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Thanatophobia, an extreme fear of death or the dying process, is a type of specific phobia that can have a significant impact on a person’s life. Symptoms can occur when thinking about death or dying, when faced with the death of a loved one or when you encounter any triggering places, situations, people or objects.
It is thought that between 3% and 10% of people experience a higher than average fear response in relation to death and dying. However, it is unknown how many of these people are truly experiencing thanatophobia.
Today, we are going to look at thanatophobia in more detail, including the common causes, symptoms, triggers and treatments.
What is thanatophobia?
Thanatophobia is an extreme and overwhelming fear of death or the dying process. Someone with thanatophobia may fear their own death and the deaths of their loved ones. Sometimes referred to as death anxiety, thanatophobia is characterised by intense, overwhelming and persistent feelings of fear, anxiety, panic or dread when thinking about death or dying.
Although many people are scared of dying, it doesn’t usually impact their day-to-day life. Instead, it may be something they think about occasionally, for example, if they are diagnosed with an illness, as they grow older, if someone close to them dies or if they witness an accident. However, a person with thanatophobia will have such an intense fear of death that it can impact their daily life, affect their behaviour and result in them being scared to engage in any behaviours that they deem to be risky.
In some cases, a person’s thanatophobia can be so severe that it causes them to refuse to leave their home. A person with thanatophobia may also fear dying even in situations where the risk is low, for example, they may be young, fit and healthy with no indicators that they are at risk of dying.
Thanatophobia is a type of specific phobia, which is a lasting, overwhelming and unreasonable fear of a specific object, situation, activity or person, in this case, an overwhelming fear of death or dying.
To be classified as a phobia, your fear of death should include:
- Feelings of extreme fear, panic or anxiety when faced with death or dying or when thinking about death or dying.
- Feelings of fear, panic or anxiety that are difficult to control or manage.
- Engaging in avoidance behaviours or experiencing interference with everyday activities, for example, not engaging in any activities you deem risky or dangerous or that could affect your health or wellbeing.
- Experiencing anticipatory anxiety or worry when thinking about dying.
Thanatophobia often includes the fear of:
- Situations or places that could result in death
A person with thanatophobia may avoid situations or places that they deem dangerous, and which they think could cause their death. For example, they may fear hospitals because of the fear of being exposed to an illness or disease, or they may refuse to swim in the sea in case they drown or encounter a shark. Someone with thanatophobia may be scared of any place or situation that has any risk attached to it or only certain places or situations.
A fear of other people could be connected to several things.
– The fear of being close to other people and contracting an illness or disease.
– The fear of encountering a murderer or serial killer.
– The fear of another person accidentally killing them.
– The fear of witnessing another person dying.
– The fear of being close to other people who die, meaning you experience loss.
Some people with thanatophobia fear animals because of the threat they believe they pose to their health and safety.
The fear they experience in relation to animals could involve:
– The fear of being attacked or bitten by an animal.
– The fear of an animal spreading illnesses, viruses or contaminating them in some way.
– The fear of being accidentally killed, for example, when riding a horse.
- Objects that could result in death
A person with thanatophobia can experience fear in relation to objects that they deem to be dangerous. This could include objects that are typically considered to be dangerous, such as guns and knives and objects that are not usually considered to pose a risk or are extremely common in everyday life. For example, someone may fear plants, in case they are poisoned, large signs, in case they fall on them, and cars, in case they are hit by a car or are involved in a car accident.
- Contamination that could result in death
Some people with thanatophobia also develop mysophobia (also known as germaphobia), which is an extreme fear of germs. They may fear they will be exposed to germs, bacteria or viruses that could infect them and may avoid any places, situations, objects or people that could contaminate them. This fear could become so severe that a person develops agoraphobia, an extreme fear of leaving their home or other safe environments.
- Superstitions or stories that result in death
A person with thanatophobia can become superstitious or fear superstitions that involve dying. For example, they may believe that birds are bad omens so try to avoid them, they may always touch a button if they see a hearse (to prevent the hearse from coming to collect them next) and will never leave slippers or shoes upside down (so nobody in their home dies). Superstitions can become such a big part of a person’s life that they result in compulsive behaviours and obsessive compulsive disorder (OCD).
