Fear of injections

There are many different pathological fears, and among them, the fear of injections is particularly common, which in medicine is called trypanophobia. This phobia can be justified or spontaneous, and often becomes a major obstacle to necessary medical procedures and, in particular, vaccinations. Fear of injections can be a temporary phenomenon, but sometimes it becomes a permanent course, with increasing intensity and further transformation into panic attacks. [1]

Causes of the fear of injections

In examinations of patients who have a fear of injections, experts have identified such causes of this condition:

• omissions in educational work, threats and intimidation of the baby ("if you do not obey, we will give you a shot", etc.). Overly sensitive and impressionable children may be frightened of injections after visiting doctor's offices, simply after hearing the screaming and crying of other children.
• Facing cases of unprofessionalism and tactlessness of medical professionals.
• Fear of the sight of blood, other genetically programmed phobias that can trigger the appearance and fear of injections.
• Prolonged periods of treatment in childhood, prolonged intensive care in early life.
• Incidence of post-injection complications (in the patient or his/her community).

The formation of fear of injections takes place in childhood, which is facilitated both by one's own anxiety and the behavior of adults, as well as siblings and peers. Most children receive their first injection at an early age - in particular, as part of vaccination. In this case, some children practically do not react to the procedure, or quickly forget about the discomfort, while others experience severe stress, which later serves as the basis for the formation of fear.

The emergence of the problem is more often noted in overexcitable children, impressionable and mistrustful, having a low threshold of pain sensitivity. In some cases, fear of injections is provoked not by their own experiences, but by the stories of strangers, read fairy tales, seen illustrations or cartoons, and so on. Even a long heard scary story, seemingly already forgotten, is hidden in the subconscious and manifests itself by forming a relationship between the experience and injections, syringes, etc.

The very moment of the first injection is also important. If the mother is worried, nervous, and the child sees and feels all this, the degree of anxiety increases in him. There are many parents who literally threaten their children - for example, "you don't want to take a pill, the doctor will come and give you a shot", "if you don't eat well, you will get sick, and you will be injected", etc. Often after the first or second statement the child begins to develop a fear of such manipulations, or of doctors in general.

Sometimes the provoking role is also played by personal unfortunate experience - unsuccessfully performed procedure, incompetence of medical personnel, the development of post-injection complications, the use of inappropriate syringes and so on.

As statistics shows, the most common fear of injections is formed in children whose parents and relatives also have a similar phobia and unconsciously "set" the child on it.

Risk factors

Specialists have identified such categories of causes that can lead to fear of injections:

1. Social factor. This category includes unprofessionalism and inexperience of health workers, nurses' disregard for sanitary rules and medical ethics. A special role is played by their own negative experience - for example, unsuccessful manipulation, the emergence of adverse effects.
2. Psychological factor. Fear of injections originates from childhood: the leading role is played by intimidation (even joking, according to adults). Problematic moral principle is strengthened subconsciously, further growing into a full-dimensional anxiety-phobic disorder. The start for the emergence of phobia is often an episode from a cartoon or fairy tale, where the character is "threatened" with injections for disreputable deeds, or a visit to the clinic, where you can hear screaming and crying of other children.
3. Hereditary factor. Specialists admit that the fear of injections can be subconscious and passed on genetically.

In most cases, the child does not inherit the phobia, but acquires it - for example, when he sees or hears his peers or relatives panic-stricken of doctors and injections. As a result, the child himself begins to feel fear of injections. Intimidation and reproaches contribute to the formation of a negative reaction.

Pathogenesis

There are many pathogenetic mechanisms for the emergence of a specific fear of injections. In most situations, it is about some stressful incident in childhood, which further influenced the person's perception of a particular procedure or medicine in general. However, one clearly defined factor that provokes phobia, there is no: the root of the problem can hide in family patterns, principles of education. Sometimes fear develops actively not in early childhood, but already in adolescence, after which it is actively consolidated and persists into old age.

