Nosocomephobia (hospital phobia): symptoms causes and treatments

This anxiety disorder is based on the fear of hospitals.

All of us have been sick at one time or another, and have gone to a hospital or doctor's office in an attempt to improve our situation and regain our health. Going to the hospital is not exactly a leisure or fun activity, but usually, unless we are faced with a serious problem, most people go with some peace of mind.

However, it is also not uncommon that it can generate some concern: we go there to see a doctor to assess whether everything is okay ... or not. In addition, some tests can be painful or uncomfortable, and some people are apprehensive about visiting certain units.

But for some people, going to the hospital is not something neutral or only slightly unsettling, but an ordeal and somewhat frightening. We are talking about people who feel panic and enormous anxiety at the mere thought of going to or even seeing a hospital, causing them even physical symptoms and greatly limiting their life and the maintenance of their health. This is what happens to people with nosocomefobiaof which we are going to speak throughout this article.

What is nosocomefobia?

It receives the name of nosocomefobia a relatively infrequent phobia and that can have dangerous implications for the life of those who suffer it: It is a phobia of hospitals and health care facilities in general..

As a phobia, it implies the existence of a deep level of panic and anxiety that appears irrationally and excessively in the presence of a specific stimulus or situation. These sensations appear in an uncontrollable manner and usually the subject himself recognizes that his sensations are disproportionate to the possible danger that the stimulus in question could imply.

Exposure to the stimulus will cause anxiety to be triggered to levels that the person considers unbearable and that can generate symptoms such as anxiety crises in which appear tachycardia, hyperventilation, cold and profuse sweating, tremors, dizziness and/or sensation of being dying or going crazy. The degree of discomfort is such that the person will have to flee or escape from the situation, something that will lead him henceforth to avoid the phobic situation or, if necessary, to remain in it with great suffering and wishing it to end.

In the case of nosocomephobia this stimulus or situation that generates anxiety and is to be avoided is the hospital.The idea of entering or approaching them or any type of element that can be associated with them. Thus, it is not only the image of a hospital or the idea of approaching it that will generate anxiety, but it is also likely that the subject will feel panic if he/she sees an ambulance appear in the street, sees bandages, surgical instruments, stretchers or waiting rooms, meets health workers, doctors or nurses, or in some cases even simply at the sight of white coats, injuries or diseases that may require assistance in one of these centers.

Although it is not necessary that they occur together, it is common for nosocomephobia to be linked to latrophobia of doctors, nosophobia or fear of illness or of falling ill or even phobias of blood-injection-harm. In fact, sometimes the presence of one of them can become generalized and spread to the medical center, being as we will see later one of its possible origins.

However, this is not necessary for its appearance, and technically it is possible to suffer from nosocomephobia without suffering from any of the others and vice versa. There can also be a link with hypochondriaThe fear and conviction of being sick can lead some people to avoid going to the hospital (although it is more common for them to go very frequently) for fear that their diagnosis could be confirmed.

A dangerous phobia

Most phobias can be very disabling for the people who suffer from them, especially if the stimulus that generates anxiety is frequently present in the environment around them. Active avoidance of the stimulus and what is related to it will cause him to avoid certain areas, approach or associate with certain people, or even not enjoy certain types of leisure, work or studies.They may avoid certain areas, approach or associate with certain people, or even be unable to enjoy certain types of leisure, work or studies. In some cases it may even make it impossible for them to leave their home.

However, in addition to the anxiety and discomfort felt and how disabling it is at different levels and vital areas, in the case of nosocomephobia we are facing one that can pose a direct danger to the life and survival of the affected person. Those who suffer from this phobia will avoid going to hospitals and medical services, something that could prevent them from seeking medical treatment. could prevent them from seeking medical treatment in dangerous in dangerous conditions, such as heart disease, trauma or infections, among many others.

