Nosophobia
| Nosophobia | |
|---|---|
| Specialty | Psychiatry |
Nosophobia,also known asdisease phobia[1]orillness anxiety disorder,[2]is the irrational fear of contracting adisease,a type ofspecific phobia.Primary fears of this kind are fear of contractingHIVinfection (AIDS phobia or HIV serophobia),[3]pulmonary tuberculosis(phthisiophobia),[4]sexually transmitted infections(syphilophobia or venereophobia),[5]cancer(carcinophobia),heart diseases(cardiophobia[6]), and catching thecommon coldorflu.
The wordnosophobiacomes from theGreekνόσοςnososfor "disease" and φόβος,phobos,"fear".[7]
Signs and symptoms
[edit]Nosophobia is listed under hypochondriacal disorders by theICD-10,which are defined by having a persistent preoccupation with the possibility of having at least one serious and progressive physical disorders.[8]Nosophobia is described as unfounded. Medical examination and reassurance is often sought,[9][10]but may also be avoided.[2]Avoidance of internal and external phobic stimuli is present. One case study describes a woman with a fear of heart disease (cardiophobia) who avoided people she thought were at risk ofheart attacksand avoided food containingcholesterol.[11]There are sometimes checking behaviors, such as examining the body for lesions that could beKaposi's sarcomaseen inAIDSpatients or spots that could beskin cancer.[10][11]
Possible causes
[edit]Psychodynamic theory
[edit]One theorized cause of nosophobia in medical students detailed in Hunter et al.'s study is based aroundpsychodynamictheory.[12]Any pre-existing "weaknesses, sensitivities or idiosyncrasies" react to the stresses and intense focus on the body, disease, and death that medical studies bring. Students identify familiar medical histories, such as of loved ones, past patients, or themselves, to current patients or the current self.Emotionally investingwith patients causes medical students to fashion their escalating worries after memories of loved ones or previous patients.
Media influences
[edit]Older literature suggests a flawed understanding of diseases, caused by media such as newspaper articles or uneducated gossip, could evoke fears surrounding disease.[13][14]
A review shows the trend between diseases commonly feared and their prevalence at the time.[9]For example, a 1911 public education campaign about tuberculosis caused patients to present with phthisiophobia. Similarly, fear of AIDS was studied in 1991, during theHIV/AIDS epidemicwhich was commonly broadcast on radio and TV.[10]Some nosophobia regardedbovine spongiform encephalopathyas the disease received during the mass media attention in the 1990s.[1]
Family history
[edit]One study showed those with nosophobia are significantly more likely to be younger siblings than a control group and the general population.[9]One theory is that younger siblings are raised by an older family and are therefore more likely to experience illness and death of ageing relatives. Younger siblings are more likely to report having coddling,overprotectiveparents (especially mothers), who show distress at injury or sickness, while also providing the reward of care and attention. Additionally, children were more likely to report the same kind of fear as their mothers. These children are said to become acutely aware and anxious of their "personal vulnerability" to disease and death. Significantly more participants in this study claimed to have sickness or low vitality as a child. For very specific phobias, such ascarcinophobia,there is often a family or personal history of the disease.[2]Both of these factors would impair confidence in "bodily health".
Treatments
[edit]Behavioral treatment
[edit]A 1988 pilot study of behavioral treatment showed statistically significant improvements in fear and reduced impact in home and work life, with follow-up showing success in some after a median of five years after treatment.[11]This study focused on reducing fear and abnormal behaviors like avoidance and reassurance-seeking. A similar 1991 study replicated these results with similar methods.[10]Methods used includedexposureto phobic stimuli,satiation(such as writing down fears in detail) andparadoxical intervention(such as exercising to "bring on a heart attack" ). Reassurance-seeking was prevented by informing family and doctors to not entertain requests for reassurance.[10]
Cognitive therapy
[edit]One patient in a case study was able to cease avoidance and rituals after completing a cognitive therapy session when behavioral therapy had failed. Methods changed beliefs by providing and discussing evidence. The patient's belief that he had AIDS fell from 95% to 30%.[10]
Medical reassurance
[edit]While earlier literature cites medical reassurance as comforting for some varieties of nosophobia, and it is often sought, more recent sources say the fear tends to persist even after medical examination and reassurance. Some evidence suggests medical examination and reassurance may actually worsen fears in the long term.[9][10]
Differential diagnoses
[edit]Many terms have been used to describe the transient hypochondriasis and fears of illness developed during medical studies. Nosophobia has been used to refer to this, as well asmedical student's disease,hypochondriasis of medical students, and medicalstudentitis.[15]
Hypochondriasis
[edit]There is a "confusion over the classification" differences between nosophobia and hypochondriasis, especially as some definitions, such as theICD-10,[8]consider nosophobia to be a subsection of hypochondriasis.[1][10]
Some authors have suggested that the symptoms seen in medical students should be referred to as "nosophobia" rather than "hypochondriasis", because the quoted studies show a very low percentage ofhypochondriacalcharacter of the condition.[12]
One way nosophobia differs from hypochondriasis is in specificity. Nosophobia causes those affected to fear a specific disease and is unlikely to transfer to a different disease or organ. In comparison, theICD-10definition of hypochondriasis includes the belief of the presence of multiple physical diseases. Another difference is in the phobic quality. Nosophobia manifests itself in "attacks", instead of the continuous worries those with hypochondriasis experience.[1]There are differences inbehavior.Nosophobia is associated with avoidance of internal and external stimuli while hypochondriasis often results in reassurance-seeking and checking behaviours.[1]
Prevalence
[edit]Estimates of prevalence vary. Early research found that at least 70% of medical students atMcGill Universityexperience nosophobia at some point during their undergraduate degrees.[12]Further research found that 79% of a random sample of medical students at theUniversity of Southern Californiahad a history of the phobia.[16]
Relatively more recent evidence from theUniversity of New Mexicosupports earlier research with at least 70% of students showing symptoms of hypochondriasis using the Illness Behavior Questionnaire and the Illness Attitude Scales. Medical students were significantly more likely than a control group of law students to show nosophobia symptoms like health precautions (e.g. avoiding smoking).[17]
See also
[edit]- Hypochondria
- Medical students' disease
- Nosocomephobia,the excessive fear of hospitals
- List of phobias
References
[edit]- ^abcdeSirri, Laura; Grandi, Silvana (2012)."Illness Behavior".The Psychosomatic Assessment.Advances in Psychosomatic Medicine.32:160–181.doi:10.1159/000330015.ISBN978-3-8055-9854-5.PMID22056904.