It is not always that the patient is simply afraid of injections. It is noteworthy that trypanophobia also varies:

• people are not afraid of the injections themselves, but of situations: for example, that the needle will be blunt, that they will have to inject again, etc.;
• only intravenous injections are frightening - in particular, the possibility of air getting into the vein;
• the patient is frightened by the consequences in the form of bruising, seals, abscesses, and especially those that will require surgical intervention;
• the person is afraid that the needle will break during the injection, bone damage, etc..;
• the patient is not afraid of injections in general, but only of vaccinations (and their consequences);
• is afraid of contracting dangerous infectious diseases through the injection.

The overwhelming majority of cases of fear of injections are still related to the natural desire to prevent the appearance of pain, which, on the one hand, is quite natural, and at the same time devoid of any basis.

The phobia can run in several variations: vasovagal, associative, and resistive.

• The vasovagal variant is presumably genetically determined: fear to the point of fainting occurs already at the sight of a syringe and even at the thought of a possible injection. Vasovagal phobia is characterized by the following symptoms:
  • palpitations, ringing in the ears;
  • skin pallor, muscle weakness;
  • excessive sweating, dizziness, nausea;
  • changes in blood pressure.

The vasovagal form also includes aversion to injections, which is associated not only directly with the injection, but also with the fear of fainting and falling, becoming a laughingstock for other patients, etc.

• The associative variant occurs mainly as a consequence of negative experiences in childhood - in particular, it can be caused by an erroneous cause-and-effect relationship. For example, the child saw an ambulance crew come to his grandfather and give him an injection, and after a while he died. As a result, the child may draw the wrong conclusion that the grandfather died after he was injected. The main manifestations of associative phobia are considered to be:
  • hysteria, panic attack;
  • prolonged anxiety;
  • loss of sleep, pain in the head.
• The resistive variant is caused by fear not of the injection as a whole, but of being deprived of choice, of being forced to do something they do not want to do. Such a problem is often the result of the fact that in childhood the child was roughly held, tied to perform manipulation. Physically, the phobia is manifested by symptoms such as:
  • increased heart rate;
  • increased blood pressure;
  • tremors;
  • overexcitability to the point of aggression.

Panic attacks often occur not only immediately before the procedure, but also at the sight of medical personnel or a poster with a syringe, when approaching a medical facility.

Symptoms of the fear of injections

Pathological fear of injections is not difficult to recognize. The patient not only avoids such manipulations in every possible way, but also prefers not to even talk about the subject, since the banal mention adds to his suffering. Some patients are afraid only of intravenous injections or drips, others experience stress from intramuscular puncture or from taking a blood test with a scarifier. Phobic manifestations are different, but all people with trypanophobia by all means try to avoid injections, insist on replacing them with tablets or other drugs. If you can not get away from manipulation, then there are corresponding signs:

• increased heart rate;
• difficulty breathing, confused respiratory cycle;
• tremors;
• increased sweating;
• dizziness to the point of fainting;
• nausea, abdominal discomfort;
• the desire to hide, to hide;
• sometimes a loss of self-control.

A person with this type of phobic disorder may be outwardly completely normal, lead a normal life and be no different from other people. The problem does not affect mental activity, family life and career growth. The violation is detected only when approaching direct or indirect contact with a frightening object. At such a moment, a person ceases to control himself, loses the ability to think logically and rationally.

Fear of injections in children

Most children are afraid or anxious about one thing or another, and there is nothing pathological about it, as long as it concerns potentially dangerous or incomprehensible situations. However, in some children, fear is hypertrophied and transformed into a phobia - in particular, trypanophobia. Fear of injections in childhood is especially intense, rich in emotional manifestations. A child who is pathologically afraid of medical manipulations, at the moment of encountering them experiences a state of terror, he becomes hysterical, demonstrates aggression, loses control over himself.

Particularly prone to such disorders overly impressionable, vulnerable, mistrustful, suspicious children who fix excessive attention on their own feelings and experiences, spend a lot of time thinking about what worries them.

Childhood fear of injections can develop into a neurotic state and panic disorder closer to adulthood. Phobia is transformed into tics, muscle twitches, rapid blinking. Often there is a violation of sleep and the quality of night rest: the baby is long tossing and turning, unable to sleep, and often wakes up at night. Because of nightmarish dreams and frequent awakenings, the child does not get enough sleep, and in the morning and during the day feels tired and sleepy.

