Fear of water

In the vast majority of cases, hydro- or aquaphobia comes down to the fear of swimming in deep and open water. The fear does not concern water in a cup, saucepan or in your own bathtub. People can even enter the water on the beach, splash in it, swim along the shore if the depth allows you to touch the bottom with your feet, but if you do not feel it, real panic sets in. This most common fear of water has a specific name - bathophobia (fear of depth). Both adults and children can be subject to it. It has nothing to do with ordinary caution, although such fear can go away on its own, for example, when a person learns to swim well and gains self-confidence both on land and in water. But more often, without treatment, the fear of water at the height of the phobia worsens over time, and a person can no longer even be on the shore of a reservoir, think about deep water, watch photos and films with lakes and seas. Inappropriately strong experiences are accompanied by symptoms of physical illness, and fear becomes a real illness.

There are also more exotic types of hydrophobia, such as ablutophobia, when the fear causes the need to even rinse the mouth, wash the face, take a shower, wash, or perform any procedure involving water. Hydrophobia also includes a panic fear of sweating heavily in a public place and emitting an unpleasant odor.

Sometimes people swim calmly during the day, but are afraid to swim at night, or swim in clear water of a pool or sea, but cannot force themselves to swim in bodies of water if the bottom is not visible or if there are algae growing in the water. Some are scared to the point of panic by the endless expanses of the sea or ocean (thalassophobia), even frozen water in the form of ice and snow can cause aversion (chionophobia).

Fear of water is a specific phobia, or more precisely, a fear of the natural environment. It affects a person subject to it in very specific situations related to water, which have become ingrained in the subconscious as dangerous due to stress experienced in the past. [ 1 ]

Epidemiology

Aquaphobia in its various manifestations is quite common, although not as widespread as the fear of heights, crowds, dogs, blood, open/closed spaces. The exact statistics of fear of water are unknown, but in general, from 2 to 12% of the world's population admits to having various phobias in surveys. In countries with developed economies, more people suffer from isolated phobias (on average 6-8% of the population) than in developing Asian, African, and Latin American countries (2-4%). The likelihood of developing a phobic disorder throughout life is estimated at approximately 11%, although specific or isolated phobias most often develop in early childhood or puberty and can self-limit or accompany a person throughout life. In general, in older age groups of the population, the prevalence of phobias is lower. [ 2 ]

Causes fear of water

Fear of water occurs in different variants, most often it is a fear of deep big water, associated with the hypothetical danger of drowning. But there can also be a rarer phobia - fear of water procedures in general and even places associated with them, for example, a swimming pool, a bathroom, a shower cabin.

While the first type of fear can occur in people of different ages, the second is more typical for children.

The cause of the irrational, uncontrollable fear of water is usually some, possibly repeated, psychotraumatic situation, often from childhood, and, of course, the personality traits of a person - impressionability, suspiciousness, the ability to "get stuck" on certain events. An unconditional genetic predisposition has been identified: sometimes members of one family suffer from some phobia in several generations, identical twins both suffer from phobias twice as often as heterozygous ones. In addition, you can teach a child to be afraid of water: if one of the parents shows obvious fear of open water, encourages excessive caution in the child, scares him with the possibility of drowning, then the result will not be long in coming. [ 3 ]

Risk factors

The most common external risk factors for the development of fear of water in childhood are careless or violent actions of parents during bathing the child, when the child feels discomfort associated with the temperature of the water, detergent getting into the eyes or mouth, abrupt immersion in the bath, etc. Such stimuli can lead to a complete rejection of water procedures in general or any one that seems especially “scary”, for example, washing the head.

A child's fear of bathing can be caused by a power outage in the apartment during the procedure, an emergency situation involving flooding of the apartment, or other events that lead to the creation of incorrect ideas about water as an extremely dangerous substance. [ 4 ]

Later in life, such an inexplicable fear may be caused by watching a movie in which someone drowns in a river, dies at the hands of a killer in a bathtub or shower (a fairly common plot device). Disaster movies about cruise ship wrecks, tsunamis and floods, especially without taking into account age restrictions for viewing, can become an impetus for the development of thalassophobia.

Fear of open water can develop in a person who has drowned or seen someone else drown.

The background of aquaphobia can be scary stories about watermen, pools, monsters living in their depths. Often, the phobia can develop as a consequence of obsessive thoughts that appear as a result of thinking about a disturbing situation.

The development of phobias is facilitated by the weakening of the body after acute infectious diseases and intoxications, due to the presence of chronic debilitating pathologies, addictions, heavy physical or mental stress.

