What is Haemophobia?

Blood makes up approximately 10% of the human body and is essential to our survival, so why is it that so many people have haemophobia – an overwhelming fear of blood?

It is estimated that a significant number of people, between two and three million, in the UK have haemophobia. Today, we are going to look at haemophobia in more detail, including the common causes, triggers and symptoms.

What is haemophobia?

Haemophobia is the extreme and irrational fear of blood. It can also include the fear of wounds and injuries. Haemophobia differs from other phobias as being exposed to your trigger often results in a vasovagal response.

This is when your body overreacts to a specific trigger, in this case, blood, and causes you to faint. In people with haemophobia, blood is a vasovagal syncope trigger and can result in a sudden drop in your heart rate and blood pressure which leads to fainting.

Haemophobia is a type of specific phobia. A specific phobia is a lasting, overwhelming and unreasonable fear of a specific object, situation, activity or person, in this case, an overwhelming fear of blood. Haemophobia has been further characterised as a blood-injection-injury (BII) phobia. Someone with a BII phobia may feel an intense and overwhelming fear when directly or indirectly exposed to blood.

A blood phobia can result in the individual avoiding any situation where they could encounter blood. They might also avoid medical treatment, GP surgeries and hospitals, even to the detriment of their health.

Having an aversion to blood or disliking blood is completely natural. Many people feel queasy or uncomfortable when they see blood and it is thought that humans are predisposed to disliking blood.

A fear of blood could have an evolutionary basis as our ancestors associated bleeding with injury, illness or death. However, a person with haemophobia doesn’t merely experience discomfort or a little anxiety when they encounter blood.

To be categorised as a phobia, the fear must be extreme and overwhelming. It must also include:

• Feelings of intense fear, panic or anxiety that are irrational and difficult to control or manage.
• Fear that is out of proportion to the potential danger.
• Your fear of blood must have lasted longer than six months.
• The fear must negatively impact your day-to-day life.

A person who has haemophobia won’t just have a fear of blood that poses a danger to them, they will also have a physical and psychological reaction to very small amounts of blood or blood that is not their own. They may also experience feelings of anxiety and panic when thinking about blood or seeing a picture or video containing blood.

Even if you know that your fear is excessive and unreasonable, you may still be unable to control your feelings and your response.

In some cases, haemophobia can be connected to other phobias, including:

• Thanatophobia: An extreme fear of death or dying.
• Trypanophobia: An extreme fear of needles.
• Nosocomephobia: An extreme fear of hospitals.
• Latrophobia: An extreme fear of doctors or medical tests.

How common is haemophobia?

Haemophobia is one of the most common types of phobia. Although it can be difficult to determine true statistics of how many people experience a phobia, haemophobia is often more commonly diagnosed and treated. People with haemophobia are more likely to seek a diagnosis for their condition compared to people with other phobias. This could be because symptoms, such as the vasovagal response, are more severe than other phobias.

Approximately 3%-4% of the population have haemophobia or another blood-injection-injury (BII) phobia. This equates to between two million and three million people in the UK.

Negative feelings and reactions to blood are common and can occur on a spectrum, ranging from low levels of fear, anxiety, discomfort or nausea to severe fear, panic and anxiety that can impact an individual’s ability to function in their day-to-day life or affect their overall wellbeing.

Determining who is experiencing a fear of blood and who is experiencing a true phobia can be difficult. Some people with the condition may believe that their fear is not unreasonable and out of proportion to the potential risk, resulting in them not seeking a diagnosis.

Who is at risk of haemophobia?

Although anyone can develop haemophobia, there are certain risk factors that increase your likelihood of developing the condition, including:

• You have a history of anxiety, depression, panic attacks or another relevant mental health condition.
• You have another condition related to haemophobia, such as thanatophobia or another BII phobia.
• You have a close family member who also has haemophobia.
• You have a close family member with another type of phobia.
• You are a naturally anxious or nervous person.
• You were exposed to the fear of blood during childhood.
• You directly experienced or witnessed a traumatic event involving blood.

Haemophobia can develop at any age. However, the most common age for a person to develop a fear of blood does show a gender difference, with males developing the phobia at an average of nine years old and females usually developing it at seven years old.

Females are also twice as likely to be diagnosed with phobias compared to men, although it is unclear if this gender discrepancy is because women are more likely to seek a diagnosis than men.

Even if you have none of the above risk factors, you may still develop haemophobia. It is also important to note that having several of the risk factors does not mean you will definitely develop the condition. For example, just because a person has depression and has a parent with haemophobia, this does not mean they will necessarily develop haemophobia themself.

