Therapies – Fears and Phobias


We are born with only two fears: fear of falling and fear of loud noises. All other fears are learned! If those fears are learned, then they can be unlearned. Your fear or phobia was acquired through a bad experience (association) and the pain/pleasure principle (you had a bad experience which gave you pain. You continue to express that phobic nature because it gives you pleasure). Fears and phobias can affect your normal life drastically. Yet it is a relatively simple process to undo the fear or phobia. Surprisingly glucose insensitivity (blood sugar) can have an adverse effect on fears and phobias. Hypnotherapy is a valuable tool in curing fears and phobias. Hypnotherapy has a very high success rate in this area.




Please click on any of the issues below to find out about it in more detail.


Public Speaking

Public speaking (sometimes termed oratory or oration) is the process or act of performing a presentation (a speech) focused around an individual directly speaking to a live audience in a structured, deliberate manner in order to inform, influence, or entertain them. Public speaking is commonly understood as the formal, face-to-face talking of a single person to a group of listeners. It is closely allied to "presenting", although the latter is more often associated with commercial activity. Most of the time, public speaking is to persuade the audience.

Social Phobia

Social anxiety disorder (SAD), also known as social phobia, is an anxiety disorder characterized by an intense fear in one or more social situations causing considerable distress and impaired ability to function in at least some parts of daily life. These fears can be triggered by perceived or actual scrutiny from others. It is the most common anxiety disorder and one of the most common psychiatric disorders, with 12% of American adults having experienced it.

Physical symptoms often accompanying social anxiety disorder include excessive blushing, excess sweating, trembling, palpitations and nausea. Stammering may be present, along with rapid speech. Panic attacks can also occur under intense fear and discomfort. Some sufferers may use alcohol or other drugs to reduce fears and inhibitions at social events. It is common for sufferers of social phobia to self-medicate in this fashion, especially if they are undiagnosed, untreated, or both; this can lead to alcoholism, eating disorders or other kinds of substance abuse. SAD is sometimes referred to as an 'illness of lost opportunities' where 'individuals make major life choices to accommodate their illness.' Standardized rating scales such as the Social Phobia Inventory, the SPAI-B and Liebowitz Social Anxiety Scale can be used to screen for social anxiety disorder and measure the severity of anxiety.

The first line treatment for social anxiety disorder is cognitive behavioral therapy with medications recommended only in those who are not interested in therapy. Cognitive behavioral therapy is effective in treating social phobia, whether delivered individually or in a group setting. The cognitive and behavioral components seek to change thought patterns and physical reactions to anxiety-inducing situations. The attention given to social anxiety disorder has significantly increased since 1999 with the approval and marketing of drugs for its treatment. Prescribed medications include several classes of antidepressants: selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), and monoamine oxidase inhibitors (MAOIs). Other commonly used medications include beta blockers and benzodiazepines.


Hypochondriasis also known as hypochondria, health phobia, health anxiety or illness anxiety disorder, refers to worry about having a serious illness. This debilitating condition is the result of an inaccurate perception of the condition of body or mind despite the absence of an actual medical condition. An individual suffering from hypochondriasis is known as a hypochondriac. Hypochondriacs become unduly alarmed about any physical or psychological symptoms they detect, no matter how minor the symptom may be, and are convinced that they have, or are about to be diagnosed with, a serious illness.

Often, hypochondria persists even after a physician has evaluated a person and reassured them that their concerns about symptoms do not have an underlying medical basis or, if there is a medical illness, their concerns are far in excess of what is appropriate for the level of disease. Many hypochondriacs focus on a particular symptom as the catalyst of their worrying, such as gastro-intestinal problems, palpitations, or muscle fatigue. To qualify for the diagnosis of hypochondria the symptoms must have been experienced for at least 6 months.

