical or general.

Vicarious factors

While witnessing procedures that involve needles, it is possible for the phobic to suffer the symptoms of a needle phobia attack without having been injected. Prompted by the sight of the injection, the phobic may exhibit the normal symptoms of vasovagal syncope and fainting or collapsing is common. While the cause of this is unknown, it may be because the phobic imagines the procedure being performed on themselves. Recent research in neuroscience shows that feeling the sensation of a pin prick and watching a pin prick another person's hand activate the same part of the brain.

Co-morbidity and triggers

Fear of needles, especially in its more severe forms, is often comorbid with other phobias and psychological ailments; For example, iatrophobia, or an irrational fear of doctors, is often seen in patients with needle phobia.

A patient with a needle phobia does not need to physically be in a doctor's office to experience panic attacks or anxiety caused by needle phobia. There are many triggers in the outside world that can cause an attack by association. Some of these are blood, injuries, the sight of the needle physically or on a screen, paper pins, syringes, exam rooms, white lab coats, dentists, nurses, the smell of antiseptic associated with offices and hospitals, the sight from a person who physically resembles the patient's usual healthcare provider, or even reading about fear.

Treatment, mitigation and alternatives

The medical literature suggests a number of treatments that have been shown to be effective for specific cases of needle phobia, but provides very little guidance in predicting which treatment may be effective for any specific case. The following are some of the treatments that have been shown to be effective in some specific cases.

• Chloroethane spray (and other freezing agents). It is administered easily, but only provides a superficial control of pain.
• jet injectors. The jet injectors work by introducing substances into the body through a high-pressure gas jet instead of a needle. Although these remove the needle, some people report causing more pain. In addition, they are only useful in a very limited number of situations involving needles; for example, insulin and inoculation.
• Iontoforesis. iontoforesis leads anesthetic through the skin by using an electric current. It provides effective anesthesia, but is generally not available to consumers in the commercial market and some consider its use to be inconvenient.
• EMLA. EMLA is a topic anesthetic cream that is an euthectic blend of lidocaine and prilocaine. It is a prescription cream in the United States and is available without prescription in some other countries. Although not as effective as iontoforesis, since EMLA does not penetrate as deeply as iontoforesis-driven anesthetics, EMLA provides a simpler application than iontoforesis. EMLA penetrates much more deeply than common topical anesthetics and works properly for many people.
• Amétop. Ametop gel seems to be more effective than EMLA to eliminate pain during venopunction.
• Lydocaine/tetracaine patch. A self-heating patch containing an euthectic blend of lidocaine and tetracaine is available in several countries and has been specifically approved by government agencies for use in needle procedures. The patch is sold with the commercial name Synera in the United States and Rapydan in the European Union. Each patch is packed into a hermetic bag. It starts to warm slightly when the patch of the packaging is removed and exposed to the air. The patch requires 20 to 30 minutes to achieve a complete anesthetic effect. The Synera patch was approved by the United States Food and Drug Administration on 23 June 2005.
• Behavioral therapy. The effectiveness of this varies greatly according to the person and the severity of the condition. There is some debate on the effectiveness of conduct treatments for specific phobias, although there are some data available to support the effectiveness of approaches such as exposure therapy. Any therapy that approves relaxation methods may be contraindicated for the treatment of needle fear, as this approach encourages a drop in blood pressure that only improves vasovagal reflex. In response, graduate exposure approaches may include a coping component that is based on the pressure applied as a way to prevent complications associated with the vasovagal response to specific blood, injury or injection stimuli.
• Nitrous oxide (gas of laughter). This will provide sedation and reduce patient anxiety, along with some mild analgesic effects.
• General anesthesia by inhalation. This will eliminate all pain and also all memory of any needle procedure. However, it is often considered a very extreme solution. It is not covered by insurance in most cases, and most doctors will not order it. It can be risky and costly and may require hospitalization.
• Benzodiazepines, such as diazepam (Valium), lorazepam (Ativan), alprazolam (Xanax) or clonazepam (Klonopin), can help relieve the anxiety of patients with phobia to needles, according to Dr. James Hamilton. These medicines have a start of action within 5 to 15 minutes after ingestion. A relatively large oral dose may be required.
• Having stomach muscles can help prevent fainting.
• To say rudeness can reduce perceived pain.
• Distraction can reduce perceived pain, for example, pretend to cough, perform a visual task, watch a video, listen to music or play a video game.