How to deal with haemophobia

Although medical treatment is available, there are certain coping strategies you can learn to help you deal with, alleviate or prevent the symptoms of haemophobia. You may think that the best way to deal with your phobia of blood is to avoid situations where you might encounter blood. However, this may not be the most effective long-term strategy as it can be almost impossible to avoid blood for the rest of your life.

Failure to deal with your phobia can result in more severe symptoms if you encounter blood in the future, or you may find that your phobia becomes more easily triggered.

Learning how to deal with the symptoms of your haemophobia can help you to reduce the impact of your phobia on your day-to-day life and improve your overall wellbeing. You can learn and implement effective coping strategies to reduce or alleviate your symptoms. Some of these strategies can also be implemented long term to help you manage your phobia more effectively.

Some long-term strategies and symptom management strategies you can implement include:

• Get to know your anxiety – Figuring out exactly what triggers your haemophobia and where your fear originates can help you to understand your phobia and manage your symptoms more effectively.
• Find out information about any medical procedures you need – Medical procedures are a major trigger for people with haemophobia. Learning about the procedure and the low risks involved can help to reduce your anxiety.
• Implement distraction techniques – If you are in a situation where seeing blood is inevitable, implementing distraction techniques can help to reduce your physiological response to the blood. Distraction techniques could include listening to music, engaging in conversation, reading, playing a game or watching a video.
• Challenge negative thoughts – Reassuring yourself that the risk is low and that the blood does not pose a danger to you can be beneficial.
• Prevent the vasovagal response – If you are in a situation where you are likely to encounter blood, or you feel yourself becoming dizzy or faint, there are some steps you can take to prevent the vasovagal response. This includes lying down with your legs elevated and tensing and relaxing your hands and feet.
• Implement visualisation techniques – Visualisation has been found to be an effective coping strategy for reducing the symptoms of phobias. When faced with your trigger, visualising a place or memory that keeps you calm or elicits positive emotions can help to alleviate your symptoms.
• Remind yourself that the fear is irrational – Reassuring yourself that you are not in danger and that the feelings you have will pass can help you to rationalise your thoughts and calm yourself down.
• Focus on something external – Focusing on something other than your trigger can help to keep you calm. For example, you can count the letters in a sign or focus on passing traffic.
• Practise yoga, meditation or mindfulness – Yoga, meditation and mindfulness teach you how to control your breathing and your body’s physiological responses and can help you to feel more in control and calm. This can help to reduce the physiological and psychological responses you may have when faced with blood.
• Implement lifestyle changes – Reducing stress in your everyday life, eating a healthier, more balanced diet, exercising regularly and ensuring you have a good sleep routine can help to reduce the symptoms of your phobia long term. All of these lifestyle factors can impact your anxiety levels, your stress levels and your feelings of depression.
• Avoid caffeine, sugar and stimulants – If you know you could come into contact with blood, you should avoid caffeine, sugar and stimulants as these can result in an elevated heart rate and can worsen your symptoms.
• Speak to your doctor – Informing your doctor of your phobia not only allows you to be diagnosed and receive treatment but also ensures your phobia is taken into consideration if you are receiving medical treatment in the future.
• Seek support and guidance – You can get specialist information and support online, over the phone and face-to-face from organisations such as Mind. Speaking to professionals and other people who have experienced a phobia can be extremely beneficial.

What triggers haemophobia?

Haemophobia can have different triggers for different people, depending on the initial cause of your phobia and the severity of your symptoms.

Some of the most common triggers for haemophobia are:

• Seeing blood in real life, whether your own or someone else’s.
• Seeing blood in a TV programme or film or in a picture.
• Smelling something that you associate with blood, such as antiseptic.
• Seeing something you associate with blood, such as a needle or plasters.
• Thinking about blood.
• Injuring yourself, even if you do not bleed.
• Going to the doctor’s surgery or to the hospital.
• Having a medical procedure done, even if there may be no blood involved.
• Hearing a traumatic story that involves blood.

What are the symptoms of haemophobia?

The symptoms of haemophobia can differ from person to person. Some people may experience mild symptoms, whereas others experience severe symptoms. Some people with haemophobia also find that the severity of their symptoms varies in different situations, depending on the perceived danger, their current wellbeing and mental state and their coping strategies.

For example, your symptoms may be more severe if you cut yourself and have unexpected bleeding, compared to if you see blood on the television. It could be that not all blood triggers your haemophobia, for example, many women with haemophobia do not experience symptoms when they get their period.

The symptoms of haemophobia are often similar to the symptoms of anxiety or panic attacks. However, not every person with haemophobia will have the same symptoms.