The DSM-IV-TR defines this disorder, "Hypochondriasis", as a somatoform disorder and one study has shown it to affect about 3% of the visitors to primary care settings. The newly published DSM-5 replaces the diagnosis of hypochondriasis with the diagnoses of "Somatic Symptom Disorder" and "Illness Anxiety Disorder".

Hypochondria is often characterized by fears that minor bodily or mental symptoms may indicate a serious illness, constant self-examination and self-diagnosis, and a preoccupation with one's body. Many individuals with hypochondriasis express doubt and disbelief in the doctors' diagnosis, and report that doctors’ reassurance about an absence of a serious medical condition is unconvincing, or short-lasting. Additionally, many hypochondriacs experience elevated blood pressure, stress, and anxiety in the presence of doctors or while occupying a medical facility, a condition known as "white coat syndrome". Many hypochondriacs require constant reassurance, either from doctors, family, or friends, and the disorder can become a disabling torment for the individual with hypochondriasis, as well as his or her family and friends. Some hypochondriacal individuals completely avoid any reminder of illness, whereas others frequently visit medical facilities, sometimes obsessively. Other hypochondriacs will never speak about their terror, convinced that their fear of having a serious illness will not be taken seriously by those in whom they confide.


Fear is an emotion induced by a threat perceived by living entities, which causes a change in brain and organ function and ultimately a change in behavior, such as running away, hiding or freezing from traumatic events. Fear may occur in response to a specific stimulus happening in the present, or to a future situation, which is perceived as risk to health or life, status, power, security, or, in the case of humans, wealth or anything held valuable. The fear response arises from the perception of danger leading to confrontation with or escape from/avoiding the threat (also known as the fight-or-flight response), which in extreme cases of fear (horror and terror) can be a freeze response or paralysis.

In humans and animals, fear is modulated by the process of cognition and learning. Thus fear is judged as rational or appropriate and irrational or inappropriate. An irrational fear is called a phobia.

Psychologists such as John B. Watson, Robert Plutchik, and Paul Ekman have suggested that there is only a small set of basic or innate emotions and that fear is one of them. This hypothesized set includes such emotions as joy, sadness, fright, dread, horror, panic, anxiety, acute stress reaction and anger.

Fear is closely related to, but should be distinguished from, the emotion "anxiety", which occurs as the result of threats that are perceived to be uncontrollable or unavoidable.

The fear response serves survival by generating appropriate behavioral responses, so it has been preserved throughout evolution.


Many people experience specific phobias, intense, irrational fears of certain things or situations–dogs, closed-in places, heights, escalators, tunnels, highway driving, water, flying, and injuries involving blood are a few of the more common ones. Phobias aren’t just extreme fear; they are irrational fear. You may be able to ski the world’s tallest mountains with ease but panic going above the 10th floor of an office building. Adults with phobias realize their fears are irrational, but often facing, or even thinking about facing, the feared object or situation brings on a panic attack or severe anxiety.

Specific phobias strike more than 1 in 10 people. No one knows just what causes them, though they seem to run in families and are more prevalent in women. Phobias usually first appear in adolescence or adulthood. They start suddenly and tend to be more persistent than childhood phobias; only about 20 percent of adult phobias vanish on their own. When children have specific phobias–for example, a fear of animals–those fears usually disappear over time, though they may continue into adulthood. No one knows why they hang on in some people and disappear in others.

Marked and persistent fear that is excessive or unreasonable, cued by the presence or anticipation of a specific object or situation (e.g., flying, heights, animals, receiving an injection, seeing blood).

The fear is persistent, typically lasting at least 6 months.

Exposure to the phobic stimulus almost invariably provokes an immediate anxiety response, which may take the form of a situationally bound or situationally predisposed Panic Attack. (In children, the anxiety may be expressed by crying, tantrums, freezing, or clinging.)

The fear or anxiety is out of proportion to the actual danger posed by the specific object or situation and is not a typical response in the person’s social or cultural context. Most adults will recognize that their fear is excessive or unreasonable and are bothered by the fact that they have this fear.