Thanatophobia is often referred to as an existential phobia. This is because it stems from the innate knowledge that all life must end, and everybody must die. Humans have the unique ability to anticipate the future and have a heightened awareness of their own mortality. In some people, this can result in death anxiety or thanatophobia.
Thanatophobia is often connected to and can occur in conjunction with other phobias such as:
- Agoraphobia: An extreme fear of leaving safe environments (such as the home) or of being somewhere where escape may be difficult.
- Claustrophobia: An extreme fear of enclosed or crowded spaces.
- Nosocomephobia: An extreme fear of hospitals.
- Haemophobia: An extreme fear of blood.
- Iatrophobia: An extreme fear of doctors.
- Zoophobia: An extreme fear of animals.
- Aichmophobia: An extreme fear of sharp, pointed objects.
- Necrophobia: An extreme fear of dead things or things that are associated with death.
- Phasmophobia: An extreme fear of ghosts.
How common is thanatophobia?
Accurate statistics demonstrating how many people experience thanatophobia are not available. As with other phobias, many people with thanatophobia never report their symptoms or seek a diagnosis, making it difficult to determine how commonly this phobia occurs.
Studies estimate that between 3% and 10% of people report that they believe themselves to be more anxious and scared of dying compared to others. This equates to between 2 million and 6.7 million people. However, negative thoughts, feelings and behaviours in relation to death can occur on a spectrum, ranging from low levels of fear and anxiety to severe fear, panic and anxiety that can impact your ability to function in your day-to-day life and can impact your decision-making, resulting in avoidance behaviours.
They can also affect your overall health and wellbeing. This can make it difficult to determine exactly how many people are experiencing a true phobia and how many are experiencing fear.
However, cases of thanatophobia appear to be on the rise following the Covid-19 pandemic where millions of people around the world have died so far. The fear of dying from Covid-19 appears to be particularly prevalent in people who are considered to be vulnerable, such as the elderly or those with other illnesses. A fear of dying also seemed to occur more frequently in children and adolescents, particularly during the height of the pandemic.
Who is at risk of thanatophobia?
Although anyone can develop thanatophobia and the phobia is diagnosed in people of all ages and demographics, there are certain risk factors that can raise the likelihood of you developing this phobia.
- Being diagnosed with a serious, life-threatening or life-limiting illness or being in general poor health.
- Having close family or friends who are seriously ill, elderly or dying or have recently died.
- Not having religious beliefs, for example, not believing in heaven, the afterlife or reincarnation.
- Working in a profession where you regularly see people dying in a traumatic, violent, painful or distressing way (as this can make you fear the dying process).
- Having a lack of social support or close family and friends.
- Feeling a sense of dissatisfaction or regret about your life.
- Having another related condition where fear of death can also be a symptom, for example, health anxiety (hypochondria), obsessive compulsive disorder (OCD) or anxiety disorders.
- Having another related phobia, such as necrophobia or nosocomephobia.
- Having a close family member, such as a parent or sibling, with thanatophobia.
- Having a close family member, such as a parent or sibling, with another phobia.
- Being a victim of Fabricated or Induced Illness (FII) (previously known as Munchausen syndrome by proxy), particularly if this happened during childhood or adolescence.
- Being exposed to a fear of death during childhood or adolescence.
- Having a history of depression, panic attacks, panic disorders or anxiety.
- Having or witnessing a negative or traumatic experience relating to death.
Research suggests that, usually, thanatophobia manifests in different ways depending on the individual’s age. Older adults usually fear the process of dying whereas younger adults usually fear death itself.
How to deal with thanatophobia
Many people with thanatophobia think that the best way to deal with their phobia is to avoid their triggers.
However, because death is not an object, place or person, your triggers can be wide-ranging and varied and it can be much more difficult for someone with thanatophobia to avoid their triggers compared to someone with another type of phobia (for example, ophidiophobia – an extreme fear of snakes). Because the triggers of thanatophobia can be so varied, you could experience symptoms at unexpected times, making avoidance behaviours particularly unlikely to work.
Failure to address and challenge your phobia can have a significant impact on your day-to-day life and your overall wellbeing. There are certain coping strategies you can implement, both short term and long term, which can reduce the frequency and severity of your symptoms and reduce the negative impact your phobia has on your life.
