Nosocomophobia (phobia in hospitals): causes of symptoms and treatments

We have all been ill at one time, and we will have gone to a hospital or a doctor’s consultation in order to improve our situation and be healthy. Going to the hospital is not much of a leisure or fun activity, but in general and unless we are faced with a serious problem, most people go through their peace of mind.

However, it is not uncommon for us to be worried: we go there to see a doctor to assess whether everything is fine … or not. In addition, some tests can be painful or embarrassing, and some people experience apprehension when they have to visit certain units.

But for some people, going to the hospital is not something neutral or just a little disturbing, but torture and a little scary. We are talking about people who experience panic and tremendous anxiety at the very thought of going or even seeing a hospital, giving them the very idea of ​​physical symptoms and severely limiting their life and the maintenance of their health. This is what happens to people with nosocomophobia, Which we will talk about throughout this article.

    What is nosocomophobia?

    It’s called nosocomephobia, a relatively rare phobia that can have dangerous implications for the lives of those who suffer from it: this is the phobia in hospitals and health centers in general.

    As phobia as it is, it involves the existence of a deep level of panic and anxiety that arises irrationally and excessively in the presence of a specific stimulus or situation. These sensations appear uncontrollably and in general the subject himself recognizes that his sensations are out of proportion to the possible danger that the stimulus in question might involve.

    Exposure to it will trigger anxiety at levels that the person finds unbearable and may lead to symptoms such as anxiety attacks in which tachycardia, hyperventilation, cold and profuse sweating, tremors, dizziness and / or a feeling of dying or going mad. The degree of discomfort is such that the person will have to flee or escape from the situation, which will cause them to avoid the phobic situation or, in case of need, to be there with great pain and wish it was over.

    In case of nosocomophobia this stimulus or situation that generates anxiety and that will be avoided are hospitals, The idea of ​​entering or approaching them or any type of element that could be associated with them. Thus, it will not only be the image of a hospital or the idea of ​​approaching which will generate anxiety, but it is also likely that the subject will panic if he sees an ambulance appearing in the street, sees bandages, surgery. instruments, bunk beds or waiting rooms, you will find health workers, doctors or nurses or in some cases even just the sight of white robes, injuries or illnesses that may require assistance in one of these centers .

    Although they do not need to be administered together, it is common for nosocomophobia to appear to be related to latrophobia in doctors, nosophobia or fear of illness or disease or even injection phobias. blood-pain. In fact, sometimes the presence of one of them can become generalized and spread in the medical center, being as we will see later one of its possible origins.

    However, this is not necessary for its occurrence, and it is technically possible to suffer from nosocomephobia without suffering from any of the others and vice versa. There may also be a link with hypochondria, Fear and belief that they are sick can lead some people to avoid going to the hospital (although it is more common that they go there very often) for fear of confirming their diagnosis.

      A dangerous phobia

      Most phobias can become very disabling for people who suffer from them, especially if the stimulus that generates anxiety is often present in the environment around them. Actively avoiding the stimulus and what goes with it will cause you to avoid certain areas, Approaches or interacts with certain people or even those who cannot enjoy certain types of hobbies, work or study. In some cases, this can even prevent them from leaving their homes.

      However, in addition to the anxiety and discomfort felt and the disability that results in different levels and areas of life, in the case of nosocomophobia we are faced with a situation that can pose a direct danger to the patient. life and survival of the patient. And will those who suffer from this phobia avoid going to hospitals and medical services, which this could prevent them from seeking medical treatment in dangerous conditions, such as heart disease, trauma or infection, among others.

      While it is true that it is possible to call the doctor and go home, in many cases you may need instruments or technologies that are not easily transportable, or a sterilized environment. and waterproof. And even some people may even ignore this option due to its association with the medical and hospital setting.

      In addition to their own survival, this can also have socio-emotional repercussions: there must be difficulties visiting people in their environment who for some reason are hospitalized, attending births or deliveries or saying goodbye to his loved ones in his last moments. It is also possible that the fear of being entrusted with an illness taking them to hospital can lead to avoidance or rejection of sick people even outside the center. This can lead to fights and misunderstandings on the part of the environment and society.

      Possible causes and explanatory hypotheses

      The causes of nosocomophobia are not entirely clear and are usually not found in a single item but in a group of variables, and he has a multicausal origin. However, different assumptions can be made in this regard.