Pathogenesis

The pathogenesis of any phobia has not yet been fully elucidated. Phobias often develop in people with mental illnesses, then they are considered in the context of the underlying pathology as one of the painful manifestations.

Primary phobias (synonyms: simple, isolated, specific) are considered subtypes of anxiety disorder. The mechanism of their development is associated with two types of factors: predispositional and directly provoking the emergence of fear. The first include hereditarily determined personality traits, upbringing (lack of stress resistance, helplessness), certain physical disorders that contribute to the development of symptoms of vegetative disorders. The second, direct provocateurs, include any experience of negative interaction with water, which can develop into a fear of repeating a frightening situation and eventually develop into aquaphobia.

I.P. Pavlov classified phobias as disorders of higher nervous activity and considered them to be a manifestation of instability of the inhibition process. Modern neurophysiological studies show that the following brain structures are mainly involved in the pathogenesis of phobic disorders: the prefrontal cortex of the brain (located immediately behind the frontal parts of the skull, analyzes sound and visual stimuli, "turns on and off" the anxiety reaction), the amygdala (receives information from the cerebral cortex and launches a chain of chemical reactions that lead the body into a state of anxiety), the hippocampus (storage of information received from the senses), the dorsal raphe nucleus (a cluster of serotonergic neurons, immediately reacts to fear and reinforces this reaction), part of the reticular formation - the blue nucleus (receives signals from the amygdala and initiates the development of vegetative reactions: tachycardia, hypertension, sweating and dilation of the pupils). The hypothalamic-pituitary-adrenal axis is also involved in the pathogenesis. The mechanism of phobia development from a neurochemical point of view is associated with a disturbance in the metabolism of monoamine neurotransmitters, mainly norepinephrine and serotonin. Neurotransmission disturbances in other systems are also observed.

Cognitive psychology considers people with phobic disorders to be initially predisposed to distortion of the perception of signals coming from both internal organs and from the outside, when an imaginary danger appears. In our case, the supposed contact with water provokes the patient to have images and thoughts of a catastrophic nature, triggering uncontrollable fear. It is the expectation of inadequately terrible consequences, so to speak, a catastrophic interpretation of the situation, which, as experts believe, is the direct source of the appearance of phobia. Growing tension causes a series of vegetative dysfunctions. A person feels that control over the situation is slipping away from him, but it is believed that the patient is even more tense due to somatic manifestations, which he is also unable to control: increased heart rate, pressure surges, paresthesia, breathing problems, dizziness, chills, sweating - deterioration of health up to a fainting state.

Eventually, after several encounters with a frightening object, in this case water, a chain of pathological reactions is established in the subconscious: encounter with the object of fear ―> a supposedly dangerous situation ―> its catastrophic perception ―> anxiety, fear, phobia ―> disorders of the autonomic nervous system ―> avoidance behavior + attitude towards a potential encounter with a dangerous object, expectation of it.

The above diagram very simply describes the pathogenesis of phobia, cross-reactions occur between the links of the chain, while individual links support the source of psychological tension. For example, vegetative dysfunctions potentiate catastrophic thoughts: increased heartbeat is interpreted as a serious heart attack, dizziness - as a prelude to a stroke, a veil before the eyes - as a threat of collapse.

Naturally, the patient builds his behavior in such a way as to avoid meeting the frightening object if possible. In cases of bathophobia or thalassophobia, this is quite possible to achieve, with ablutophobia everything is somewhat more complicated.

In addition, in order to distract themselves from their fears, patients come up with various protective rituals, which can even be effective for some time, but the situation without treatment worsens in most cases, and it is much more difficult to get rid of an advanced phobia.

Symptoms fear of water

Fear is a basic protective emotion that promotes self-preservation, caused by a potentially dangerous object or situation. It is quite normal to experience fear in moments of danger, it helps to mobilize the body's resources and avoid dangerous situations. But ordinary caution, fear of undesirable consequences from contact with danger and phobia (pathological fear) are completely different concepts.

Firstly, with simple hydrophobia, panic fear occurs in strictly defined situations related to water, or with any contact only with water (total aquaphobia). Outside of them, a person is absolutely adequate. Secondly, he realizes that his reaction to water is not quite normal, but he is not able to control it.

The first signs of aquaphobia are noted independently. Older children, teenagers and adults begin to notice that a certain situation related to water causes them anxiety and a strong desire to avoid it. If they fail to avoid it, a sharp rejection, panic fear appears, accompanied by increased sweating, tremors of the limbs, accelerated heartbeat, shortness of breath, dizziness. Outwardly, a person who does not want to admit his fear can suddenly flare up, show aggression, take offense at something and thus avoid contact with the frightening object. Small children also resist: they cry, throw tantrums always before the same procedure or situation related to water. An older child often tries to agree to postpone the procedure "until tomorrow", which never happens.