The phobic situation or situations are avoided or else are endured with intense anxiety or distress.

The avoidance, anxious anticipation, or distress in the feared situation(s) interferes significantly with the person’s normal routine, occupational (or academic) functioning, or social activities or relationships, or there is marked distress about having the phobia.

You might become obsessed with minor ailments, fearing that they will require medical treatment. It is relatively common for iatrophobia to occur alongside hypochondriasis or nosophobia, which are both phobias of illness.

Fear of Dentist

Dentophobia can be divided into numerous elements. Most people with this phobia fear more than one element, while those with severe dentophobia may fear all or most elements simultaneously:

• The Dentist – Like doctors, IRS auditors and others in commonly feared professions, “The Dentist” is often cast as cold and unfeeling at best, or sadistic at worst. If you have had a negative personal experience with a particular dentist, you may be more prone to this phobia.
• Pain – Until relatively recently, completely painless dentistry was difficult or impossible. Even today, some procedures may involve a slight amount of pain. Many people are extremely sensitive to mouth pain, and fear that the pain may be excruciating.
• Numbness or Gagging – Some people, particularly those who have experienced choking or difficulty breathing, are afraid of having their mouths numbed. You might worry that you will be unable to breathe or swallow.
• Sounds and Smells – Many people, particularly those who have had previous bad experiences with dentists, are afraid of the sounds and smells of a dentist’s office, particularly the sound of the drill.
• Needles – If you have needle phobia, you might be extremely afraid of the injections that dentists use to numb the mouth.

Fear of Doctor

Most of us do not particularly enjoy going to the doctor. From the often long waits to the cold, sterile environment to the possibility of a painful procedure, doctor visits can cause anxiety in nearly anyone. For some people, however, normal anxiety gives way to outright panic. Iatrophobia, or fear of doctors, is surprisingly common today.
Since it is normal to be nervous before a doctor visit, it can be difficult to tell whether your symptoms constitute a full-blown phobia.

Only a qualified mental health professional can make this determination. However, a few signs may signify that your fear is out of proportion. You may experience all, some or none of the following:

Obsessive Worrying – Normal anxiety is typically transitory. You might feel a wave of nervous when actively thinking about an upcoming appointment. You may feel stress on the way to the doctor’s office or while sitting in the waiting room. However, you will not spend a great deal of time thinking about an upcoming visit, and you will be able to distract yourself from the anxiety.

If you have iatrophobia, however, an upcoming doctor visit may be the source of endless worrying. You might find it difficult or impossible to focus on other things. Once you have reached the doctor’s office, you are likely to experience feelings of panic and a sensation of being out of control. You might sweat, shake or cry, or even refuse to enter the examination room.

Other Illness-Related Phobias – Many people with iatrophobia worry that they might need to see a doctor, even if no visits are currently scheduled.
You might become obsessed with minor ailments, fearing that they will require medical treatment. It is relatively common for iatrophobia to occur alongside hypochondriasis or nosophobia, which are both phobias of illness.

Postponing Doctor Appointments – Those who merely experience nervousness about doctor visits typically do not try to avoid them. If you have iatrophobia, however, you might find yourself putting off checkups, vaccinations and other routine care. You might suffer through even relatively serious illnesses on your own, rather than seeking professional treatment.

White Coat Hypertension – Although controversial, the phenomenon of white coat hypertension has been documented by numerous researchers. This occurs when the stress of seeing a doctor is enough to raise your blood pressure to a clinically significant level. Your blood pressure is normal when checked at home or in another setting, such as a health fair, but is high at the doctor’s office.

