What is Trypanophobia?

Trypanophobia is one of the most common types of phobia. It is particularly prevalent in children, with up to 66% of children experiencing a needle phobia at some point in their childhood. However, these statistics decline as the child ages and reduce significantly by adulthood, with approximately 10% of adults experiencing trypanophobia.

Today, we are going to look at trypanophobia in more detail, including common causes, triggers, symptoms and treatments.

What is Trypanophobia?

Trypanophobia, also known as needle phobia or injection phobia, is an intense, overwhelming and persistent fear of needles. Trypanophobia specifically refers to the fear of needles in medical settings, such as a hospital, doctor’s surgery or clinic, and needles used for medical procedures, such as blood tests, vaccinations and intravenous (IV) fluids.

Trypanophobia can be a serious phobia as it can cause people to avoid necessary or life-saving treatments or refuse to visit the doctor completely. Because trypanophobia is specific to medical needles, many people with the type of phobia don’t display a fear response when faced with non-medical needles, such as those used in tattoos and body piercings.

Trypanophobia is a type of specific phobia, meaning it is a lasting, overwhelming and unreasonable fear of a specific object, situation, activity or person, in this case, an overwhelming fear of needles. Trypanophobia is often referred to as a blood-injection-injury (BII) phobia, particularly within the NHS. Someone with a BII phobia may feel an intense and overwhelming fear when directly or indirectly exposed to needles.

BII phobias, including trypanophobia, differ from other types of phobias because a needle acts as a vasovagal syncope trigger. This means being exposed to needles can result in a vasovagal response, characterised by a sudden drop in heart rate and blood pressure which can lead to fainting.

Although many people dislike needles and may feel nervousness or anxiety before a medical procedure involving a needle, someone with trypanophobia will experience fear that is overwhelming and irrational. The fear of needles may also interfere with their overall wellbeing and sense of safety.

Because the vast majority of people feel some anxiety towards needles, determining whether you are experiencing fear or a phobia can be difficult. To meet the criteria for a phobia, your trypanophobia must:

• Include feelings of intense fear, panic or anxiety that are irrational and difficult to control or manage.
• Include fear that is out of proportion to the potential danger.
• Last longer than six months.
• Negatively impact your day-to-day life.

Even if you know your fear of needles is excessive, you may be unable to control your physiological and psychological response to them.

Trypanophobia can exist on its own, or in conjunction with other phobias, including:

• Thanatophobia: An extreme fear of death or dying.
• Haemophobia: An extreme fear of blood.
• Nosocomephobia: An extreme fear of hospitals.
• Iatrophobia: An extreme fear of doctors or medical tests.
• Merinthophobia: A fear of being restrained or bound.

How Common is Trypanophobia?

Trypanophobia is particularly common in children. Research suggests that between 33% and 66% of children have a phobia of needles. However, many children grow out of their phobia as they get older. Even though many people become less afraid of needles as they get older, it is thought that 10% of adults still have a phobia of needles.

However, these figures are thought to be increasing following the Covid-19 pandemic. This is likely because of the misinformation and harmful news regarding dangerous side effects and the risk of death that was spread around the world following the introduction of the Covid-19 vaccination.

Although phobias are typically an under-diagnosed mental health condition, people with trypanophobia are more likely to receive a diagnosis than with some other types of phobias. This could be because symptoms, such as the vasovagal response, can be more severe. It could also be that trypanophobia prevents you from getting important medical procedures, resulting in you or your doctor recognising that you are experiencing a phobia.

Because needles are generally considered to be unpleasant, negative thoughts and reactions to needles can occur on a spectrum, ranging from low levels of fear, anxiety and dislike to severe fear, panic and anxiety that can impact your ability to function in your day-to-day life, prevent you from having medical procedures done or affect your overall wellbeing.

Who is at risk of Trypanophobia?

Although anyone can develop trypanophobia, there are certain risk factors that can increase your likelihood of developing a needle phobia.

These can include:

• Having another blood-injection-injury (BII) phobia.
• Having a history of anxiety, depression or panic attacks.
• Having another relevant phobia, such as iatrophobia or nosocomephobia.
• Having a close family member with trypanophobia.
• Having a close family member with another type of phobia.
• Being exposed to the fear of needles during childhood.
• Being a naturally more anxious or fearful person.
• Having a traumatic, negative or painful experience with needles, particularly during childhood.

It is important to keep in mind that even if you have some of the above risk factors, this does not mean you are going to develop trypanophobia. A person who has an anxiety disorder and has a parent with trypanophobia may never develop the phobia themselves. On the other hand, a person with none of the above risk factors may develop trypanophobia.

