Nosocomephobia (phobia of hospitals): symptoms causes and treatments

All of us have been sick on some occasion, and we will have gone to a hospital or doctor's office in order to improve our situation and recover our health. Going to the hospital is not exactly a leisure or fun activity, but in general, and unless we are facing a serious problem, most people do it with some peace of mind.

However, it is not infrequent that it can cause us some concern: we go there to see a doctor to see if everything is fine... or not. In addition, some tests can be painful or annoying, and some people feel apprehensive when they have to visit certain units.

But for some people, going to the hospital is not something neutral or even slightly unsettling, but rather excruciating and terrifying. We are talking about people who feel panic and enormous anxiety at the mere idea 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 nosocomephobia, which we are going to talk about throughout this article.

• Related article: "Types of Phobias: Exploring Fear Disorders"

What is nosocomephobia?

A relatively rare phobia is called nosocomephobia and can have life-threatening implications for those who suffer from it: It is about the phobia of hospitals and health centers in general.

As a phobia that it is, 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 uncontrollably and generally the subject himself recognizes that his sensations are disproportionate to the possible danger that the stimulus in question could imply.

Exposure to it will trigger anxiety up to levels that the person considers unbearable and that can generate symptoms such as anxiety attacks in which tachycardia, hyperventilation, cold and profuse sweating, tremors, dizziness and/or sensation of dying or turning crazy. The degree of discomfort is such that the person will have to flee or escape from the situation, something that will lead to forward to avoid the phobic situation or, if necessary, remain in it with great suffering and wishing that I finished.

In the case of nosocomephobia this stimulus or situation that generates anxiety and will be avoided are hospitals, the idea of ​​entering or approaching them or any type of element that can be associated with them. Thus, it will not only be the image of a hospital or the idea of ​​getting closer that will generate anxiety, but it is also likely that the subject will feel Panic if you see an ambulance appear on the street, see bandages, surgical instruments, stretchers or waiting rooms, meet health workers, doctors or nurses or in some cases even simply at the sight of white coats, injuries or illnesses that may require assistance in one of said centers.

Although it is not necessary that they occur together, it is common for nosocomephobia to appear linked to latrophobia to doctors, nosophobia or fear of illness or of falling ill or even phobias of blood-injections-damage. 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 may also be a link to hypochondria., while the fear and conviction of being sick can lead some people to avoid going to the hospital (although it is more common for them to come very frequently) for fear that they could confirm their diagnosis.

• You may be interested in: "Hypochondria: causes, symptoms and possible treatments"

a dangerous phobia

Most phobias can become very disabling for the people who suffer from them, especially if the stimulus that generates anxiety is frequently present in the environment that surrounds them. Active avoidance of the stimulus and what is related to it will cause you to avoid certain areas, approach or relate to certain people or even not be able 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 invalidating it is at different levels and areas vital, in the case of nosocomephobia we are facing one that can pose a direct danger to the life and survival of the affected. And it is that those who suffer from this phobia will avoid going to hospitals and medical services, something that could cause them not to seek medical treatment in dangerous conditions, such as heart disease, trauma or infections among many others.

Although it is true that there is the possibility of calling the doctor and having him come to the home, in many cases it can instruments or technologies that are not easily transportable, or a sterile environment and watertight. And even some people may also ignore this option due to its association with the medical and hospital context.

In addition to their own survival, it can also have repercussions on a socio-affective level: there will be difficulties visiting people around them who for some reason are hospitalized, attend deliveries or births or say goodbye to loved ones in their last moments. It is also possible that the fear of catching a disease that takes them to the hospital may result in the avoidance or rejection of sick people even outside the center. This can cause fights and misunderstandings by the environment and society.

Possible causes and explanatory hypotheses

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

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

This same principle also explains the fact that in the event that there are phobias to doctors, to blood, to damage, to injections or to disease, or even germs, it is possible that sometimes the fear of such stimuli can become generalized and condition our response to the center in question. In this way, a stimulus that is initially neutral (the hospital itself) is related to what terrifies us (the damage, death or other 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 can be found in the experience of anxiety-producing situations in the past within 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 treatment or painful medical test (for example chemotherapy)... These situations can generate great discomfort and can trigger anxiety towards the environment in which they are produced. It 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 we are dealing with a type of phobia mainly linked to the idea of ​​damage. 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, can have a biological meaning.

As Seligman's theory of preparation proposes, some phobias may have been inherited at the phylogenetic level given that in the past avoiding such stimuli protected us and served to survive as a species. Although it may not be a direct case, it must be taken into account that there are cognitive factors that can link hospital with damage: although we can go to the hospital to be cured, basically this fact implies that we are suffering from some disease, which at a cognitive level can be difficult to accept.

Another possible cause can be found in the existence of worry 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 who suffer from it is highly recommended, due to the profound affectation or even risk that it can have for their lives. Fortunately, there are different alternatives that allow treating both these and other phobias with great success.

The first and most successful of them all is exposure therapy.. In it, a series of objectives and a hierarchy of stimuli or situations that generate anxiety 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 one of them. the items or stimuli (starting at intermediate levels) until the subject sees their anxiety reduced until it disappears or is controllable.

As each item is passed at least twice without anxiety or at least that it does not exceed a certain level, they will go on to the next item.

This technique is usually used live (in reality), but if it is not possible it can be used in imagination (in which, although it has less effect, it has also shown some utility). It is also possible to use 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 of highly controlled manner (although generally somewhat less effective than in vivo exposure, it is effective and may even serve as a pre-practice step in alive)

There is also systematic desensitization, whose main difference with the previous one is the fact that in the second one, instead of waiting for the reduce anxiety, the performance of an activity incompatible with this is considered, such as exercises relaxation.

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

In this sense, it may be of great interest to carry out various cognitive restructuring techniques that can be worked on aspects such as beliefs about what a hospital is, the evaluation of the real risk it entails, the link between hospital and pain, potential cognitive biases or dysfunctional beliefs or fear of loss of control or health and what such loss might suppose. They can also strengthen themselves and undergo training in stress management, self-esteem or perception of control.

Finally, the practice of relaxation techniques can be useful to reduce the anxiety felt before exposing yourself. Sometimes the use of tranquilizing drugs can also be useful, although some of them the reasons that may lead us to need to go to a hospital may require not consuming drugs.

Bibliographic references:

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