While it is true that it is possible to call the doctor and have him or her come to the home, in many cases instruments or technologies that are not easily transportable, or a sterilized and watertight environment, may be required. And some people may even choose to forego this option because of its association with the medical and hospital setting.

In addition to their own survival, it may also have repercussions at the socio-affective level: there will be difficulties in visiting people in their environment who for some reason are hospitalized, attending births or deliveries, or saying goodbye to loved ones in their last moments. It is also possible that the fear of catching an illness that could lead to hospitalization may have The fear that they may become ill and go to the hospital may result in avoidance or rejection of sick people, even outside the facility. This can lead to quarrels and misunderstandings on the part of the environment and society.

Possible causes and explanatory hypotheses

The causes of nosocomephobia are not entirely clear and are generally not found in a single element but in an accumulation of variables, and has a multicausal origin. However, different hypotheses can be established in this regard.

Firstly, it should be borne in mind that hospitals are establishments where people with health problems come to be cured or to find out what is wrong with them. It is also a place where people sometimes spend their last moments before they die. We all know this, and it is an idea that can be transmitted socially. In this sense, one of the possible explanations would be that the center or what reminds us of it at a cognitive level has been conditioned with a stimulus that is in itself aversive: pain and suffering.

This same principle also explains the fact that in the case of phobias of doctors, blood, harm, injections or disease, or even germs, it is possible that sometimes the fear of these stimuli can become generalized and condition our response to the center in question. Thus, an initially neutral stimulus (the hospital itself) is related to what terrifies us (harm, death or another phobic stimulus) and ends up provoking in us a conditioned response of fear and anxiety.

Linked to this hypothesis we can suggest that another possible explanation may be found in the experience of anxiogenic 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 hospitalization in childhood, a painful medical treatment or test (e.g. chemotherapy)... These situations can generate great discomfort and can trigger anxiety towards the environment in which they occurred. This would be a conditioning of the response, as in the previous point, although in this case derived from past experiences.

In addition, it should be taken into account that we are dealing with a type of phobia mainly linked to the idea of harm. In this sense it is a phobia whose origin, in the same way that can occur with others such as the phobia of spiders or snakes, may have a Biological meaning.

As proposed by Seligman's priming theory, some phobias may have been inherited at the phylogenetic level. since in the past avoiding such stimuli protected us and helped us to survive as a species. Although it may not be a direct case, it should be taken into account that there are cognitive factors that may link hospital with harm: although we may go to the hospital to be cured, deep down this fact implies that we are suffering from some illness, which at a cognitive level may be difficult to accept.

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

Treatment of fear of hospitals

Treating nosocomephobia in those people who suffer from it is highly recommended, due to the deep affectation or even risk that it can have for their life. Fortunately, there are different alternatives that allow treating these and other phobias with great success.

The first and most successful of them all is exposure therapy.. In this therapy, a series of objectives and a hierarchy of anxiety-generating stimuli or 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 little by little the subject will be exposed to each of the items or stimuli (starting with intermediate levels) until the subject's anxiety is reduced until it disappears or becomes controllable.

As the subject overcomes each item at least twice without anxiety or at least without it exceeding a certain level, he/she will move on to the next item.

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

There is also systematic desensitizationwhose main difference with the previous one is the fact that in the latter, instead of waiting for the anxiety to be reduced, the performance of an activity incompatible with it, such as relaxation exercises, is proposed.

In addition to exposure, it is necessary to take into account that in nosocomephobia there may be very powerful cognitive factors that mediate or are at the basis of the anxiety felt.

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

Finally, the practice of relaxation techniques can be useful to reduce the anxiety felt before exposure. Sometimes the use of tranquilizing drugs can also be useful, although some of the reasons that may lead us to need to go to a hospital may require the non-consumption of drugs.

Bibliographical references:

• Bourne, E. J. (2005). The Anxiety & Phobia Workbook. New Harbinger Publications.
• Hamm, A. O. (2009). Specific phobias. The Psychiatric Clinics of North America. 32 (3): 577 - 591.