Some people have a fear of medical procedures at some point in their lifetime, which can include the fear of surgery, dental work, doctors, or needles. These fears are seldom diagnosed or treated, as they are often extinguished into adulthood and do not often develop into phobias preventing individuals from seeking medical attention. Formally, medical fear is defined as "any experience that involves medical personnel or procedures involved in the process of evaluating or modifying health status in traditional health care settings."
Iatrophobia is the extreme fear of medical attention, even with signs of a serious illness. The term "iatrophobia" comes from the Greek words iatros, meaning healer, and phobos, meaning fear. While there is no information regarding the prevalence of iatrophobia specifically, a survey found that 1 in 3 Americans avoid going to the doctor, even when they feel it is necessary. Rates of iatrophobia likely increased following the COVID-19 pandemic, where individuals experiencing iatrophobia avoided testing for the virus or visiting a physician with symptoms.
Classification Fear of medical procedures can be classified under a broader category of "blood, injection, and injury phobias". This is one of five subtypes that classify specific phobias. A specific phobia is defined as a "marked and persistent fear that is excessive or unreasonable, cued by the presence (or anticipation) of a specific object or situation." Often these fears begin to appear in childhood, around the age of five to nine. It is normal to become squeamish at the sight of blood, injury, or gross deformity, but many overcome these fears by the time they reach adulthood. Those who do not are more likely to avoid medical and dental procedures necessary to maintain health, jobs, etc. Research shows that when people encounter something that they have a specific phobia of many of them have a feeling of disgust which makes them not want to come near or experience the object or situation which is disgusting to them. This feeling of disgust, especially in the blood, injection, and injury phobias may be passed down in families. Women have been known to avoid becoming pregnant because it requires blood and medical examinations that they would rather avoid. Also, most individuals who experience phobias have an increased heart rate upon encountering the thing they fear, but blood, injection, injury-phobic people also seem to have an increase of fainting after the initial speeding up of heart rate. Their heart rate will go up and then slow again, leading to nausea, sweating, pallor, and fainting. This fainting can also lead to seizures, making life very difficult for those who have this fear. However, only 4.5% of individuals who have this phobia as a child will have this fear their entire lifetime. Additionally, procedural anxiety is frequently recognized in people who need to take part in medical procedures regularly. Due to their constant exposure to these procedures, patients may attend their treatments with recurrent experiences of significant anxiety, sometimes associated with previous negative experiences. For those who do experience this phobia in an extreme manner, specific coping treatments have been found to help them. Biological treatments, such as medications used for other anxiety ailments, are generally found to be inappropriate for fear of medical procedures or other specific phobias. Psychological treatments are the treatment of choice because they are more accurate at addressing the problem. Some of these treatments used especially for fear of medical procedures include exposure-based treatments, eye movement desensitization and reprocessing, and applied tension to react against fainting.
Signs and diagnosis A situational-specific phobia is defined as an extreme or irrational fear of or aversion to particular situations. While it can be common to feel nervous before a doctor appointment, iatrophobia expands beyond a general anxiety for medical experiences. Signs of iatrophobia include, but are not limited to:
Postponing or rearranging medical appointments, neglecting preventive care, or missing vaccinations. Managing symptoms independently rather than consulting a healthcare professional. Experiencing elevated blood pressure in clinical settings, known as white coat hypertension. Difficulty sleeping, skipping meals, crying, or struggling to focus due to anxiety about an upcoming medical visit. Feeling fearful of healthcare providers, hospitals, or specific illnesses, beyond just a fear of doctors.
In the recent past years post-COVID-19, people have become more wary of doctor visits due to virus exposure, and negative experiences during the pandemic, such as uncomfortable or painful swab tests, have created fearful attitudes towards clinical experiences. People with iatrophobia may be less likely to seek testing after a known virus exposure or symptoms.
Formal diagnosis according to the American Psychiatric Association (APA):
Experience an intense fear of doctors or medical tests for at least six months Symptoms begin or worsen when visiting a doctor, undergoing medical tests, or even thinking about such situations Intense fear or anxiety that leads to avoiding medical visits or tests, even when you are feeling sick Physical or emotional symptoms that negatively impact your overall health and daily life Overwhelming fear, anxiety, or a sense of dread that is out of proportion to any actual medical threat
Consistent avoidance of medical treatment can put patients at serious risk of medical issues and disease complications that affect future quality of life and longevity. Regular medical exams and tests, such as blood pressure and cholesterol levels, are crucial to sustaining good health.