Fear of Surgery

Fear of medical procedures can be classified under a broader category of “Blood, Injection, and Injury Phobias”. This is one of five subtypes that classify specific phobias. A specific phobia is defined as a “marked and persistent fear that is excessive or unreasonable, cued by the presence (or anticipation) of a specific object or situation.” Often these fears begin to appear in childhood, around the age of 5 to 9. It seems to be a natural feeling to become squeamish at the sight of blood, injury or gross deformity, but many overcome these fears by the time they reach adulthood. Those who do not are more likely to avoid medical and dental procedures necessary to maintain health, jobs, etc. Research shows that when people encounter something that they have a specific phobia of many of them have a feeling of disgust which makes them not want to come near or experience that which is disgusting to them. This feeling of disgust, especially in the Blood, Injection, and Injury Phobias seems to be passed down in families. Women have been known to avoid becoming pregnant because it requires blood and medical examinations that they would rather avoid. Also, most phobic people have an increased heart rate upon encountering the thing they fear, but Blood, Injection, Injury phobic people also seem to have an increase of fainting after the initial speeding up of heart rate. Their heart rate will go up and then slow again, leading to nausea, sweating, pallor and fainting. This fainting can also lead to seizures making life very difficult for those who have this fear. However only 4.5% of individuals who have this phobia as a child will have this fear their entire lifetime. For those who do experience this phobia in an extreme manner, specific coping treatments have been found to help them. Biological treatments, like medications used for other anxiety ailments, are generally found to be inappropriate for fear of medical procedures or other specific phobias. Psychological treatments are the treatment of choice because they are more accurate at addressing the problem. Some of these treatments used especially for fear of medical procedures include, Exposure-Based Treatments, Eye Movement Desensitization and Reprocessing, and Applied Tension to react against fainting.

Fear of School

School refusal is the refusal to attend school due to emotional distress. School refusal differs from truancy in that children with school refusal feel anxiety or fear towards school, whereas truant children generally have no feelings of fear towards school, often feeling angry or bored with it instead. While this was formerly called school phobia, the term school refusal was coined to reflect that children have problems attending school for a variety of different reasons and these reasons might not be the expression of a true phobia, such as separation or social anxiety.

Symptoms of school refusal include the child saying they feel sick often, or waking up with a headache, stomachache, or sore throat. If the child stays home from school, these symptoms might go away, but come back the next morning before school. Additionally, children with school refusal may have crying spells or throw temper tantrums.
Warning signs of school refusal include frequent complaints about attending school, frequent tardiness or unexcused absences, absences on significant days (tests, speeches, physical education class), frequent requests to call or go home, excessive worrying about a parent when in school, frequent requests to go to the nurse’s office because of physical complaints, and crying about wanting to go home.

It is important for parents to keep trying to get their child to go back to school. The longer a child stays out of school, the harder it will be to return. However, it may be hard to accomplish as when forced they are prone to temper tantrums, crying spells, psychosomatic or panic symptoms and threats of self-harm. These problems quickly fade if the child is allowed to stay home.

Fear of Loss of Control/OCD

Obsessive–compulsive disorder (OCD) is a mental disorder where people feel the need to check things repeatedly, have certain thoughts repeatedly, or feel they need to perform certain routines repeatedly. People are unable to control either the thoughts or the activities. Common activities include hand washing, counting of things, and checking to see if a door is locked. Some may have difficulty throwing things out. These activities occur to such a degree that the person's daily life is negatively affected. Often they take up more than an hour a day. Most adults realize that the behaviors do not make sense. The condition is associated with tics, anxiety disorder, and an increased risk of suicide.

The cause is unknown. There appears to be some genetic components with identical twins more often affected than non-identical twins. Risk factors include a history of child abuse or other stress inducing event. Some cases have been documented to occur following infections. The diagnosis is based on the symptoms and requires ruling out other drug related or medical causes. Rating scales such as Yale–Brown Obsessive Compulsive Scale can be used to assess the severity. Other disorders with similar symptoms include: anxiety disorder, major depressive disorder, eating disorders, tic disorders, and obsessive–compulsive personality disorder.