Trypanophobia is significantly more common in children than in adults. Although it can develop at any age, the majority of adults who have trypanophobia developed the condition during childhood. The fear of needles usually develops between the ages of 4 and 6, and the percentage of people with trypanophobia steadily decreases from this age. Similarly to other phobias, trypanophobia is more common in females than males.

How to deal with Trypanophobia?

Many people with trypanophobia think the best way to deal with their fear of needles is to avoid them. However, although this may work in the short term, it isn’t realistic that you can avoid needles for the rest of your life.

Needles in a medical setting can help to diagnose certain conditions, administer important vaccinations and even provide life-saving treatment. If you don’t address your phobia and deal with your symptoms and triggers, you may find yourself avoiding essential treatment or may experience more severe symptoms when faced with needles in the future.

Learning coping strategies that can help you deal with the symptoms of your phobia can help to reduce the impact your phobia has on your life. It can help to reduce avoidance behaviours and can help you to manage your phobia more effectively. Coping strategies can also help you to reduce or alleviate your symptoms if you are faced with your trigger in the future.

Some coping strategies and long-term phobia management techniques you can implement include:

• Learn about your phobia – Thinking about what initially caused your phobia and what your triggers are can help you to understand your phobia and rationalise your thoughts and emotions. This can help you to manage your symptoms more effectively.
• Create a fear ladder – A fear ladder allows you to analyse your phobia and determine which situations cause you the most anxiety. For example, your fear ladder could look like this:
  1 = Having a blood test.
  2 = Having an injection or another type of needle.
  3 = Seeing a needle in real life.
  4 = Watching a video involving a needle.
  5 = Seeing a picture of someone having a needle.
  6 = Hearing someone talking about having a needle.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).
• Talk to your doctor – If your doctor or another healthcare worker has said that you require a needle, informing them of your phobia can help them to take your fears into consideration and treat you accordingly. They can also help to ensure the environment is calm and stress-free, so as not to exacerbate your symptoms.
• Use medication or a topical anaesthetic cream – Many people develop a phobia of needles because of the association between pain and needles. By removing the pain, or the fear of pain, this can help people to overcome their fear.
• Use the show and tell approach – This approach is particularly successful with children with trypanophobia. Showing them the needle and syringe and how an injection works can help to take away the fear. Many people fear the unknown, so having a greater understanding of needles can be beneficial. If the child has a condition such as diabetes, where they will have to be injected or inject themselves regularly, practising injections on an object or teddy bear can help them overcome their phobia.
• Reduce the risk of the vasovagal response – The fear of fainting and the physical symptoms you feel in the lead-up to fainting can reinforce your phobia and exacerbate your fear. Lying down with your feet elevated and repeatedly tensing and relaxing your hands, feet and leg muscles can help to prevent the vasovagal response.
• Implement distraction techniques – If you are in a triggering situation or you need to have a needle, implementing distraction techniques can help to reduce your physiological and psychological responses to your trigger. Distraction techniques could include listening to music, engaging in conversation, reading, playing a game or watching a video. Focusing on something external, such as a ticking clock or passing traffic, can also help.
• Challenge negative thoughts – Remind yourself that you are not in any danger and that needles in a medical setting pose an extremely low risk. Educating yourself with facts and information about the importance of needles, why there are used in medicine and the low risks can also help you to challenge your negative thoughts. Remind yourself that your fear is irrational, you are not in any danger, and the negative feelings you have will pass.
• 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.
• 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 needles.
• 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. Staying hydrated, particularly in the lead-up to a triggering situation can also be beneficial, as dehydration can increase the likelihood of a vasovagal response. Avoiding caffeine, sugar and other stimulants can also be beneficial as these can increase your heart rate and blood pressure and worsen your physiological symptoms.

What triggers Trypanophobia?

Trypanophobia can have different triggers for different people. Your triggers can depend on what initially caused your trypanophobia, the severity of your symptoms and your current mental health.

Some of the most common triggers for trypanophobia are:

• Having a medical needle, including vaccinations, injections, blood tests and IVs.
• Being told you require a medical needle.
• Attending a medical setting, such as a hospital or a clinic, even if you aren’t there to have a needle.
• Having a medical procedure done, even if no needles are involved.
• Seeing a needle or a syringe.
• Seeing something you associate with needles, such as cotton wool balls, small plasters or blood.
• Seeing a needle on TV or in a film or seeing a picture of a needle.
• Hearing that someone else is having a needle.

What are the symptoms of Trypanophobia?

The symptoms of trypanophobia can vary from person to person and situation to situation, depending on the severity of your phobia, your triggers, your current mental health and wellbeing, and your coping strategies.