The symptoms of haemophobia can be both physiological and psychological and can include:

Physiological Symptoms:

• A sudden drop in heart rate.
• A sudden drop in blood pressure.
• Fainting.
• Light-headedness or feeling like you are going to faint.
• Heart palpitations or a pounding heart.
• Breathlessness or difficulty breathing, such as hyperventilating or rapid breathing.
• Nausea, vomiting or stomach distress.
• Excessive sweating, hot flushes or chills.
• A dry mouth.
• Shaking or trembling.
• Loss of appetite.
• Tightness in the chest or chest pains.
• A choking sensation or feeling like you have something stuck in your throat.
• Feeling confused or disorientated.
• Feeling numbness or tingling in different parts of your body.
• Unusual headaches.
• Feeling frozen or like you are unable to move.
• Crying, hiding or being clingy (common in children with haemophobia or other mental health difficulties).

It is thought that up to 80% of people with haemophobia experience a vasovagal response when they encounter blood. While other phobias are associated with an increase in cardiac activity, the vasovagal response associated with haemophobia can result in a sudden and sometimes dangerous reduction in cardiac activity. This makes haemophobia one of the most dangerous phobias.

In rare situations, the vasovagal response can result in cardiac arrest and death. If you are concerned that the symptoms that you or someone else with haemophobia are experiencing are serious, seek medical help immediately.

Psychological Symptoms:

• Extreme feelings of fear and panic.
• Overwhelming feelings of anxiety.
• Feelings of irritability.
• Feelings of intense disgust if you see blood.
• Feeling detached from yourself.
• Feeling a loss of control.
• Feeling trapped or unable to escape.
• Anticipatory anxiety in the lead-up to situations where you may encounter blood.
• Difficulty sleeping in the lead-up to situations where you may encounter blood.
• A sense of impending doom.
• A fear of death or dying.
• Avoiding any situation where you may encounter blood.
• Avoiding medical procedures, such as blood tests and surgery or avoiding visiting the doctor completely.
• An inability to control your feelings of fear, anxiety or panic.

What causes haemophobia?

There are several reasons why a person can develop haemophobia. Multiple factors can contribute to the development of a phobia. Alternatively, your phobia may have one single cause that you can pinpoint.

The main causes of haemophobia are:

• A negative or traumatic experience involving blood
  In many people, haemophobia is caused by a traumatic experience involving blood. This trauma can be direct, meaning it happened to you, or indirect, where you witness a traumatic experience happening to others. This could include a serious injury, major blood loss or a hospital stay. The negative experience could have occurred during childhood or adulthood.
• The association between blood and pain
  Some people learn to associate blood with pain, and this can result in them developing haemophobia, particularly if this association happens during childhood or adolescence.
• A learned phobia
  Phobias can be learned in what is known as an observational learning experience. This is more likely to happen if you are exposed to haemophobia during childhood or adolescence. The exposure can come from a close family member or friend.
• The portrayal of blood in the media
  Phobias can develop because of something you have seen in the media, most commonly in a movie or a TV show. If you were exposed to blood in a negative way, such as seeing someone die from major blood loss on TV, this can result in you developing a blood phobia. Blood is also often shown to scare people, such as in horror movies. Horror movies often create feelings of fear and anxiety and experiencing these negative emotions in relation to blood can be enough to cause a phobia.
• An information learning experience
  In some cases, people develop phobias because they were exposed to facts or information that scared them. For example, learning facts about how many people die from injuries or from major blood loss, or learning how quickly you can bleed out can result in a person developing haemophobia.
• A genetic predisposition
  Some people are more likely to develop phobias than others because of a genetic predisposition. Although scientists are unsure which specific gene is related to phobias, the familial link suggests that some people may be more susceptible to phobias.
• Significant stress
  Significant, long-term stress can result in disproportionate fear responses or an inability to manage intense situations. This could result in you developing a phobia, particularly if you are exposed to the phobia or a traumatic situation involving blood while you were already experiencing stress.

How is haemophobia diagnosed?

Haemophobia can be difficult to diagnose, as many people feel anxiety and nausea when faced with blood. Differentiating a fear from a phobia can be difficult. Because the majority of people do not like blood, a person experiencing haemophobia may not realise that their fear and anxiety are overwhelming and unreasonable and may not realise they have a phobia, meaning they will never seek a diagnosis.

Haemophobia can also be difficult to diagnose because BII phobias are often diagnosed using the criteria for specific phobias. This means that the specific characteristics of haemophobia may not be listed in the diagnostic criteria. In some cases, this can make a diagnosis more difficult.

If you think you have haemophobia, you should first visit your GP. Visiting your GP as soon as possible can help you get an earlier diagnosis. This can help you to receive treatment and learn coping strategies earlier, reducing the overall impact your phobia has on your life.