- ^abc"What Is Nosophobia?".WebMD.Retrieved2022-02-09.
- ^Mariner WK (November 1995)."AIDS phobia, public health warnings, and lawsuits: deterring harm or rewarding ignorance?".American Journal of Public Health.85(11): 1562–8.doi:10.2105/AJPH.85.11.1562.PMC1615706.PMID7485674.
- ^Riva MA, Ploia PR, Rocca S, Cesana G (September 2013). ""Phthisiophobia": the difficult recognition of transmission of tuberculosis to health care workers ".La Medicina del Lavoro.104(5): 359–67.PMID24180084.
- ^Janssen, Diederik F. (2020). "Noddle Pox: Syphilis and the Conception of Nosomania/Nosophobia (c. 1665–c. 1965)".Canadian Bulletin of Medical History.37(2). University of Toronto Press Inc. (UTPress): 319–359.doi:10.3138/cbmh.432-032020.ISSN0823-2105.PMID32822549.S2CID221239420.
- ^Eifert GH (July 1992). "Cardiophobia: a paradigmatic behavioural model of heart-focused anxiety and non-anginal chest pain".Behaviour Research and Therapy.30(4): 329–45.doi:10.1016/0005-7967(92)90045-I.PMID1616469.
- ^"What Is Fear of Getting Sick (Nosophobia)?".clevelandclinic.org.cleveland clinic. 2022-03-15.Retrieved2022-08-31.
The word nosophobia originates from the Greek words for disease, nosos, and fear, phobos.
- ^ab"ICD-10 Version:2019".icd.who.int.Retrieved2022-02-06.
- ^abcdBianchi, G. N. (December 1971)."Origins of Disease Phobia".Australian & New Zealand Journal of Psychiatry.5(4): 241–257.doi:10.1080/00048677109159654.ISSN0004-8674.PMID5292055.S2CID45352025.
- ^abcdefghLogsdail, Stephen; Lovell, Karina; Warwick, Hilary; Marks, Isaac (September 1991)."Behavioural Treatment of AIDS-Focused Illness Phobia".British Journal of Psychiatry.159(3): 422–425.doi:10.1192/bjp.159.3.422.ISSN0007-1250.PMID1958954.S2CID22274776.
- ^abcWarwick, Hilary M. C.; Marks, Isaac M. (February 1988)."Behavioural Treatment of Illness Phobia and Hypochondriasis".British Journal of Psychiatry.152(2): 239–241.doi:10.1192/bjp.152.2.239.ISSN0007-1250.PMID3167340.S2CID31960296.
- ^abcHunter RC, Lohrenz JG, Schwartzman AE (August 1964). "Nosophobia and hypochondriasis in medical students".The Journal of Nervous and Mental Disease.139(2): 147–52.doi:10.1097/00005053-196408000-00008.PMID14206454.S2CID34311871.
- ^Ryle, John A. (January 1948)."The Twenty-First Maudsley Lecture: Nosophobia".Journal of Mental Science.94(394): 1–17.doi:10.1192/bjp.94.394.1.ISSN0368-315X.
- ^Coster, Geraldine (September 2011).Psycho-analysis for normal people.ISBN978-1-4474-2600-4.OCLC1024313928.
- ^Salkovskis, Paul M; Howes, Oliver D (May 1998)."Health anxiety in medical students".The Lancet.351(9112): 1332.doi:10.1016/s0140-6736(05)79059-0.ISSN0140-6736.PMID9643804.S2CID36595251.
- ^Woods, S M; Natterson, J; Silverman, J (August 1966)."Medical students' disease: hypochondriasis in medical education".Academic Medicine.41(8): 785–90.doi:10.1097/00001888-196608000-00006.ISSN1040-2446.PMID4380602.
- ^Kellner, Robert (1986-05-01)."Hypochondriacal Fears and Beliefs in Medical and Law Students".Archives of General Psychiatry.43(5): 487–489.doi:10.1001/archpsyc.1986.01800050093012.ISSN0003-990X.PMID3964027.
