Lives in Peril, Careers Lag in the Grip of Blood Phobia
Blood is not a pretty sight. It makes many people queasy and others faint. But worse, fear of blood can even ruin careers or threaten lives.
Blood-injury phobia is an exaggeration of the natural squeamishness nearly everyone feels at the sight of blood, mutilated bodies and other gore. In its mild form, it can prompt blood donors to faint or make medical students pass out while observing their first operation.
When the fear escalates to the point it creates avoidance patterns and other difficulties in day-to-day life, the condition meets the American Psychiatric Assn.’s criteria for a phobia.
Although blood-injury phobia may be aggravated by modern-day medical procedures and graphic news accounts of bloody accidents, the problem appears deeply rooted in the human psyche.
Even Shakespeare noted the trait, observing in his play “As You Like It”: “Many will swoon when they do see blood.”
Most psychologists and psychiatrists agree blood-injury phobia triggers physical responses markedly different from most other phobias, lowering the blood pressure rather than raising it and slowing the heart rate rather than speeding it up. Controversy arises over whether the intense fear has a stronger biological basis than other phobias.
Impact Not Disputed
But the impact on victims is not disputed.
Dr. David Charney, a psychiatrist who is on the board of the Phobia Society of America, tells of treating a commercial airline pilot who almost lost his job because he was terrified of taking an annual physical, which required a blood test. Careers can also be aborted before they even begin, with some young people dropping plans to become doctors or nurses rather than battle their extreme reactions to blood and injury.
Another of Charney’s psychiatric patients decided to seek treatment for her phobia after she became pregnant, knowing she probably would be confronted with blood during delivery of her baby.
“Some patients with blood-injury phobia avoid urgent medical procedures that could save their lives: Those who become diabetic may eschew insulin injections, and those who develop cancer may shun surgery. They avoid hospitals, sick people or viewing medical programs on television,” wrote Dr. Isaac Marks in a review of blood-injury phobia in a recent issue of American Journal of Psychiatry.
Marks estimates about 2% to 4.5% of people suffer from fear of blood intense enough to be considered blood-injury phobia.
In his article, the British psychiatrist cited examples of phobics who faint upon hearing the word “blood,” descriptions of surgery or the sound of ambulance sirens. And Charney, of the Roundhouse Psychiatric Center in Alexandria, Va., added, “Even a black-and-white picture of blood could be enough to send them into an anxiety state.”
Pain No Special Issue
According to Charney, blood-injury phobics are not particularly afraid of pain, even though the sensation is closely linked to blood and injury. “Most people aren’t able to exactly describe how it (the phobia) feels, but it seems to center on not liking the idea of blood coming out of them,” he said.
The hallmark of blood-injury phobia is vasovagal syncope, a temporary condition marked by lowered blood pressure, anxiety, nausea and fainting. The condition is believed to be caused by disturbances of the vasomotor and vagus nerves that regulate the blood vessels and involuntary muscle function.
Blood-injury phobics may also be stricken by attacks of crying, sweating, embarrassment, ringing of the ears and urinary urgency.
Dr. Suzanne Shepherd, an attending physician in the emergency room at Georgetown University Medical Center in Washington, said, “We see a fair amount of people who faint at the sight of blood. It’s actually fairly common.”
“It’s usually not the person who is being treated. It’s the people who are with them who have the opportunity to focus in on the blood,” Shepherd added. “Most of the patients we see are so sick that it overrides any fears they may have of blood.”
Queried on Reactions
Emergency room workers routinely ask people accompanying patients if the sight of blood bothers them, and Shepherd said if they indicate it does, they are offered a chair to sit on or the opportunity to leave the treatment area.
Persons who unexpectedly grow dizzy are directed to sit down and put their heads between their legs to restore blood pressure. In severe cases, people may need medication to get their blood pressure up to normal, Shepherd said.
The doctor warns it should not be assumed that all such fainting spells are linked to blood-injury phobia. In some people, particularly those who are older, the dizziness may stem from potentially fatal heart problems aggravated by stress, she said.
Most people suffering from blood-injury phobia cope by avoiding situations where they may be exposed to blood, such as doctors’ offices, television newscasts and horror movies. They generally seek treatment for their problem “only when they have no choice,” such as when they face an operation, Charney said.
The basic strategy Charney and other mental health experts use to treat blood-injury phobics usually takes four to eight weeks and involves gradual desensitization.
For example, while under a therapist’s supervision, a patient may be progressively required to look at pictures of accidents or operations, handle needles, hold vials of blood and visit emergency rooms.
Draw Own Blood
“The final point is where we actually draw blood from them, sticking their finger with a lancet to produce a little drop of blood, and they have to deal with that over the course of a half-hour,” Charney said.
The psychiatrist said unlike many phobias, such as agoraphobia, blood-injury phobia generally is not accompanied by other mental health problems, such as panic attacks.
Charney agrees with Marks there is a tendency for blood-phobia to run in families, but said he does not know why. In his article, Marks argued genetics may be the reason people with blood-injury phobia often have family members with a similar problem.
Marks cites a Swedish study showing people with blood-injury phobias were three to six times more likely to have a relative with the same phobia, than were patients with agoraphobia, social phobia, dental phobia or animal phobia. Results of a U.S. study were not as striking, but 27% of blood-injury phobics had a family history of the disorder.
In addition, Marks said studies have shown identical twins having the same genetic makeup, are more likely to share a blood-injury phobia than are fraternal twins, who do not have exactly the same genes.
Alan Goldstein, a psychologist at Temple University’s Agoraphobia and Anxiety Center in Bala Cynwyd, said although there may indeed be a genetic sensitivity toward developing blood-injury phobia, he also believes environmental factors come into play.
Children Pick It Up
Familial links do not necessarily indicate genetic links, Goldstein cautioned. “If children, their parents or other adults around them have a fear of something in particular, they may adopt that fear,” he said.
In addition, Goldstein said the onset of blood-injury phobia can often be traced to a trauma event, such as being involved in or witnessing a bloody accident.
To further bolster his view that blood-injury phobia has a stronger biological basis than other phobias, Marks noted human aversion to blood-injury cues “echoes the alarm” by many other animals when members of their group are hurt.
The psychiatrist from the Institute of Psychiatry in London said studies have found chimpanzees are terrified at seeing a severed chimpanzee head and they “grin with fear” at a physically disabled chimp. In addition, he pointed out that mice and rats discriminate and avoid air streams from stressed animals.
Marks argues the vasovagal faint experienced by blood-injury phobics may have evolved out of the “tonic immobile reaction” that causes many animals, including grouse and opossums, to “play dead” when confronted with danger.
“Slowing of the heart rate in response to blood-injury cues could be an adaptive reflex that evolved in circumstances where immobility produced less risk of further injury than did flight,” Marks writes. “Predators tend to attack prey that is moving and to lose interest when it become still.”
Hypothesis on Heart Rate
Marks speculates the degree the heart rate slows in response to blood or injury may be differentially distributed in the population, in a manner similar to intelligence, height and other genetically influenced traits.
If that is the case, the psychiatrist hypothesizes people with a greater physical reaction to blood-injury cues would be more prone to develop the phobia than those with a less pronounced physical response.
However, Marks’ argument for blood-injury phobia’s unique biological status has not swayed everyone in the psychological field.
Dr. Thomas Uhde of the National Institute of Mental Health said, “Blood-injury phobia is only unique in that its physical response is well-documented and it is something we are more aware of.”