Coping strategies can also help you to manage your thanatophobia more successfully and reduce avoidance behaviours in the future.
Some long-term and short-term coping strategies that are effective in dealing with thanatophobia are:
- Learn about your phobia
Think about what initially caused the onset of your symptoms and caused you to develop thanatophobia to allow you to address the root of your phobia. You should also consider what your triggers are. This can help you to understand your fear of death and rationalise your thoughts and emotions. This can help you to manage your symptoms more effectively and address any negative patterns of thought that exist around death and the dying process.
- Educate yourself
Many people fear the unknown and the process of dying. Death can be painful and distressing for the family and friends left behind, and this causes many people to think of dying itself to be painful and distressing. Learning about what hospitals and other healthcare settings do to make death as pain-free and peaceful as possible can help to remove some of the trauma you have associated with death. Looking at statistics on increasing life expectancy can also help to reassure you, particularly if you are still young. Focusing on positive information and statistics can help to remove some of the fear you have attached to dying.
- Create a fear ladder
A fear ladder can help you to analyse your fear of death and determine whether certain scenarios, places, objects or people create more severe fear, anxiety and panic than others. A fear ladder allows you to organise your triggers from least severe to most severe. Your fear ladder should not focus on dying itself, but on things that trigger your fear of death and dying.
For example, your fear ladder can look like this:
– 1 = Going to the doctor or a hospital because of an illness or injury.
– 2 = Using public transport, including buses, trains, trams and aeroplanes.
– 3 = Being in a very busy or crowded place.
– 4 = Not wearing gloves and a mask outside of your home.
– 5 = Not washing your hands regularly.
– 6 = Hearing/watching news reports of someone dying, particularly people who live close to you or who are a similar age to you.
– 7 = Seeing someone dying on a TV show or in a film.
Once you have created your fear ladder, you can then tackle your triggers one at a time, starting at the bottom of the ladder (the situation that results in the lowest phobic response). This can help you to build up the tolerance of your triggers gradually.
- Avoid negative or traumatic stories about death
Hearing negative stories in the news, on social media or from family and friends can be distressing and can worsen your phobia. We hear stories of people dying daily, particularly in the news, and this can increase your negative thoughts and your fear response. Avoid negative stories surrounding death (where possible) by turning off the TV, unfollowing people who spread these stories online and informing family and friends of your fears.
- Challenge negative thoughts
Negative thoughts can exacerbate your symptoms and worsen your phobia. Remind yourself that the risks are minimal and that you are not in danger. If you begin to experience symptoms of thanatophobia, remind yourself that the feelings will soon pass and that your fear is irrational.
- Implement distraction techniques
If you are in a triggering situation or are in a place or situation that you associate with death, implementing distraction techniques can help to reduce your physiological and psychological responses to your triggers. Distraction techniques could include listening to music, engaging in conversation, reading, playing a game or watching a video. Focusing on something external, such as counting the number of objects in a room or the number of passing cars can also help to keep you calm.
- 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. Successful visualisation techniques include recalling some of your favourite memories or visualising yourself in your favourite place, such as a forest or a beach.
- Practise deep breathing techniques
Deep breathing has been proven to be an effective way of lowering stress levels, relieving tension in your body and reducing anxiety and panic. Deep breathing sends a message to your brain to relax and calm down. It can also help you to control your central nervous system, which is central to your phobic responses. Practise deep breathing regularly, as part of your daily routine, and implement the strategies you have learnt when faced with your triggers in the future.
- Practise yoga, meditation or mindfulness
Yoga, meditation and mindfulness can all teach you how to control your breathing and manage your body’s response to your triggers. This can help you to feel more in control and calm and reduce the physiological and psychological responses you may have when faced with your triggers in the future. Yoga, meditation and mindfulness are long-term coping strategies that can improve your phobia over a period of time.
- Implement lifestyle changes
Multiple lifestyle factors have been found to exacerbate the symptoms of phobias, including thanatophobia. For example, lack of sleep and unnecessary stress can worsen anxiety and make your symptoms worse. Implementing a sleep routine and taking steps to reduce your everyday stress can help to reduce the severity of your phobia both short term and long term. Other lifestyle factors that could help you deal with your thanatophobia include eating a healthy, balanced diet and increasing the amount of exercise you do.