Fear of Failure

Atychiphobia is the abnormal, unwarranted, and persistent fear of failure, a type of specific phobia. As with many phobias, atychiphobia often leads to a constricted lifestyle, and is particularly devastating for its effects on a person’s willingness to attempt certain activities. The term atychiphobia comes from the Greek phóbos, meaning "fear" or "morbid fear" and atyches meaning "unfortunate".

Persons afflicted with atychiphobia considers the possibility of failure so intense that they choose not to take the risk. Often these persons will subconsciously undermine their own efforts so that they no longer have to continue to try. Because effort is proportionate to the achievement of personal goals and fulfillment, this unwillingness to try, that arises from the perceived inequality between the possibilities of success and failure, holds the atychiphobic back from a life of meaning and the realization of potential.

By definition, the anxiety of any particular phobia is understood to be disproportionate to reality, and the victim is typically aware that the fear is irrational, making the problem a largely subconscious one. For this reason there are no simple treatments for atychiphobia, however there are several options available.

It is generally believed that phobias arise from a combination of heredity, genetics, brain chemistry, and life-experience. Demeaning parents or family members, traumatic and embarrassing events that arise from minor failure early in life, or when an individual experiences a significant failure and is ill-equipped to effectively cope with the resulting feelings, are all thought to produce the fear of failure in the long term. When a developing brain is raised in a home where approval or the feeling of being loved is linked to performance it becomes difficult to separate the two. Such a person comes to believe that such feelings must be earned, and that they can be withdrawn if failure occurs. In addition, some individuals who struggle with phobias have a genetic predisposition toward anxiety, compounding the problem of atychiphobia and making it more difficult to handle. As a result of these factors, those with an irrational fear of failure often settle for mediocrity to avoid the risks inherent in distinguishing themselves.

Those with atychiphobia create a direct link between the possibility of failure and competition; and in an inherently competitive society, they find that it is best to avoid the problem altogether. The person more strongly motivated to avoid failure, rather than to achieve success, tends to be more unrealistic in aspiration.

Because the modern society places so much emphasis on perfection in every aspect of life, a person with atychiphobia will often not risk trying until perfection is assured. They draw their value as an individual from their success relative to societal standards. This dynamic is most readily observed in the classroom setting, where students are forced to compete for a limited number of rewards, most often the scarcity of good grades. A restricted supply of rewards pushes student aspirations for grades and other forms of recognition beyond the capabilities of many children, with the result that they are unable to keep pace with these inappropriate goals. Such circumstances tend to force a fateful decision for countless youngsters. The child may reason, unwittingly and without recognition of the consequences, that if they cannot be sure of succeeding, then at least they can try to protect a sense of dignity by avoiding failure. In essence the atychiphobe seeks to avoid at whatever cost the same experience he or she may have endured that triggered such a potent and irrational fear of failure.

Those suffering from atychiphobia may experience physiological symptoms typical of phobias such as:

• Irregular heartbeat
• Shortness of breath
• Rapid breathing
• Nausea
• Overall feelings of dread
• Nervousness
• Stomach disorders
• Flushing of the face
• Perspiration
• Muscle tension
• Tremulousness
• Faintness

These symptoms manifest when one is confronted with the possibility of failure, such as when they are asked to perform a task at which they believe they cannot be 100% successful. The individual may suffer from a breakdown, and if left unchecked, these symptoms will continue to worsen. A drop in self-confidence and loss of motivation are likely to occur,[9] which can lead to depression. As a result, it is common to avoid situations where this confrontation may occur. However, it is this avoidance that impairs the sufferer’s freedom as opportunities are lost in all aspects of life such as career and family. In addition, the inability to overcome this anxiety is in itself a form of failure. Achievement-oriented individuals learn… to strive for excellence, maintain optimistic expectations, and to not be readily discouraged by failure. Conversely, individuals who consistently fear failure… set goals that are too high or too low and become easily discouraged by obstacles.

