Fear of water

In the vast majority of cases, hydro- or aquaphobia comes down to the fear of swimming in a deep and open body of water. The fear does not touch the water in the cup, saucepan, or your own bathtub. People can even enter the water on the beach, splash in it, swim along the shore, if the depth allows them to touch the bottom with their feet, but if you don't feel it, real panic sets in. This most common fear of water is specifically called batophobia (fear of depth). It can affect both adults and children. 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 is aggravated over time, and a person can no longer even be on the shore of a reservoir, think about deep water, watch photographs and films depicting lakes and seas. Symptoms of physical ailment are added to inadequately strong feelings, and fear becomes a real illness.

There are also more exotic types of hydrophobia, for example, ablutophobia, when fear causes the need to even rinse your mouth, wash your face, take a shower, wash, carry out any procedure involving water. Hydrophobia also includes the fear of sweating heavily in public and emitting an unpleasant odor. 

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

Fear of water refers to specific phobias, or rather, fears of the natural environment. It covers a person exposed to it in very specific situations related to water, fixed in the subconscious as dangerous because of the stress experienced in the past. [1]

Epidemiology

Aquaphobia in various forms is quite common, although not as widespread as fear of heights, crowds, dogs, blood, open / closed space. The exact statistics of the fear of water is not known, but in general, the presence of various phobias is recognized in surveys from 2 to 12% of the world's population. In advanced economies, more people suffer from isolated phobias (on average 6-8% of the population) than in developing Asian, African, Latin American countries (2-4%). The probability of a phobic disorder occurring throughout life is estimated at about 11%, although specific or isolated phobias most often develop in early childhood or adolescence and can be self-limited or accompany a person throughout his life. In general, in older age groups of the population, the prevalence of phobias is less. [2]

Causes fear of water

The fear of water is found in different ways, more often it is the fear of deep large water associated with a hypothetical danger of drowning. But there may be a more rare phobia - the fear of water procedures in general and even of places associated with them, for example, a swimming pool, bathroom, shower.

If the first variant of fears can occur in people of different ages, then the second is more typical for children.

The reason for the emergence of an irrational uncontrollable fear of water usually becomes some, possibly repeated, traumatic 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 tendency has been revealed: sometimes members of the same family in several generations suffer from any phobia, identical twins both suffer from phobias twice as often as heterozygous ones. In addition, you can teach the child to be afraid of water: if one of the parents shows a clear fear of an open reservoir, encourages excessive caution in the child, scares the child with the possibility of drowning, then the result will not be slow to affect. [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 when bathing a child, when he feels discomfort associated with the temperature of the water, contact with the detergent in the eyes or mouth, sudden immersion in the bath, etc. Such stimuli can lead to to a complete rejection of water procedures in general or any one that seems especially "scary", for example, washing your hair.

A child's fear of bathing can be caused by a blackout in the apartment during the procedure, an emergency due to flooding of the apartment, and other events that lead to the creation of misconceptions about water as an extremely dangerous substance. [4]

At a later age, such inexplicable fear can be caused by watching a movie in which someone is drowning in a river, dying at the hands of a murderer in a bath or shower (a fairly common plot move). Disaster films about cruise ship crashes, tsunamis and floods, especially without age restrictions for viewing, can trigger the development of thalassophobia.

Fear of open bodies of water can develop in a person who was drowning or saw someone else drown.

The underpinnings of aquaphobia can be scary stories about water, pools, monsters living in their depths. Often, a phobia can develop as a result 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 suffering acute infectious diseases and intoxication, due to the presence of chronic debilitating pathologies, addictions, severe physical or mental stress.

Pathogenesis

The pathogenesis of any phobia is not yet fully understood. Phobias often develop in people with mental illness, 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 appearance of fear. The former include hereditarily determined personality traits, upbringing (lack of stress resistance, helplessness), certain physical disorders that contribute to the development of symptoms of autonomic 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 attributed phobias to disorders of higher nervous activity and considered them a manifestation of the instability of the inhibition process. Modern neurophysiological studies show that the following brain structures are mainly involved in the pathogenesis of a phobic disorder: the prefrontal cortex (located immediately behind the frontal parts of the skull, analyzes sound and visual stimuli, "turns on and off" the alarm response), the amygdala (receives information from the cortex of the brain and starts a chain of chemical reactions that lead the body to a state of anxiety), the hippocampus (storage of information received from the senses), the dorsal nucleus of the suture (an accumulation of serotonergic neurons, immediately responds to fear and fixes such a reaction), part of the reticular formation is the blue nucleus (receives signals from the amygdala and initiates the development of autonomic reactions: tachycardia, hypertension, sweating and dilated pupils). The hypothalamic-pituitary-adrenal axis is also involved in the pathogenesis. The mechanism of development of phobia from a neurochemical point of view is associated with impaired metabolism of monoamine neurotransmitters, mainly norepinephrine and serotonin. Disorders of neurotransmission in other systems are also observed.