What triggers thanatophobia?
Thanatophobia can have different triggers for different people. Your triggers can vary, depending on what initially caused you to develop a fear of death, your perception of danger, the severity of your symptoms and your current mental health and mindset.
Some of the most common triggers of thanatophobia include:
- Being diagnosed with a serious illness or obtaining a serious injury.
- Going to a place you typically associate with death, such as a hospital or cemetery.
- Someone you care about dying or being told that they will die.
- Seeing someone dying in a TV show or movie or hearing news reports about real-life deaths.
- Seeing objects that you consider to be dangerous or a risk to your life.
- Thinking of dying or your own mortality.
- Visiting any medical settings, such as hospitals, GP surgeries and clinics, as you may fear being told you have a serious illness.
- Finding something unusual on your body, such as a mole or lump.
- Experiencing symptoms of illness, even if the symptoms are mild and common.
- Recalling a traumatic memory that you associate with death.
- Being close to other people (if this is part of your phobia).
- Being close to animals (if this is part of your phobia).
- Leaving your home or places you consider as safe (in severe cases of thanatophobia).
What are the symptoms of thanatophobia?
The symptoms of thanatophobia can vary from person to person, with some people experiencing severe symptoms and some people experiencing more mild symptoms. Some people also experience symptoms more frequently than others. Certain situations, places, people or objects may also trigger your thanatophobia more than others, and you may find that there are times when your symptoms are more severe than others.
The occurrence and severity of your symptoms can vary depending on your triggers, your perceived risk and threat of danger, your current mental and emotional health and wellbeing and any coping or calming strategies you have implemented.
The symptoms of thanatophobia can be similar to the symptoms of anxiety and panic attacks.
The symptoms can be both physiological and psychological and can include:
- Dizziness or light-headedness.
- Heart palpitations or feeling like your heart is racing or pounding.
- Shortness of breath, rapid or shallow breathing or hyperventilating.
- Excessive sweating.
- Nausea, vomiting or stomach upset.
- Trembling or shaking.
- Chills or hot flushes.
- Unusual or severe headaches.
- Fatigue or insomnia.
- Unusual sensitivity to hot or cold temperatures.
- Muscle tension.
- A dry mouth.
- Elevated blood pressure.
- A choking sensation or feeling like something is stuck in your throat.
- Tightening in your chest, chest pain or feeling like something is stuck in your chest.
- Feeling confused or disorientated.
- Unusual flushing or paleness, particularly in the face.
- Numbness or tingling in your body.
- A lack of appetite.
- Obsessively checking for signs of illness, such as checking your heart rate and blood pressure, checking abnormal moles or looking for lumps.
- Extreme and overwhelming feelings of fear, anxiety, panic or dread.
- Panic attacks.
- Experiencing frequent or distressing nightmares about death or dying.
- Engaging in avoidance behaviours, particularly of certain places, situations or objects or experiencing the urge to run away or hide if you encounter anything triggering.
- Avoiding your loved ones.
- Feelings of anger, agitation or irritability.
- Feeling defenceless or vulnerable or like you are trapped and unable to escape.
- Feeling like you are losing control.
- Feeling detached from reality.
- Inability to function normally.
- Being unable to control your negative thoughts or feelings, even if you are aware that they are out of proportion with the danger.
- Having a sense of impending doom.
- Feeling like you are going to die.
What causes thanatophobia?
Thanatophobia has many possible causes. Different people have different experiences of what caused their phobia to develop. It could be that your phobia has one clear cause, or that multiple factors contributed to you developing thanatophobia.
Some people find it difficult to pinpoint exactly what caused their phobia to develop. However, being aware of the origin of your phobia can help you to address the root cause and any negative thought processes or feelings that are attached to the initial onset of your phobia, making it easier to treat your phobia and for you to cope with your symptoms.