Fear of surgery Fear of surgery or other invasive medical procedure is known as tomophobia. Fear of surgery is not a fear experienced often, but is still just as harmful as other phobias that are more common. Since surgery is not a common occurrence, the fear is based on inexperience or something that is out of the ordinary. Surgery is a strong stressor that can trigger physiological reactions such as tachycardia, hypertension, hyperventilation, hyperthermia, muscle tension, sweating, and psychological reactions such as fear, anxiety, and acute panic attacks. This fear is one of those categorized under all fears of medical procedures that can be experienced by anyone, all ages, and have little need for actual psychological treatment, unless it is uncharacteristically causing the patient to react in a way that would be harmful to his or her health.
Children Fear of surgery is common among young children. Christine Gorman, of Kids and Surgery, states "Surgery is scary enough for adults. But imagine what goes through the mind of a three-year-old when he sees a doctor or nurse all suited up and wearing a surgical mask: "It's a monster! It's got big eyes and no mouth! It's taking me away from Mommy and Daddy." No wonder half of all children from ages of 2 to 10 show evidence of distress—from bed-wetting to nightmares—for at least two weeks after their operation. Some of them remain traumatized even six months later." This statement shows that the fear that comes when young children go into surgery can be a serious matter because they are still traumatized by the effects for weeks after the surgery has taken place. Being scared of surgery has led to "eating disorders, sleep disturbances, regression to earlier levels of behavior, depression, and somatization such as loss of voice after tonsillectomy." Many children see surgery as a form of punishment and, since they sometimes can't see what they did "wrong", the fear is escalated, leaving greater chance for a longer effect on the psychological and emotional feelings of the child. Many ways have been tried to help children overcome this fear, including their parents and doctors simply telling them that the surgery won't hurt, or sedatives given by the doctor to minimize the feelings of anxiety later. There are certain types of treatments that have been proven to be better methods than others. Some hospitals allow parents to come into the surgery room and stay with the child, calming them until the anesthetic has taken effect. This is noted to keep anxiety down for both the parent and the child. If the child can enter the surgery calmly, there is much less of a chance that they will have many complications after the surgery due to fear. Other ways to treat the fear of surgery for children include having a doctor explain to them what the surgery is going to do and acting out the operation on a doll or stuffed animal. This makes the surgery something less scary and able to be understood in the child's mind. When the surgery is understood by the child, the fear of the unknown is less of a factor of how scared the child will be, and how much that will impact their reaction to the surgery.
Adults Children are not the only ones to express fear of surgery or have after effects that can affect their mental and physical well-being. Adults most fear the pain they expect to receive from the surgery. "The Roche Pain Management Survey polled 500 Americans, 27% of whom had surgery during the previous five years. Of those who had surgery, 77% reported pain afterwards, with four out of five of those saying they experienced moderate to extreme pain. 70%, indicated they experienced pain even after receiving medication; 80% reported they received pain medication on time, although 33% had to ask for it; and 16% had to wait for medication." Unlike children, adults seem to have less fear of the surgery itself, but rather fear of the effects of surgery.
Milano and Kornfeld in 1980 said "Any operation is a destructive invasion of the body and therefore frightens many patients". Some operations seem to invoke more fear from patients than others. Aged persons who require cataract surgery often fear the procedure, even though success is very likely. The fear of going blind because of the surgery is more apparent in women, who over all fear surgery more than men. The cataract is a disease that attacks the lens, causing it to swell until sight becomes obscured. Operation is recommended when the disease begins to hamper everyday activities. Even though becoming blind was the only option without the surgery, over 25% of the patients were afraid of becoming blind as a result of the surgery: 34% feared the failure of the operation. Ritva Fagerström, concerning the fears of cataract operation said, "These fears are understandable as the condition of the retina was not known in advance," Two women out of 75, taking part in a study dealing with the fear of cataract operation felt that the experience of the first operation was so bad that they would not agree to have the second eye operated on. If a patient had this fear, understandable, and did not go through with the surgery, the blindness that would follow would keep them from being able to do normal things, easily leading them into situations of depression, or other dangerous situations which would be destructive to their overall health.