      First of all, it should be borne in mind that hospitals are establishments where people with health problems go for treatment or to find out what is happening to them. It is also a place where people sometimes spend their last moments before dying. We all know that, and it’s an idea that can be transmitted socially. In this sense, one of the possible explanations would be the fact that he conditioned the center or what reminds it at the cognitive level with a stimulus in itself aversive: pain and suffering.

      This same principle also explains the fact that in case of phobias of doctors, blood, lesions, injections or diseases, even germs, it is possible that sometimes the fear of these stimuli can generalize and condition our response to center in question. In this way, a stimulus at the neutral principle (the hospital itself), is linked to what terrifies us (evil, death or other phobic stimulus) and ends up provoking in us a conditioned response of fear and anguish.

      Related to this hypothesis, we can suggest that another possible explanation can be found in the experience of anxious situations in the past in a medical or hospital context: The experience of the illness and death of a loved one, the diagnosis of a serious illness, a long hospital stay in childhood, a painful medical treatment or a test (for example chemotherapy) … These situations can generate great discomfort and can trigger anxiety towards the environment in which it occurred. This would be a conditioning of the response, as in the previous point, although in this case derived from past experiences.

      In addition to this, it should be borne in mind that this is a type of phobia mainly related to the idea of ​​harm. In this sense the origin is a phobia, just as it can happen with others like the phobia of spiders or snakes, it can have a biological significance.

      As Seligman’s preparation theory suggests, some phobias may have been inherited at the level phylogenetic because in the past, avoiding these stimuli protected us and helped us survive as a species. Although this may not be a direct case, it should be remembered that there are cognitive factors that can link the hospital to harm: although we may go to the hospital for treatment, this fact implies ultimately we suffer from some prejudice, which cognitively can be difficult to accept.

      Another possible cause can be found in the existence of worry or fear of losing control of oneself: in the hospital becomes a patient, a passive being subjected to the criteria of another human being with a decision-making power over us.

      Treatment of fear in hospitals

      Treating nosocomophobia in those who suffer from it is highly recommended, because of the deep affect or even the risk it can have for their life. Fortunately, there are different alternatives that can successfully treat these and other phobias.

      The first and most effective of all is exposure therapy. In it, a series of objectives and a hierarchy of stimuli or anxiety-inducing situations are established between the professional and the patient. This hierarchy will be ordered according to the degree of anxiety it generates, and in a structured way and will gradually expose the subject to each of the items or stimuli (starting with the intermediate levels) until the subject sees his anxiety reduced. until it disappears or is controllable.

      As you go through each item at least twice without any anxiety or at least it does not exceed a certain level, you will move on to the next item.

      This technique is usually used live (in reality), but if this is not possible, it can be used in the imagination (in which, although it has less effect, it has also shown some usefulness. ). It is also possible to use the exposure in virtual reality, generating a virtual environment in the form of a hospital or consultation in which the subject is exposed to various stimuli in a highly controlled manner (although in general it is is slightly less effective than live exposure, it is effective and could even serve as a prelude to live practice)

      There is also systematic desensitizationThe main difference with the previous one is the fact that in the second instead of waiting for the anxiety to decrease, we consider the performance of an activity incompatible with it, like relaxation exercises.

      In addition to exposure, it should be noted that in nosocomephobia there may be very powerful cognitive factors that are present or included at the basis of the anxiety experienced.

      In this sense, it may be of great interest to implement various cognitive restructuring techniques in which aspects such as beliefs about what a hospital is, the assessment of the actual risk involved, the link between the hospital and pain, can be worked on. possible cognitive biases or dysfunctional beliefs or fear of losing control or health and what that loss could cause. Training in stress management, self-esteem or the perception of control can also be reinforced and carried out.

      Finally, the practice of relaxation techniques can be useful in reducing the anxiety felt before exposure. Sometimes the use of tranquilizers can also be helpful, although some of the reasons that may cause us to need to go to the hospital may require not taking medication.

      Bibliographical references:

      • Bourne, EJ (2005). The Anxiety and Phobia Workbook. New publications from Harbinger.
      • Hamm, AO (2009). Specific phobias. Psychiatric clinics in North America. 32 (3): 577-591.

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