Some of the most common causes of thanatophobia are:
- A traumatic experience related to death or dying
This could be a direct experience, meaning it happened to you. For example, having a near-death experience or experiencing extreme pain or fear when you were sick or injured (causing you to think you were dying) can result in you developing a fear of death. You could also have had an indirect traumatic experience, meaning you witnessed it happening to someone else. If you witnessed another person dying, particularly if the death was traumatic or violent, this can cause you to associate death with trauma, fear and pain and can result in you developing thanatophobia.
- A loved one dying
The experience of a loved one dying, particularly if this happened during your childhood or adolescence, can cause you to develop a fear of death. This is more likely to happen if your loved one dies in a traumatic or violent way, dies in pain, or dies suddenly and unexpectedly. You may also develop thanatophobia if your loved one is diagnosed with a terminal illness or begins to grow old, as you may begin to fear their death.
- Having religious beliefs
Although religion can be a source of comfort to many people when thinking about death or dying, for those who feel they have sinned or strayed from the path of salvation, they may fear death because they fear they will be judged negatively or will not be allowed into heaven, paradise, nirvana or their religion’s alternative. A person with strong religious beliefs who has not always followed their religion’s teachings may begin to fear death.
- Being diagnosed with a serious illness
Being diagnosed with a serious illness can make someone face their own mortality. Even if the illness is not immediately life-threatening, considering your own death or feeling like you could be close to dying can cause death anxiety, particularly in people who do not feel ready to die.
- A negative portrayal of death
TV shows and films often dramatise deaths, particularly deaths that are violent or traumatic. Although this is done for entertainment purposes, this is often the only exposure to death that many people have. It can cause someone to create a negative image of death and the idea of death can scare and distress them. This is particularly true if the exposure to these negative portrayals happened during childhood.
- Fear rumination
This is when you engage in repetitive negative thought processes and persistently and/or repetitively recap a traumatic or scary experience involving death. Over time, these thoughts and memories can become increasingly distressing and intrusive and can make you think about death as being traumatic, painful or scary. Fear rumination reinforces your natural fear responses and can result in you developing thanatophobia.
- A learned phobia
Known as an observational learning experience, many people learn to feel fear or anxiety because of their exposure to another person’s fear or anxiety. A learned phobia is more likely to occur if you are exposed to the fear during childhood or adolescence. If a close family member, such as a parent or sibling, has thanatophobia, you are more likely to develop the condition yourself.
- Hypersensitivity to pain
People who are hypersensitive to pain may have an extreme, negative response to pain or the possibility of pain. They can develop a negative association between death and pain and if they believe that they could experience great pain during the dying process, this can cause them to develop thanatophobia.
- 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 the number of violent deaths that occur, the number of young people that die every year or hearing about obscure or strange ways that people have died can cause you to develop a fear of death, particularly of death that is unexpected.
How is thanatophobia diagnosed?
A lot of people experience some fear or anxiety when thinking about death or dying or thinking about someone they love dying. Because negative connotations are frequently attached to death and many people experience negative thoughts and emotions in relation to death, it can be difficult to determine whether the thoughts, feelings and symptoms you are experiencing are normal or whether they qualify as thanatophobia.
If you experience negative patterns of thoughts, fear, anxiety or panic, or your fear is overwhelming and out of proportion, you may be experiencing thanatophobia.
To help you differentiate between a fear and a phobia, consider whether:
- Your fear and anxiety are out of proportion to the actual risks.
- Your fear impacts your ability to function in your everyday life or in certain situations.
- Your thoughts and feelings have a negative impact on your quality of life.
- Your symptoms occur when faced with your triggers or when thinking about death or dying.
- Your fear or anxiety results in avoidance behaviours.
- Your fear has a negative impact on your mental health or wellbeing.
If you think you could be experiencing thanatophobia, you should first visit your GP.
Your GP may look at a variety of things such as:
- Your symptoms.
- Your medical history.
- Any medication or supplements you take.
- Whether you have a family history of phobias.
If your GP thinks you could be experiencing thanatophobia, they will likely refer you to a psychologist or mental health professional.
The psychologist will ask questions about your fear of death and may conduct a phobia questionnaire that looks at:
- Your triggers.
- The type of symptoms you experience.
- The frequency and severity of your symptoms.
- How much your phobia interferes with your everyday life.
- When your phobia began and what caused the onset of symptoms.