Children with trypanophobia often present with somatic manifestations such as abdominal pain, recurrent episodes of liquid stools, and brief unexplained fever. In such cases, it is important to consult a pediatrician or family physician to diagnose and rule out somatic diseases.

If the fear in the child has pathological signs, interferes with treatment or vaccination, can grow into more serious mental disorders, it is necessary to consult with a psychiatrist or psychotherapist, less often - with a neuropsychologist (by indication).

Complications and consequences

Phobias and anxiety disorders can complicate if the necessary therapeutic intervention is not available. Complications can manifest themselves as physiological or psycho-emotional disorders.

At the moment of stress, concerning the fear of injections, the human heart begins to work faster, which adversely affects both the general condition of the body and the functionality of the nervous system. With a pronounced panic attack, the risk of developing a myocardial infarction, heart attack increases significantly. There is an acceleration of the adrenal glands, increased production of stress hormones, which worsens the condition of muscle fibers and bones, depresses the activity of the immune system.

Complications can involve the gastrointestinal tract, as stress disrupts digestive function and enzyme production.

Prolonged or frequent phobic episodes can negatively affect the quality of life of a person, worsen his adaptation in society. Negative consequences are often depressive states, social isolation, isolation. In neglected cases, prolonged depression and neuroses may develop.

The decision not to vaccinate a child who has a fear of shots also carries risks and puts both the baby and others at risk of contracting a potentially fatal disease. For example, children who have not been immunized against measles run a 35 times greater risk of contracting the infection than vaccinated children. Such diseases are known to spread among people by infecting those who are unprotected - that is, those who are not immunized or who are immunized but not fully immunized (out of schedule).

The consequences can be very diverse, up to the transformation of trypanophobia into panic attacks and other psychopathologies. The main problem is the possible difficulties with social adaptation and lowering the quality of life of patients. In some cases, people do not consult doctors about serious enough diseases to avoid possible injections. This becomes the cause of development and aggravation of various pathologies, up to disability and death.

Diagnostics of the fear of injections

During the initial examination, the doctor collects the necessary anamnestic information, listens carefully to the patient (and/or the child's parents), performs a physical examination:

• inspects and evaluates external characteristics;
• measures height, weight;
• assesses the degree of physical development;
• Notes the presence/absence of physical injuries;
• determines somatic status.

A reliable diagnosis is made if the patient's condition is not explained by other disorders. If there are reasons to suspect other disorders, a number of additional studies are prescribed - first of all, to exclude somatic pathologies that may be accompanied by anxiety-phobic manifestations. The doctor most often prescribes:

• general clinical blood analysis (general examination, leukocytic formula, COE);
• General therapeutic biochemical blood test (gives the opportunity to assess the state of the kidneys, liver, metabolic processes, the general state of the body);
• general urinalysis (to exclude pathology of the kidneys and urinary system);
• Hormonal screening (thyroid hormones);
• electroencephalography (to assess the functional state of the brain);
• ultrasound Dopplerography, cerebral vascular study to rule out vascular disease;
• magnetic resonance imaging of the brain, to rule out organic brain pathologies;
• electrocardiography to detect cardiovascular disease.

During the consultation, the doctor asks the patient leading questions, determines the presence of other phobias, if possible - finds the cause that may have provoked the fear of injections. In practice, he or she uses various clinical diagnostic tests and scales to classify fears and determine their severity, which further affects the specifics of treatment.

Differential diagnosis

The diagnosis of trypanophobia is often complicated by the fact that patients have secondary anxiety signs that are perceived as the main, primary problem. Nevertheless, careful questioning reveals some features of the pathologic condition.

• Iatrophobia - differs from the fear of injections in that the phobic object here is not an injection or syringe, but doctors or medical personnel, as well as any person wearing a doctor's dress (pharmacist in a pharmacy, dentist, etc.).
• Nosophobia is the fear of getting sick, and it doesn't matter if the treatment involves injection manipulation.
• Pharmacophobia is the fear of any medication, whether in the form of shots, pills or mixtures.
• Agoraphobia is the fear not only of injections, but of pain in general.
• Hemophobia is the fear of seeing blood, regardless of the reason for it.
• Trypophobia is the fear of getting a wound or puncture, whether by injection or any other kind of puncture.

