General Definition

Blood-Injection-Injury (BII) phobia is triggered when an individual comes in contact with or witnesses any type of injury or injection that results in exposure to blood. This fear can cause individuals, especially children, to become afraid of seeking medical attention if a mishap occurs.

Symptoms

When triggered, most people with a specific phobia experience an increase in blood pressure and an extreme amount of anxiety; however, an individual who has BII phobia experiences something different: first, the person’s blood pressure increases and then swiftly decreases the next moment. During this rapid change in blood pressure, a period of a vasovagal response occurs, which causes less blood and oxygen to be sent to the brain, resulting in loss of consciousness momentarily. The heart rate then slows down, due to the activation of the parasympathetic nervous system. The parasympathetic activation is believed to be associated with the disgust response, which is a characteristic of BII phobia, making it stand out from other phobias. Other symptoms can include extreme discomfort in the chest and tunnel vision.

Moreover, FMRI studies have confirmed that the activation level of the prefrontal cortex, which is responsible for controlling and regulating emotions, is lower in people with this type of phobia when exposed to a fear-inducing stimuli. This shows that people with BII phobia have less control over their emotions because of the lessened activity in their prefrontal cortex. This lessened emotional control could contribute to the high disgust reaction as well as less control over phobic symptoms, such as fainting.

Effects on a Person

BII phobia tends to have an affect on people's health, since the individuals with this phobia, usually avoid needles, vaccinations, and blood tests, making them susceptible to diseases and other health-related issues. Women, in particular, suffering from BII phobia, reported to have avoided pregnancy in fear of injections, vaccinations, and the pain associated with labor. BII phobia patients suffering from diabetes or multiple sclerosis are often unable to get injections and are thus more likely to discontinue their treatment.

Related Diseases

Dental phobia patients, similar to those with BII phobia, tend to avoid their source of fear. A study, done in 1998, examined the relationship between BII phobia and dental phobia, comparing the measures of fear and anxiety in patients with either condition. Upon the study’s completion, 57% of the dental phobic patients were classified as BII phobics as well.

BII phobia is also related to Hemophobia, but is not the same thing. Unlike BII phobia patients whose fears are tied with pain, needle breakage inside the body, or needle contact with the bones, hemophobia patients are more concerned about an exposure to blood, whether it is their own blood or someone else’s. However, both phobias have similar symptoms, and patients diagnosed with hemophobia are likely to be diagnosed with BII phobia as well.

Causes

The cause of BII phobia is not well known. Some studies show that specific genes make one more vulnerable to the phobia. Other studies suggest that just like any other phobia, BII phobia could be caused by a traumatic experience (Chapman). It has been proved that social stress amplifies BII symptoms, however, it is not a main cause.

Statistics

BII phobia is one of the more common psychiatric disorders, affecting about 3 to 4% of the general population, and in about 80% of the BII phobia cases, the patient experiences syncope or presyncope. After a random survey was completed in Aligarh, India, with 1648 male and 1613 female, it was found that a significantly higher percentage of females compared to males had BII phobia; 23.36% of females were diagnosed with BII phobia while only 11.19% of males were diagnosed. Females also fainted more often than males, at 64.09% compared to a male rate of 39.4%.

Furthermore, only 5.3% of BII phobia patients reported to have visited the hospital once or twice for consultation about BII phobia, however, without engaging in any kind of treatment.

Another study, involving participants from all 50 states and the District of Columbia, ages 65 years and older, found that a total of 386 participants disclosed having BII Phobia throughout their whole lifetime, 90% of those cases consisted of patients dealing with BII Phobia as well as other lifetime fears.

Treatments

Patients are typically sent to therapy for BII phobia in order to receive therapeutic treatments to calm their levels of anxiety and stress. Therapists use a combination of psychological and physical measures, such as applying muscle tension, in order to help the patient to be aware that there is certainly a needle in front of them.

A popular method of treatment for BII phobics is Cognitive-Behavior Therapy (CBT), which is a technique that allows the patient to become immune to their fear by being exposed to it. For BII phobics, patients are given pictures of needles or blood, they are also asked to draw pictures of these needles and speak about it. Afterwards, they are given an actual needle, and the goal is: by that point, that the patient is to be comfortable enough with their fear of needles and blood.

Some patients may refuse professional help for their phobia. Instead, a different type of treatment solely revolves around motivation and whether or not the patient is willing to undergo through treating their phobia with self-help. Similar to CBT, patients treat themselves by completing exercises to become immune to their fear. This requires no professional assistance and merely relies on the person.

Research on hypnotherapy has been looked upon to treat patients with BII phobia. Hypnotherapists are known for using relaxing therapies towards individuals with common anxiety issues. A form of therapy given to patients with BII phobia include the “Applied Tension” method, which was developed by Lars-Göran Öst and his colleagues at the University of Uppsala in Sweden. This “coping method involves creating tension on a person’s arms, legs, and chest until they start to feel their body temperature rising,” (Robertson) which usually occurs within 10 to 20 seconds. These sessions of muscle tension is repeated 5 times with 20 to 30 second breaks. Patients should complete this form of therapy over the course of 5 weeks. This helps to prevent the patient from fainting by applying tension to the body, the blood pressure steadily rises, preventing any sudden drop until their vaccination is complete. By using this treatment, there was a noticeable improvement by 90% of patients with BII phobia. Compared to patients that only used the relaxation methods, where only 60% showed noticeable improvement.

Along with muscle tension,there are several methods of physical maneuvers that can help with the treatment of BII phobia. Therapists suggest that while being injected, patients should perform movements, such as: leg crossing, muscle tensing, and holding in the breath. Patients are instructed by their therapist to perform these maneuvers simultaneously while being injected with a needle. It’s also recommended that the patient stays seated with their head lowered while performing these movements.