To diagnose you with thanatophobia, your symptoms will be compared with the diagnostic criteria for specific phobias.
Your symptoms will need to fit with the seven key criteria below:
1. The fear must be persistent, excessive and unreasonable. It can occur either when you encounter a trigger or when you think about death or dying.
2. Exposure to your triggers 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 you.
4. You avoid your triggers where possible. If you are faced with your triggers, you will experience extreme fear, anxiety or distress.
5. The anticipation of death or dying and any avoidance behaviours you implement can have a significant impact on your day-to-day life.
6. The phobia has lasted for at least six months.
7. The phobia is not associated with another disorder or mental health condition.
If your symptoms fit the diagnostic criteria, you will receive a diagnosis of thanatophobia. Depending on the severity of your phobia, you may be offered treatment.
How is thanatophobia treated?
There are multiple treatment options for someone with thanatophobia. However, not all people with thanatophobia require treatment. If your symptoms are mild, you have implemented successful coping strategies or your phobia doesn’t significantly impact your day-to-day life and your wellbeing, you may not require official treatment.
However, if your fear of death or dying results in avoidance behaviours, causes you distress, impacts your life and wellbeing, or your symptoms occur frequently, treatment may be recommended.
A treatment plan that is personalised to you, the cause of your phobia, your symptoms and your triggers will be created to ensure maximum effectiveness.
Some of the considerations that will be made when creating your treatment plan include:
- How severe your symptoms are and how frequently they occur.
- What the root cause of your phobia is.
- How significantly your phobia impacts your life.
- Your overall health and wellbeing, including your mental health.
The most common treatment options for thanatophobia are:
Cognitive Behavioural Therapy:
Cognitive behavioural therapy (CBT) aims to change your negative patterns of thought and the associated emotions and behaviours in relation to death and dying. CBT can help you to address any unrealistic beliefs you have about death or the dying process.
It can also teach you some important techniques and coping strategies to help you manage negative and harmful thoughts about death or help you cope when faced with your triggers in the future.
CBT sessions can be done individually or as part of a group, with other people with thanatophobia. The sessions work to help you understand and manage your thoughts, feelings and behaviours and overcome your phobia.
CBT sessions will involve:
- Discussing your triggers and symptoms.
- Exploring what caused your fear of death or the dying process.
- Exploring your fears in more detail.
- Learning how to recognise your negative thoughts and change the way you are thinking.
- Learning coping strategies and calming strategies, such as deep breathing exercises, distraction techniques and coping statements.
Exposure therapy, also known as systematic desensitisation, involves you being gradually exposed to thoughts, places, objects and situations that trigger your phobia in a safe and controlled environment. The aim is to reduce your fear and anxiety responses so that you can eventually think about death or encounter previous triggers without experiencing symptoms.
As part of your sessions, you will work with the psychologist to assess your phobia and create a fear ladder of scenarios and situations that are the least to the most triggering. Your exposure will begin gradually, with a situation that creates the least phobic response, such as watching a video involving death. Once you are comfortable with this level of exposure, you will then progress to the next level.
Some common exposure techniques could include going to a hospital, writing your own will or planning your funeral and meeting someone who has a terminal illness. You will eventually lead up to the situation that creates your biggest phobic response.
Exposure therapy helps you to address the negative thoughts and emotions you experience in relation to death and the dying process and can help you to change your physiological and psychological responses. You will also learn relaxation and coping techniques.
Hypnotherapy uses a combination of guided relaxation techniques and focused attention. It helps you to identify the root cause or causes of your phobia and your common triggers and helps you change your thought patterns and any negative feelings you have about death and the dying process. Hypnotherapy helps you to change your perception of situations and reduce your phobic response.
Hypnotherapy can repattern your thoughts, memories and feelings towards death and the dying process. It can also teach you calming strategies, such as deep breathing and relaxation techniques which can help you to reduce your symptoms in the future.
Medication is not commonly prescribed for thanatophobia and other phobias, as it is often not very effective in treating phobias. However, you may be prescribed medication if you experience other mental health conditions, such as anxiety or depression or to manage your symptoms in a one-off, particularly triggering situation.
The types of medications you may be prescribed include:
- Selective serotonin reuptake inhibitors (SSRIs).