Teenagers and adults can hide hydrophobia for a long time. Much depends on the situation in which water causes fear in them. For example, if it is caused by diving into deep water, a person simply does not like going to the beach, swimming pool or water park, does not go to the sea. Fear of depth in water is usually not very noticeable to strangers. A person, as a rule, can calmly relax on the shore of reservoirs, even swim in shallow water. His reaction to the lack of a bottom under his feet is often known only to him. It is generally easy to hide your horror of night swimming. If the phobia concerns easily avoidable situations related to water and does not interfere with a full life, then usually no treatment is required. But the fear of hygienic and medical water procedures interferes with life much more.

For example, a fear of hot water can develop in a child who was dipped into a bathtub filled with too warm water. Then each procedure and even the very sight of the bathtub can cause hysterical crying for a long time. More often, such phobias disappear with age, since adults control the water temperature themselves.

Fear of large amounts of water is a separate type - thalassophobia. By large we mean the endless expanses of seas and oceans, uncontrollable elements, tsunamis, the Mariana Trench and similar trenches, monsters living in the depths of the sea. This fear manifests itself in different ways: some cannot look at even marine paintings or films about sea adventures without shuddering, others simply do not go on vacation to the sea, and others will live their lives without realizing that they have such a phobia.

As a variant of anxiety disorder, aquaphobia manifests itself with the following symptoms:

• a state of anxiety arises every time the possibility of the same situation related to water or contact only with a water object is mentioned;
• the prospect of experiencing further contact with the object of fear causes aversion, it is avoided by any means possible;
• Psychologically, aquaphobia manifests itself as: a premonition of a catastrophe from encountering a water object or getting into a phobic situation; increasing anxiety and worry; absent-mindedness, temporary memory loss, a feeling of “emptiness” in the head; hypersensitivity to sounds and light; expectation of deterioration of physical condition.

Vegetative symptoms appear almost simultaneously with the increase in mental stress and can manifest themselves in a variety of ways from virtually all body systems. Such manifestations are provoked by hyperactivity of the sympathetic nervous system and increasing involuntary muscle tension. An attack of phobia may be accompanied by a pressing headache (the so-called "neurasthenic helmet"); tremor of the limbs; myalgia; dizziness and ringing in the ears; hyperhidrosis; a veil before the eyes; tachycardia or bradycardia; heart pain; a lump in the throat; dry mouth; pain in the epigastrium; urge to empty the bowels and bladder; difficult or rapid breathing.

From situation to situation, fear grows uncontrollably and is experienced more and more intensely each time. When expected to meet the object of fear, panic attacks may develop - increasing intense fear with pronounced vegetative manifestations. The cognitive effect of anxiety gradually increases, which consists in the fact that a person subject to a phobia inadequately assesses the accompanying physical symptoms. He assumes that he is developing a serious disease, for example, a brain tumor or expects a myocardial infarction, stroke.

The patient may develop sleep disorders: nightmares, with a corresponding theme, during which he wakes up in horror with a strong heartbeat, mostly without understanding what woke him up. However, with simple phobic disorders, the patient may later fall asleep again and sleep until morning.

Complications and consequences

Simple phobias, which include pathological fear of water, in many cases significantly worsen the quality of life of the person affected by them. Not everyone can cope with them on their own, and without treatment, aquaphobia can become chronic and complicated by more pronounced vegetative symptoms, depersonalization/derealization syndrome. Patients try to avoid the frightening situation with all their might, afraid of looking ridiculous in the eyes of others, because they realize the inadequacy of their fear. In addition, thoughts of developing madness, serious and fatal somatic diseases come to their minds.

Development of obsessive-compulsive disorder is possible. If at the initial stage fear arises only with direct contact with the object or situation that causes it, later - already with the mere thought of the object of fear, for some these thoughts become obsessive and regularly arise without reason.

It is believed that even the risk of suicide in people who suffer from any phobia is higher than in those who do not suffer from it.

Diagnostics fear of water

When diagnosing aquaphobia, the doctor relies on the results of a conversation with the patient himself, his parents (if the patient is a child), and the patient's personal and family history. To assess the general condition of the patient, examinations may be prescribed, since with a simple phobic disorder, the massiveness of the patient's complaints does not correspond to his state of health. Sometimes it is necessary to meet with the patient several times. The main diagnostic markers are the patient's statement that his uncontrollable fear is caused by contact with water or a situation related to it, he tries with all his might to avoid contact, as well as the primacy of psychological and somatic manifestations, and not delusional obsessive thoughts. [ 5 ]

Differential diagnosis

Differential diagnostics are carried out with other phobias, hypochondriacal or delusional disorder, obsessive-compulsive disorder, OCD, depression, schizophrenia, in the symptom complex of which phobias may be observed as concomitant conditions.