The line between the above varieties of phobias is quite thin, so sometimes it is difficult to consider and separate it. Specialists say that phobic disorders tend to be combined, intertwined, which makes diagnosis much more difficult.

Another pathology that requires differentiation from trypanophobia is extreme timidity. Although this condition is more general in nature and does not have a clear focus on specific procedures and manipulations.

In fact, phobic disorders are not as common as they seem at first glance. The vast majority of such cases are normal, adequate fear of injections, or mild anxiety or aversion to similar procedures. Phobia, on the other hand, is spoken of when it is an extremely pronounced, irrational condition that defies logic. In people with pathological phobia, even the mention of injections causes a panic reaction: a person trembles, sweating increases, heart rate increases. Pathological fear cannot be controlled, whereas normal fear can be suppressed or corrected.

Treatment of the fear of injections

Fear of injections, if it is a phobic disorder, is treatable with the involvement of psychiatrists and psychologists. However, only an experienced specialist will be able to recognize the problem and competently prescribe medication and supportive treatment. Most often, psychotherapy and drug therapy are used to eliminate phobia.

Psychotherapy is appropriate in terms of applying cognitive-behavioral correction. During the consultation, the doctor brings the patient into contact with the phobic object, simultaneously changing the perception of sensations and redirecting the person's thought process. As a result, the patient's reaction to the phobic object changes. Other techniques can also be used, such as confrontation and desensitization - gradually presenting the phobic object to the patient and changing the patient's attitude towards it.

Drug therapy is indicated only for more complicated cases. The following medicines are prescribed:

• antidepressants;
• anti-anxiety medications;
• β-blockers that limit the negative effects of stress on the body.

In some cases, relaxation sessions, meditation, yoga classes have a positive effect.

It is not possible to overcome the fear of injections on your own if you have a true phobic disorder. Treatment should be carried out by a specialist - a qualified psychiatrist or psychotherapist. The greatest success is noted when using cognitive-behavioral correction, which allows you to discover the real causes of the problem. An experienced doctor will not put pressure on the patient, persuade him to overcome fear. His goal is to change the key beliefs of a person that activate the chain of panic attacks. It is possible to conduct individual or group sessions, with the practice of hypnosis, suggestion, neurolinguistic programming. The methods of deep muscle relaxation, autotraining demonstrate a positive effect.

It is important to realize that the problem of fear of injections cannot be ignored. Parents of children who categorically avoid injections and immunizations should contact specialists as early as possible: a phobia that has just started is much easier to correct.

Prevention

The vast majority of cases related to fear of injections develop in early childhood. Parents should be particularly patient and attentive to vulnerable, sensitive children. It is important to exclude any moments that can frighten the baby: avoid inappropriate behavior, excessive emotional reaction to the child.

Adults and even elderly people are not immune to fear of injections. In such situations, you should not "hide" your fears and worries, they should be shared with friends and family. It is necessary to systematically control your psycho-emotional state, to maintain favorable conditions for life and health, to eat a full and rational diet, to observe the regime of work and rest with mandatory and sufficient night sleep.

It is obligatory to adhere to psychohygiene - that is, exclude watching violent scenes, horror movies, avoid themes of violence and rudeness. It is optimal to take more walks, socialize, travel, get positive emotions.

There are many ways to get rid of the fear of injections. However, it is much more effective to prevent the problem in advance.

Forecast

Fear of injections is diagnosed against the background of various pathologies and conditions - from neurotic disorder to schizophrenia. Therefore, in each individual case, the prognosis is evaluated individually - depending on the existing disorder. In general, the problem may disappear over time, or, conversely, worsen.

The probability of the development of adverse consequences is associated with the intensity of pathological symptomatology, with the presence of concomitant pathology. More favorable prognosis has fears that developed on a personal and emotional basis, but not on the background of psychopathological disorders.

A person (and even more so a child) should not be shamed for fear of injections. In certain situations where contact with a phobic object is anticipated, it is important to support the patient and reassure them of their abilities and courage.