Some people experience mild symptoms, whereas others experience more severe symptoms. The severity of your symptoms can also vary depending on the perceived threat and the proximity of the needle. For example, you may experience more severe symptoms if you are in your GP’s surgery waiting to have a blood test, compared to if you see a blood test on TV.

The symptoms of trypanophobia are often similar to the symptoms of anxiety or panic attacks. However, it is important to note that not every person will have the same symptoms.

Symptoms can be both physiological and psychological and can include:

Physiological Symptoms:

• A sudden drop in your heart rate.
• A sudden drop in your blood pressure.
• Fainting (also known as syncope).
• Dizziness, light-headedness or feeling like you are going to faint.
• Feeling like your heart is racing or pounding or you have heart palpitations.
• Feeling confused or disorientated.
• Sweating, chills or hot flushes.
• Rapid breathing, breathlessness, hyperventilating or difficulty breathing.
• Nausea, vomiting or stomach distress.
• Insomnia.
• A dry mouth.
• A choking sensation or the feeling that something is blocking your throat.
• Chest pains or a tight feeling in your chest.
• A loss of appetite.
• Unusual paleness or flushing in your skin, particularly your face.
• Numbness or tingling.
• Headaches.
• Feeling like you are unable to move.

A common physiological symptom in people with trypanophobia is a vasovagal response, where they experience a sudden and potentially dangerous drop in their blood pressure and heart rate. In extreme cases, this reduction in cardiac activity can result in cardiac arrest and even death. If you are concerned that the symptoms that you or someone else are experiencing are serious, seek medical help immediately, by calling 999 or 111.

Psychological Symptoms:

• Overwhelming feelings of fear, terror or panic.
• Overwhelming feelings of anxiety.
• Feeling detached from yourself or unable to move when faced with a needle.
• Feeling you are losing or have lost control.
• Feeling trapped or unable to escape.
• Feeling like you want to run away and hide.
• A sense of impending doom.
• An extreme fear of death or dying when faced with a needle.
• Avoiding injections, vaccinations, blood tests and any medical procedures that may involve a needle.
• Avoidance of places and situations where you may encounter needles.
• Anticipatory anxiety in the lead-up to a triggering situation.
• Insomnia or difficulty sleeping in the lead-up to a triggering situation.
• An inability to control your fear, pain or anxiety, no matter how unreasonable you know it is.

Symptoms often manifest differently in children experiencing trypanophobia. Children are more likely to display symptoms such as:

• Crying.
• Screaming, lashing out or having a tantrum.
• Running away or trying to run away.
• Hiding.
• Becoming clingy to their parent or caregiver.

What causes Trypanophobia?

The exact cause of trypanophobia is unknown. There are several reasons why someone might develop trypanophobia. It could be that your phobia has one single cause, or that multiple factors contributed to you developing a fear of needles. It could also be that your phobia has no clear cause.

Some of the most common causes of trypanophobia include:

• A negative or traumatic experience – Having a previous negative or traumatic experience involving needles, either as a child or an adult, can result in a person developing trypanophobia. This experience is usually direct, meaning it happened to you. However, it can also be indirect, meaning you witnessed the event happening to someone else; for example, a child witnessing a younger sibling being extremely upset and in pain following an injection can result in a phobic response.
• Hypersensitivity to pain – People who are hypersensitive to pain, also known as hyperalgesia, are often particularly sensitive to pain and have an extreme response to pain. The increased pain they feel when having an injection or blood test can result in them negatively associating needles with pain and developing a phobic response.
• Negative association – The shock reflex can cause you to feel pain and negative emotions when your skin is punctured by a needle. This can cause you to associate needles with pain and fear. This is known as a learned phobic response and may happen after a person (usually a child) has had several negative experiences with needles.
• Fear rumination – This is when you engage in a repetitive negative thought process and persistently and repetitively recap a negative experience with needles or think about needles in a negative way. Over time, these memories can become increasingly distressing and intrusive and can make you remember your encounter with needles as being more painful and scary than it actually was. Fear rumination reinforces your fear responses and can result in you developing a phobia.
• An evolutionary basis – Trypanophobia may have an evolutionary basis. Some evolutionary psychologists believe that a fear of needles may have been developed by our ancestors as a survival technique. Puncture wounds, from snake bites or stabbings, were likely to be fatal and fearing things that can puncture your skin may have developed as an evolutionary response to this perceived danger.
• A learned phobia – If you have a close family member, such as a parent or sibling, or a close friend who has trypanophobia, you are more likely to develop the same phobia. This is particularly true if you are exposed to the phobia during childhood.
• Media portrayal – You can develop a phobia from something you’ve seen on TV or in a movie. If you were exposed to distressing scenes on TV involving needles, for example, someone dying from an injected drug overdose or dying during a medical procedure involving needles, this could create a negative association in your mind, particularly if the exposure happened during childhood.