If you are unsure whether to visit your GP, consider if your fear of blood:

• Impedes your ability to function in your everyday life.
• Has a specific negative impact on your quality of life.
• Causes you to avoid certain situations or places.
• Has a negative impact on your mental health or wellbeing.

During your GP appointment, your GP will ask if you have previously experienced any anxiety disorder, panic disorders, phobias or other mental health conditions. They will likely look at your medical history and your family history and perform a physical examination. Your GP will consider any already known medical conditions you have and any medication or supplements you take, to ensure your symptoms cannot be attributed to anything else.

The next step will be for your GP to refer you to a psychologist, or another mental health professional. The psychologist will consider your symptoms against the diagnostic criteria for phobias. They will likely conduct a phobia questionnaire and a psychological evaluation. They will also look at when your symptoms began and what initially caused your symptoms.

To determine whether you are experiencing a phobia or a fear, the psychologist will ask for information about:

• Your triggers.
• The type of symptoms you experience.
• The frequency and severity of your symptoms.
• How much your phobia interferes with your everyday life.

To receive an initial diagnosis of haemophobia, your symptoms must fit in with the seven key criteria:

1. The fear must be persistent, excessive and unreasonable. It can occur either when blood is present or when it is not present, e.g. if you think about blood or see a picture of blood.

2. Exposure to blood leads to an immediate anxiety response in the majority of situations.

3. The fear is excessive and disproportionate to the threat, and this is recognised by the individual.

4. The individual avoids places or situations where they could encounter blood. If they encounter blood, the individual will experience extreme fear, anxiety or distress.

5. The anticipation of encountering blood and the avoidance behaviours they may implement can have a significant impact on the individual’s day-to-day life.

6. The fear has lasted for a minimum of six months.

7. The phobia is not associated with another disorder or mental health condition.

If your symptoms fit the criteria, a diagnosis of haemophobia will be made and you may be offered relevant treatment.

How is haemophobia treated?

Treatments for haemophobia can vary depending on the severity of your symptoms and how significantly the phobia impacts your life and your overall health and wellbeing. Some people may not require treatment for their phobia. However, if your fear of blood negatively impacts your day-to-day life or impacts your wellbeing, then treatment could be beneficial.

There are several different types of treatment available. Your doctor will create a treatment plan based on the severity of your phobia, your triggers, and the impact your phobia is having on your life.

The most common treatments for haemophobia are:

Exposure Therapy:

Exposure therapy, also known as systematic desensitisation, has been found to be an effective treatment for people with blood phobias. It involves you being exposed to blood in a safe and controlled environment. Exposure will be gradual and repeated.

It may first begin with talking about blood and imagining blood, before looking at pictures and videos. You may then use Virtual Reality (VR) before being exposed to real blood or your other triggers in real life. Exposure therapy can help to alter your physiological and psychological responses to blood and help you deal with any negative thoughts and feelings you have about blood.

Cognitive Behaviour Therapy (CBT)

Cognitive Behaviour Therapy helps you to manage your phobia by gradually changing your thoughts, beliefs, feelings and behaviours. CBT focuses on the root cause of your phobia and any negative patterns of thought. It can also help to teach you coping strategies that you can utilise when faced with blood in the future.

CBT sessions will include:

• Discussing your triggers and symptoms.
• Exploring what caused your haemophobia.
• Exploring your fears in more detail.
• Learning how to recognise your negative thoughts and change the way you are thinking.
• Learning coping strategies.
• Learning calming strategies.

CBT sessions can be done individually or as a group session.

Rational Emotive Behavioural Therapy (REBT)

REBT is a type of Cognitive Behaviour Therapy that is used less frequently but can be equally as effective. REBT helps you to identify irrational and negative thoughts and unhealthy attitudes, emotions and behaviours. REBT is an action-oriented approach that helps you challenge irrational beliefs and manage the thoughts, emotions and behaviours that occur when faced with blood.

Hypnotherapy

Hypnotherapy is a popular treatment option for people with phobias. Hypnotherapy uses guided relaxation techniques and focused attention to help you to identify the underlying causes of your phobia and help you change your thoughts and feelings.

You will be put into a relaxed, hypnotic state and then a combination of techniques will be used to re-pattern your thoughts and memories related to blood. Hypnotherapy can also teach you deep breathing and relaxation techniques. This can help you to reduce your phobic response.

Medication

Medication is a less frequent treatment choice for people with phobias. It is only likely to be recommended if your symptoms are particularly severe, or if you also experience anxiety, panic attacks or depression. Medication will likely be given alongside another type of treatment, such as CBT.

Medication that may be used to treat haemophobia includes:

• Anxiety medication.
• Beta-blockers.
• Antidepressants.