Treatment fear of water

Preference in the treatment of specific phobias is given to non-drug treatment methods: sessions with a psychologist, psychotherapist, hypnosis sessions.

The most effective in getting rid of phobias are considered to be psychotherapeutic practices that allow identifying the causes of anxiety-phobic disorder, teaching the patient to adequately respond to the object of fear, independently redirect negative thoughts, analyze the situation, relieve stress and control their behavior. Various techniques for working with the patient are used, but the method of choice is cognitive behavioral therapy. Its essence lies in the fact that during sessions, the psychotherapist helps the patient identify his false beliefs about the object of fear and, using logic and analysis, independently redirect thoughts in a positive direction. Therapy occurs in stages under the guidance of a doctor. The patient first "acts out" fictitious phobic situations and learns to identify parasitic thoughts on which the feeling of anxiety is based, independently redirect them and stop an attack of phobia. When the patient learns to resolve fictitious situations, he is "immersed" in reality. Over time, he develops a habit of being in a situation that previously disturbed him, skills are developed that allow him to cope with anxiety.

Other methods are also used: neuro-linguistic programming, rational psychotherapy, psychological assistance.

The psychologist's assistance is provided individually; there are no specific methods for treating aquaphobia. The specialist and the patient have conversations during which they exchange information and the psychologist determines the necessary tactics for providing assistance. It comes down to psychological education, when the specialist helps the patient master a certain amount of knowledge about the origin of obsessive fears and introduces methods for overcoming them, conducts practical classes to develop skills and techniques for eliminating phobias, and suggests tactics for behavior in a phobic situation. Consultations with a specialist help find answers to questions that interest a specific patient. The patient learns to control his fear, as applied to a frightening situation, analyze his behavior and develop adequate reactions.

An effective and fast-acting method of treatment is hypnosis, it is usually used in cases where work with a psychotherapist does not lead to an improvement in the condition. Both classical directive techniques of trance hypnosis and hypnosis according to the M. Erickson method are used, based not so much on suggestion as on modeling an alarming situation and "pushing" the patient to independently make the right decision.

Various relaxation techniques are used as additional treatment methods: art therapy, sand therapy, self-hypnosis, meditation. Treatment approaches are individual, depending on the patient's age and psychological resources. The doctor may recommend changing the diet or increasing (decreasing) physical activity.

Drug therapy is used as an additional method to alleviate the symptoms of phobic manifestations. The patient may be prescribed mild sedatives (often herbal or homeopathic); β-blockers to minimize most physical manifestations; psychotropic drugs: antidepressants and tranquilizers to reduce anxiety, antipsychotics for established rituals. Psychotropic drugs successfully relieve psychotic and vegetative manifestations, but require extreme caution from the doctor and compliance with the doses and timing of administration from the patient, since they have many side effects, can cause addiction, and failure to comply with the rules of administration can cause a paradoxical deterioration in the condition and even an expansion of the list of objects of fear.

Prevention

Nobody knows the exact reasons for the development of phobias at the moment. Hereditary tendencies cannot be corrected yet, but the influence of exogenous provoking factors can be minimized. Since the birth of a phobia is preceded by stress and some physical disorders, prevention should begin from birth. A healthy lifestyle (feasible physical activity, optimal diet, sleep-wake schedule) and a positive attitude in the family will contribute to the development of a stress-resistant personality. In addition, you just need to learn to swim. This skill will come in handy in life and will serve as a basis for confidence in the aquatic environment.

If the development of a phobia could not be avoided, it is necessary to understand that this is the same disease as, for example, the flu, and to contact a qualified psychotherapist. Prejudices prevent many from starting treatment on time, but at the very beginning of the disease it can be cured in one or two sessions.

Forecast

Children's fears of bathing, caused by careless handling, often go away on their own when a person begins to perform hygiene procedures independently.

If the fear does not go away, then any fear of water, revealed in childhood, is well amenable to psychotherapeutic influence of a suggestive nature. Teenagers and adults, on the contrary, are better amenable to rational psychotherapy. This is in general, and an individual approach is selected for a specific patient. Aquaphobia is curable and, like all other pathologies, is better amenable to therapy at an early stage.