Cognitive psychology considers people with phobic disorders initially predisposed to distort the perception of signals from both internal organs and from the outside, when an imaginary danger appears. In our case, the alleged contact with water provokes in the patient the appearance of 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, according to experts, is the direct source of the appearance of a phobia. The increasing tension causes a series of autonomic dysfunctions. A person feels that control over the situation eludes him, but it is believed that the patient is strained even more by somatic manifestations, which he is also unable to control: increased heart rate, pressure surges, paresthesias, respiratory problems, dizziness, chills, sweating - deterioration of well-being up to to fainting.

Ultimately, after several encounters with a frightening object, in this case water, a chain of pathological reactions is fixed in the subconscious: a meeting with an object of fear -> a supposedly dangerous situation -> its catastrophic perception -> anxiety, fear, phobia -> disorders of the autonomic nervous system -> avoidant behavior + setting on a potential meeting with a dangerous object, waiting for it.

The scheme presented above describes the pathogenesis of phobia in a very simplified manner, cross reactions occur between the links of the chain, while individual links support the source of psychological stress. For example, autonomic dysfunctions potentiate catastrophic thoughts: an increased heart rate is interpreted as a serious heart attack, dizziness - as the eve of a stroke, a veil in front of the eyes - as the threat of collapse.

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

In addition, in order to distract from their fears, patients invent various protective rituals that may even be effective for a while, but the situation without treatment is aggravated 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. Feeling fear in moments of danger is quite normal, it helps to mobilize the body's resources and avoid dangerous situations. But ordinary caution, fear of unwanted consequences from contact with danger and phobia (pathological fear) are completely different concepts.

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

The first signs of aquaphobia are noted independently. Older children, adolescents and adults begin to notice that a certain water situation causes them anxiety and a strong desire to avoid it. If it is not possible to evade, there is a sharp rejection, panic fear, 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 flare up sharply, show aggression, take offense at something and thus avoid contact with a frightening object. Small children also resist: they cry, they will always be worn out before the same procedure or situation related to water. An older child often tries to negotiate a postponement of the procedure "until tomorrow", which never comes.

Adolescents and adults can hide hydrophobia for a long time. Much depends on the situation in which the water makes them fear. For example, if it is caused by immersion in deep water, the person simply does not like to go to the beach, pool or water park, does not go to the sea. The fear of depth in water is usually not very noticeable to outsiders. A person, as a rule, can calmly rest on the banks of water bodies, even swim in shallow water. His reaction to the lack of a bottom under his feet is often known only to him. To hide your fear of night swimming is generally easy. If the phobia concerns easily avoidable situations associated with water and does not interfere with a full life, then usually no treatment is required. The fear of hygienic and medical water procedures interferes in life much more.

For example, a child may develop a fear of hot water if they are dipped in a tub filled with too warm water. Then each procedure and even the very type of bath can cause hysterical crying for a long time. More often, such phobias disappear with age, as adults control the temperature of the water on their own.

The fear of large amounts of water has been singled out as a separate type - thalassophobia. Large is meant the endless expanses of seas and oceans, uncontrollable elements, tsunamis, Mariana and similar depressions, monsters living in the depths of the sea. Such fear manifests itself in different ways: some cannot even look at paintings by seascapes or films about sea adventures without a shudder, others simply do not go to rest at sea, and still others will live like this, not realizing that they have such a phobia.

As a variant of anxiety disorder, aquaphobia is manifested by the following symptoms:

• the state of anxiety arises every time when mentioning the possibility of the same situation related to water, or contact only with a water body;
• the prospect of experiencing another contact with the object of fear causes rejection, it is avoided by any means, whenever possible;
• psychologically aquaphobia manifests itself: a premonition of a catastrophe from a meeting with a water body or falling into a phobic situation; an increase in anxiety and anxiety; absent-mindedness, temporary loss of memory, feeling of "emptiness" in the head; hypersensitivity to sound and light; expectation of deterioration in physical condition.

Vegetative symptoms appear almost simultaneously with an increase in mental stress and can manifest themselves in a very diverse way from almost all body systems. Such manifestations provoke hyperactivity of the sympathetic nervous system and the growing 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; sensation of a lump in the throat; dry mouth; epigastric pain; urge to empty the bowels and bladder; Difficulty or rapid breathing.