How is Trypanophobia diagnosed?

Differentiating fears from phobias can be difficult, particularly in phobias such as trypanophobia. This is because the majority of people dislike needles and feel some anxiety or fear before a medical procedure involving a needle.

If you are unsure whether you are experiencing a fear of needles or a phobia, consider whether your fear of needles:

• 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.

If you suspect you are experiencing trypanophobia, your first step will be to visit your GP. Visiting your GP earlier, before your symptoms worsen and your phobia overwhelms you, is recommended. This can ensure you get treatment and learn coping strategies earlier.

During your appointment, your GP will ask whether you have any other mental health conditions, anxiety or panic disorders or other phobias or extreme fears. They will also look at your medical history and ask about your family history, for example, whether you have a close relative with trypanophobia. Your GP will also look at any medication or supplements that you take, to ensure your symptoms cannot be attributed to another source.

Once your GP has conducted their initial examination, they will then refer you to a psychologist or another mental health professional. The psychologist will ask for specific 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.

The psychologist will consider your symptoms against the diagnostic criteria for phobias. To assist them, they will likely conduct a psychological evaluation and a phobia questionnaire. They will look at when your symptoms began and what originally triggered your phobia.

To receive an official diagnosis of trypanophobia, the symptoms must fit the seven criteria listed below:

1. The fear must be persistent, excessive and unreasonable. It can occur either when needles are present or when they are not present, e.g. if you see a picture or video or think about an injection.
2. Exposure to needles 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 needles or avoids any procedures where they may need an injection, a blood test or another type of needle. If they encounter needles, the individual will experience extreme fear, anxiety or distress.
5. The anticipation of encountering needles 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.

How is Trypanophobia treated?

There are many different treatment options available for people with trypanophobia and the treatment you will be recommended will depend on:

• The frequency and severity of your symptoms.
• The root cause of your phobia.
• How significantly your phobia impacts your life.
• Your overall health and wellbeing, including your mental health.

Some people don’t require treatment for their phobia and manage their symptoms themselves. However, if your phobia negatively impacts your life or affects your willingness to have medical procedures, treatment could be beneficial. Your doctor or psychologist will likely create a treatment plan specific to you.

The most common treatments for trypanophobia are:

Exposure Therapy

Also known as systematic desensitisation, this can be an effective way of treating trypanophobia in both children and adults. You will be exposed to needles in a gradual way in a safe and controlled environment. Your phobia will be assessed and then a psychologist will create a series of needle-related exposures for you to face.

Your exposure will be gradual, for example, it may begin with looking at a picture of a needle. Once you are comfortable with this level of exposure, you will then move on to the next level, which could be talking about injections or watching a video of someone having a needle. Exposure therapy can address the negative thoughts and emotions you experience in relation to needles and can help you to change your physiological and psychological response to needles.

Cognitive Behaviour Therapy (CBT)

Cognitive behaviour therapy is a popular treatment option for people with phobias. It helps you to identify and change your negative perceptions and thoughts surrounding needles and the associated emotions and behaviours you experience. It can also help you to address the root cause of your phobia.

During your CBT sessions, you will likely:

• Discuss your triggers and symptoms.
• Explore what caused your needle phobia.
• Explore your fears in more detail.
• Learn how to recognise your negative thoughts and change the way you are thinking.
• Learn coping strategies.
• Learn calming strategies.

CBT will teach you a variety of coping strategies, such as:

• Deep breathing exercises.
• Coping statements and rational thoughts.
• Distraction techniques.

CBT can be done individually or as part of a group.

Rational Emotive Behaviour Therapy (REBT)

This is an action-oriented form of therapy that helps you to identify negative and irrational beliefs and thought patterns. It is a type of CBT that is used less frequently but can still be extremely effective in treating phobias. It can help you to manage your thoughts and any unhealthy emotions, behaviours and attitudes centred on needles.

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 root cause of your trypanophobia and help you change your thought patterns and any negative feelings you have about needles. 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 needles. Hypnotherapy can also teach you deep breathing and relaxation techniques to help you to reduce your phobic response.

Medication

You may be prescribed medication if other treatment options fail, or if your phobia is particularly severe. In many cases, medication will only be offered in conjunction with other treatments, such as CBT.

Some possible medications that you may be offered include:

• Anti-anxiety medication.
• Beta-blockers.
• Selective serotonin reuptake inhibitors (SSRIs).