It’s a common scene: A phlebotomist guides her patient into the room, asks him to sit. She cleans his skin with rubbing alcohol, loops a tourniquet around his forearm. She puts the needle in position and warns him that he may feel a slight pinch. The clear vial attached to the needle fills with a bright pool of red. Minutes later, the procedure is over, and the patient is free to go.
It seems simple enough, but for many people, appointments like these are impossible to complete. If you’re always postponing your regular doctor check-ups in a cold sweat, you may be facing the anxiety condition hemophobia.
Hemophobia is the fear of blood, and it can be extremely inhibiting for those who live with it. People who have hemophobia may avoid necessary medical care or stay away from activities or sports that involve the risk of being injured (and bleeding). Just thinking about surgery or seeing one acted out on a TV show can be enough to make your heart race if you live with the condition.
If any of this sounds like you, you’re not alone. Researchers estimate that hemophobia affects approximately 3-4% of the population, but with the right treatment, you can get past your anxiety. Read on to learn more about hemophobia and what you can do if you’re struggling.
What Is Hemophobia?
Hemophobia is an intense fear of blood. It’s listed as blood injection injury phobia in the Diagnostic and Statistical Manual of Disorders (DSM-5), though it differs from injection phobia and injury phobia in a number of key ways.
“[Hemophobia] can come on as a result of seeing one’s own blood or the blood of another,” Sheva Rajaee, LMFT, director of the Center for Anxiety and OCD, told the Mighty. While many people experience unease at the sight of blood, your discomfort may rise to the level of a phobia when your “anxiety response to the sight, mention or thought of blood causes an exaggerated or prolonged fear response.”
Hemophobia can manifest in a number of ways, according to Rajaee. Some common experiences of people who live with the condition are:
- Avoidance of blood, including the sight or mention of blood
- Avoidance of situations or activities that could result in bleeding or injury
- Experiencing sweaty palms, dizziness, nausea or racing thoughts at the sight of blood
Dr. Tabasom Vahidi, Ph.D., told The Mighty that unlike other phobias, people living with hemophobia can experience a vasovagal response, or “fainting induced by a decrease in blood pressure.” John Sanford, who used to struggle with hemophobia, once described the vasovagal response in a piece for Stanford Medicine:
Observing blood seep from a wound, flow into a syringe or spatter on the ground, blood phobics initially will respond like other phobics — that is, their heart rate and blood pressure will increase. But then something else will happen: Their heart rate and blood pressure will suddenly drop, causing dizziness, sweatiness, tunnel vision, nausea, fainting or some combination of these symptoms. This is a vasovagal response … which does not generally occur with other phobias.
It’s worth noting that the vasovagal response is usually harmless, though it is possible to be injured from falling when the response is activated.
What Causes Hemophobia?
Researchers have yet to determine what exactly causes hemophobia. While Rajaee said that phobias can manifest in response to something that happened in your environment, she noted that “unlike other psychological conditions, many phobias and anxiety-related disorders do not have a basis in trauma and do not need to have a rational or familial basis in order to manifest.”
Some studies have suggested that individuals can be genetically predisposed to develop the condition. Researchers have also put forward the idea that hemophobia developed as an evolutionary response to being injured. According to this theory, ancient humans injured by predators may have escaped a grisly fate by catching sight of their own blood and fainting. Predator species tend to pass over prey that abruptly stops moving.
Another possible cause of hemophobia is “an overactive amygdala,” according to Rajaee. The amygdala is a part of the brain responsible for detecting threats and initiating the body’s survival fear responses. Several researchers have proposed a link between amygdala dysfunction and anxiety disorders, including phobias.
Treatment for Hemophobia
In order to protect themselves, people living with hemophobia often engage in “safety” or avoidance behaviors to temporarily reduce their anxiety. It may seem to help in the moment, but unfortunately, these patterns of avoidance actually worsen your fear over time: “Research has confirmed that any attempt to reduce anxiety or avoid your fear can intensify it in the long run,” Vahidi explained.
For that reason, treatment for hemophobia centers on staying with your discomfort and anxiety in small but increasingly difficult steps while a therapist teaches you tools to manage your anxiety. “[It] involves a great deal of motivation and willingness to temporarily intensify anxiety to ultimately overcome your fear,” Vahidi said. This may feel scary at first, but phobias have high recovery rates when treated in this way.
Exposure therapy also happens over a long period of time, and exposures are repeated. In this way, the brain “gets retrained to experience the fear as safe so that the body’s ‘fight or flight’ [response] does not get activated each time one is faced with a trigger,’ Vahidi said.
While some phobias — such as the fear of snakes — can be relatively benign because it’s typically best practice to avoid dangerous situations anyway, “the risks are high” for people who live with hemophobia:
“One of my patients had an intense fear of needles and she avoided getting her blood drawn for years, in spite of the medical risks,” Vahidi said. “Everyone, at some point in their lives, may need to have surgery and medical assessments that involve blood and needles.”
Vahidi guided her client through a series of exposures, including watching videos of blood draws, tying a tourniquet on her arm, being exposed to a medical lab and watching in-person blood draws. “We worked collaboratively to plan every exposure, and I closely guided her through the steps while tracking her anxiety,” Vahidi said. At the end of treatment, the patient had her blood drawn by a phlebotomist.
If you have experienced a vasovagal response, your therapist may also teach you the “applied tension” technique developed by Swedish psychologist Lars-Göran Öst. The technique involves tensing the muscles in your arms, torso and legs to counter the lowered blood pressure and slow heart rate that can lead to fainting.
Vahidi said it’s also important for you and your therapist to identify what is triggering your fear: “As a clinician, it’s important to identify the fear. Do they fear fainting or do they fear the needle?”
If exposure therapy sounds difficult to you, that’s because it is. Dr. Vahidi, who went through exposure therapy for her fear of flying, knows that firsthand. But “treating your fear is possible,” Vahidi said. “In fact, phobias have high recovery rates when treated properly.”
“Anxiety disorders, including phobias, are highly treatable with the right treatment,” Rajaee agreed. “Though it may seem incredibly difficult to imagine, rewiring of the fear response when faced with blood or possible contamination is achievable.”
For more on phobias, check out the following stories from our Mighty community:
- Is Pistanthrophobia Getting in the Way of Your Relationships?
- The Reality of Emetophobia and How I’m Beating It
- Trypophobia: The Anxiety Struggle That Can Make Your Skin Crawl
Article updated Feb. 14, 2020.