From situation to situation, fear grows uncontrollably and each time it is experienced more and more pronounced. At a supposed meeting with the object of fear, panic attacks can develop - a growing intense fear with pronounced vegetative manifestations. The cognitive effect of anxiety is also gradually increasing, consisting in the fact that a person prone to a phobia does not adequately assess the accompanying physical symptoms. He assumes that he is developing a serious disease, for example, a brain tumor, or is expecting myocardial infarction, stroke.

The patient may develop sleep disturbances: nightmares of the appropriate subject, during which he wakes up in horror with a strong heartbeat, mostly not understanding what woke him up. True, with simple phobic disorders, the patient may later fall asleep again and sleep until morning.

Complications and consequences

Simple phobias, which include the pathological fear of water, in many cases, significantly worsen the quality of life of the person exposed to them. Not everyone can cope with them on their own, and without treatment, aquaphobia can take on a chronic course and be complicated by more pronounced autonomic symptoms, depersonalization / derealization syndrome. Patients try with all their might to avoid a frightening situation, fearing to look ridiculous in the eyes of others, since they are aware of the inadequacy of their fear. In addition, thoughts of developing insanity, serious and fatal somatic diseases come to their minds.

The development of an obsessive-compulsive disorder is possible. If at the initial stage fear arises only during direct contact with the object or the situation causing it, later - at the very thought of the object of fear, for some these thoughts become obsessive and regularly arise for no reason.

It is believed that even the risk of suicide in people susceptible to any kind of phobia is higher than in those who do not.

Diagnostics fear of water

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

Differential diagnosis

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

Treatment fear of water

In the treatment of specific phobias, preference is given to non-drug methods of treatment: classes with a psychologist, psychotherapist, hypnotic sessions.

The most effective in getting rid of phobias are psychotherapeutic practices that allow to identify the causes of anxiety-phobic disorder, teach the patient to adequately respond to the object of fear, independently redirect negative thoughts, analyze the situation, relieve tension and control their behavior. Various patient management techniques are used, but CBT is the treatment of choice. Its essence lies in the fact that the psychotherapist during the sessions helps the patient to reveal his false beliefs about the object of fear and, using logic and analysis, independently redirect thoughts in a positive direction. The therapy takes place in stages under the guidance of a doctor. The patient first "plays out" fictional phobic situations and learns to identify the parasitic thoughts on which the feeling of anxiety is based, to redirect them independently and to stop the phobic attack. When the patient learns to resolve fictional situations, he is "immersed" in reality. Over time, he develops the habit of being in a previously disturbing situation, and skills are developed to cope with anxiety.

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

The help of a psychologist is provided individually, there are no specific methods for treating aquaphobia. Conversations take place between the specialist and the patient, during which they exchange information and the psychologist determines the necessary tactics for providing assistance. It boils down to psychological education, when a specialist helps the patient to master a certain amount of knowledge about the origin of obsessive fears and introduces methods for overcoming them, conducts practical exercises in order to develop skills and techniques for eliminating phobia, and suggests tactics of behavior in a phobic situation. Specialist consultations help to find answers to questions of interest to a particular patient. The patient learns to control his fear in relation to a frightening situation, analyze his behavior and develop adequate reactions.

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

As additional methods of treatment, various relaxing techniques are used: art therapy, sand therapy, self-hypnosis, meditation. Treatment approaches are individual, depending on the patient's age and psychological resources. Your doctor may advise you to change your diet or increase (decrease) your physical activity.

Drug therapy is used as an additional method to ease 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 in the formed rituals. Psychotropic drugs successfully stop psychotic and autonomic manifestations, however, they require extreme caution from the doctor and adherence to the doses and timing of admission from the patient, since they have many side effects, can be addictive, and non-compliance with the rules of admission can cause a paradoxical deterioration of the state and even expand the list of objects of fear...

 

Prevention

Nobody currently knows the exact reasons for the development of phobias. Hereditary tendencies are not yet amenable to correction, but the influence of exogenous provoking factors can be minimized. Since the birth of a phobia is preceded by stress and some physical disorders, it is necessary to start prevention from birth. A healthy lifestyle (feasible physical activity, optimal diet, adherence to sleep-wakefulness) and a positive attitude in the family will contribute to the upbringing of a stress-resistant personality. Besides, you just need to learn how to swim. This skill will come in handy in life and will serve as the 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 turn to 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 about bathing, caused by careless handling, often go away on their own when a person begins to perform hygiene procedures on their own.

If the fear persists, then any fear of water revealed in childhood lends itself well to psychotherapeutic influence of a suggestive nature. In contrast, adolescents and adults respond better 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, it is better amenable to therapy in a non-advanced stage.