Fear of Success

The Jonah complex is the fear of success which prevents self-actualization, or the realization of one's potential. It is the fear of one's own greatness, the evasion of one's destiny, or the avoidance of exercising one's talents. Just as the fear of achieving a personal worst can motivate personal growth, the fear of achieving a personal best can also hinder achievement.

Jonah escapes from the belly of the great fish that has held him captive.

Although Abraham Maslow is accredited for the term, the name “Jonah complex” was originally suggested by Maslow’s friend, Professor Frank Manuel. The name comes from the Biblical story of Prophet Jonah's evasion of the destiny to prophesy the destruction of Ninevah. Maslow states, "So often we run away from the responsibilities dictated (or rather suggested) by nature, by fate, even sometimes by accident, just as Jonah tried—in vain—to run away from his fate".

Any dilemma or challenge faced by an individual may trigger reactions related to the "Jonah Complex". These challenges may vary in degree and intensity. Such challenges may include career changes, beginning new stages in life, moving to new locations, interviews or auditions, and undertaking new interpersonal commitments such as marriage. Other causes include

• Fear of the sense of responsibility that often attends recognizing our own greatness, talents, potentials
• Fear that an extraordinary life would be out of the ordinary, and hence not acceptable to others
• Fear of seeming arrogant, self-centered, etc.
• Difficulty envisioning oneself as a prominent or authoritative figure


Agoraphobia is an anxiety disorder characterized by anxiety in situations where the sufferer perceives certain environments as dangerous or uncomfortable, often due to the environment's vast openness or crowdedness. These situations include wide-open spaces, as well as uncontrollable social situations such as the possibility of being met in shopping malls, airports, and on bridges. Agoraphobia is defined within the DSM-IV TR as a subset of panic disorder, involving the fear of incurring a panic attack in those environments. In the DSM-5, however, agoraphobia is classified as being separate from panic disorder.[2] The sufferer may go to great lengths to avoid those situations, in severe cases becoming unable to leave their home or safe haven.

Although mostly thought to be a fear of public places, it is now believed that agoraphobia develops as a complication of panic attacks. However, there is evidence that the implied one-way causal relationship between spontaneous panic attacks and agoraphobia in DSM-IV may be incorrect. Onset is usually between ages 20 and 40 years and more common in women.
Approximately 3.2 million, or about 2.2%, of adults in the US between the ages of 18 and 54, suffer from agoraphobia. Agoraphobia can account for approximately 60% of phobias. Studies have shown two different age groups at first onset: early to mid twenties, and early thirties.

In response to a traumatic event, anxiety may interrupt the formation of memories and disrupt the learning processes, resulting in dissociation. Depersonalization (a feeling of disconnection from one’s self) and derealisation (a feeling of disconnection from one's surroundings) are other dissociative methods of withdrawing from anxiety.

Standardized tools, such as Panic and Agoraphobia Scale, can be used to measure the severity of agoraphobia and panic attacks and monitor treatment

Fear of Heights

Fear of flying is a fear of being on an airplane or other flying vehicle, such as a helicopter, while in flight. It is also referred to as flying phobia, flight phobia, aviophobia or aerophobia (although the last also means a fear of drafts or of fresh air).

Fear of flying may be a distinct phobia in itself, or it may be an indirect combination of one or more other disorders, such as claustrophobia (a phobia of being restricted, confined, or unable to escape) or acrophobia (anxiety or dread of being at a great height). It may have other causes as well, such as agoraphobia (especially the type that has to do with having a panic attack in a place they can't escape from). It is a symptom rather than a disease, and different causes may bring it about in different individuals.
This phobia receives more attention than most other phobias because air travel is often difficult for people to avoid—especially in professional contexts—and because it is common, affecting a significant minority of the population. Inability to maintain emotional control when aloft may prevent a person from going on vacations or visiting family and friends, and it can cripple the career of a businessperson by preventing them from traveling on work-related business.
The fear of flying may be created by various other phobias and fears:

• Fear of crashing, which most likely results in death, is the most common reason for the fear of flying.
• Fear of closed in spaces (claustrophobia), such as that of an aircraft cabin
• Fear of heights (acrophobia)
• Feeling of not being in control
• Fear of vomiting, where a person will be afraid that they'll have motion sickness on board, or encounter someone having motion sickness and have no control over it (such as escaping it)
• Fear of having panic attacks in certain places, where escape would be difficult and/or embarrassing (agoraphobia)
• Fear of hijacking or terrorism

Fear of Water

Aquaphobia is a persistent and abnormal fear of water. Aquaphobia is a specific phobia that involves a level of fear that is beyond the patient's control or that may interfere with daily life. People suffer aquaphobia in many ways and may experience it even though they realize the water in an ocean, a river, or even a bathtub poses no imminent threat. They may avoid such activities as boating and swimming, or they may avoid swimming in the deep ocean despite having mastered basic swimming skills. This anxiety commonly extends to getting wet or splashed with water when it is unexpected, or being pushed or thrown into a body of water.

Fear of Animals

Zoophobia or animal phobia is a class of specific phobias to particular animals, or an irrational fear or even simply dislike of any non-human animals.

Examples of specific zoophobias would be entomophobias, such as that of bees (apiphobia). Fears of spiders (arachnophobia) and snakes (ophidiophobia) are also common. See the article at -phobia for the list of various phobias. Sigmund Freud mentioned that an animal phobia is one of the most frequent psychoneurotic diseases among children.

Zoophobia is not the sensible fear of dangerous or threatening animals, such as wild bears or venomous snakes. It is a phobia of animals that causes distress or dysfunction in the individual's everyday life.

The most typical fear in children is fear of dogs. This is either from an experience the child had with a dog, or associative experience based on something they have seen or heard, or was related to them.

Fear of Death

Death anxiety is the morbid, abnormal or persistent fear of one's own mortality. One definition of death anxiety is a "feeling of dread, apprehension or solicitude (anxiety) when one thinks of the process of dying, or ceasing to ‘be’". It is also referred to as thanatophobia (fear of death), and is distinguished from necrophobia, which is a specific fear of dead or dying persons and/or things (i.e. others who are dead or dying, not one's own death or dying). Lower ego integrity, more physical problems, and more psychological problems are predictive of higher levels of death anxiety in elderly people.

Predatory death anxiety arises from the fear of being harmed. It is the most basic and oldest form of death anxiety, with its origins stemming from the first unicellular organisms’ set of adaptive resources. Unicellular organisms have receptors that have evolved to react to external dangers and they also have self-protective, responsive mechanisms made to guarantee survival in the face of chemical and physical forms of attack or danger. In humans, this form of death anxiety is evoked by a variety of danger situations that put the recipient at risk or threatens their survival. These traumas may be psychological and/or physical. Predatory death anxieties mobilize an individual’s adaptive resources and lead to fight or flight, active efforts to combat the danger or attempts to escape the threatening situation.

Predation or predator death anxiety is a form of death anxiety that arises from an individual physically and/or mentally harming another. This form of death anxiety is often accompanied by unconscious guilt.[9] This guilt, in turn, motivates and encourages a variety of self made decisions and actions by the perpetrator of harm to others.

Existential death anxiety is the basic knowledge and awareness that natural life must end. It is said that existential death anxiety directly correlates to language; that is, language has created the basis for this type of death anxiety through communicative and behavioral changes. Existential death anxiety is known to be the most powerful form. There is an awareness of the distinction between self and others, a full sense of personal identity, and the ability to anticipate the future. Humans defend against this type of death anxiety through denial, which is effected through a wide range of mental mechanisms and physical actions many of which also go unrecognized. While limited use of denial tends to be adaptive, its use is usually excessive and proves to be costly emotionally.

Awareness of human mortality arose through some 150,000 years ago. In that extremely short span of evolutionary time, humans have fashioned but a single basic mechanism with which they deal with the existential death anxieties this awareness has evoked—denial in its many forms. Thus denial is basic to such diverse actions as breaking rules and violating frames and boundaries, manic celebrations, violence directed against others, attempts to gain extraordinary wealth and/or power—and more. These pursuits often are activated by a death-related trauma and while they may lead to constructive actions, more often than not, they lead to actions that are, in the short and long run, damaging to self and others.

Fear of Needles

Although most specific phobias stem from the individuals themselves, the most common type of needle phobia, affecting 50% of those afflicted, is an inherited vasovagal reflex reaction. Approximately 80% of people with a fear of needles report that a relative within the first degree exhibits the same disorder.

People who suffer from vasovagal needle phobia fear the sight, thought, or feeling of needles or needle-like objects. The primary symptom of vasovagal fear is vasovagal syncope, or fainting due to a decrease of blood pressure.

Many people who suffer from fainting during needle procedures report no conscious fear of the needle procedure itself, but a great fear of the vasovagal syncope reaction. A study in the medical journal Circulation concluded that in many patients with this condition (as well as patients with the broader range of blood/injury phobias), an initial episode of vasovagal syncope during a needle procedure may be the primary cause of needle phobia rather than any basic fear of needles. These findings reverse the more commonly held beliefs about the cause-and-effect pattern of needle phobics with vasovagal syncope.

The physiological changes associated with this type of phobia also include feeling faint, sweating, nausea, pallor, tinnitus, panic attacks, and initially high blood pressure and heart rate followed by a plunge in both at the moment of injection.

Although most phobias are dangerous to some degree, needle phobia is one of the few that actually kill. In cases of severe phobia, the drop in blood pressure caused by the vasovagal shock reflex may cause death. In Hamilton's 1995 review article on needle phobia, he was able to document 23 deaths as a direct result of vasovagal shock during a needle procedure.

The best treatment strategy for this type of needle phobia has historically been desensitization or the progressive exposure of the patient to gradually more frightening stimuli, allowing them to become desensitized to the stimulus that triggers the phobic response. In recent years, a technique known as "applied tension" has become increasingly accepted as an often effective means for maintaining blood pressure to avoid the unpleasant, and sometimes dangerous, aspects of the vasovagal reaction.
Associative fear of needles is the second most common type, affecting 30% of needle phobics. This type is the classic specific phobia in which a traumatic event such as an extremely painful medical procedure or witnessing a family member or friend undergo such, causes the patient to associate all procedures involving needles with the original negative experience.

This form of fear of needles causes symptoms that are primarily psychological in nature, such as extreme unexplained anxiety, insomnia, preoccupation with the coming procedure and panic attacks. Effective treatments include cognitive therapy, hypnosis, and/or the administration of anti-anxiety medications.

Resistive fear of needles occurs when the underlying fear involves not simply needles or injections but also being controlled or restrained. It typically stems from repressive upbringing or poor handling of prior needle procedures i.e. with forced physical or emotional restraint.

This form of needle phobia affects around 20% of those afflicted. Symptoms include combativeness, high heart rate coupled with extremely high blood pressure, violent resistance, avoidance and flight. The suggested treatment is psychotherapy, teaching the patient self-injection techniques or finding a trusted health care provider.
Hyperalgesic fear of needles is another form that does not have as much to do with fear of the actual needle. Patients with this form have an inherited hypersensitivity to pain, or hyperalgesia. To them, the pain of an injection is unbearably great and many cannot understand how anyone can tolerate such procedures.
This form of fear of needles affects around 10% of needle phobes. The symptoms include extreme explained anxiety, and elevated blood pressure and heart rate at the immediate point of needle penetration or seconds before. The recommended forms of treatment include some form of anesthesia, either topical or general.