I am a world-class weenie when it comes to letting people stick needles into me. My subconscious mind firmly believes that if God had wanted us to have direct access to our bloodstreams, He would have equipped our skin with small, clearly marked doors.
— Dave Barry
Trypanophobia is the fear of needles, and not just any needles – needles wielded by the medical profession with the sole aim of making a large number of holes in your body for their own perverse pleasures. A phobia is considered to be an irrational fear of something that, in reality, is unlikely to cause you any significant harm or damage. Okay, so being stuck through the skin with a needle could never be described as 'an enjoyable activity, suitable for ages 8 – 80', but it is very, very rare that it will cause any lasting damage to you in itself. Yes, a lethal overdose can be easily administered with a needle, but it's not the needle doing the damage.
I've stuck needles more times, in more people, than I can actually count, and have experienced a broad range of reactions to my sidling up to them and sticking them one in the buttock.
I've only been punched once.
So far.
I've never had a fear of needles myself; as a child being given vaccinations I'd watch the needle being stuck in my arm with grim fascination. In needlework class, I'd freak out my friends by sewing my fingers together. I've been pierced four times. Since starting clinical training, I have often allowed my peers to practice their skills with a hypodermic on me. But I can completely understand why someone would develop a fear of needles. They hurt. People don't like pain. It's only a short few steps from that rationale to screaming blue murder if a doctor or nurse even looks at you the wrong way.
In my experience, it's always the big, burly, rugby-playing lads who hit the floor first. I think it's mostly because they're trying so hard to act unconcerned that their incredulous subconscious wrests control from the obviously-nuts conscious and hits the 'off' button. One of my favourites was an 18yr old bloke who'd come in with a laceration to the hand that I needed to stitch up. He was determined to convince me that he wasn't scared of needles, but I could see it in his eyes.
Oh, yes.
He managed to act completely unconcerned as I laid out my suture set, opened up a suture, and irrigated his wound with some saline to clean the pavement crap out of it. Then I turned around to pick up the hypodermic syringe that contained the local anaesthetic... and turn back to him again to find him slumped back in the chair, out for the count.
I quickly sewed him up while I had the chance.
Some things are easier to do when your patient isn't conscious.
Trypanophobia is closely related to haemophobia, a fear of blood. These two fears have a very unique manifestation in the world of phobias: they can cause the person to faint. Or, in slightly more complicated terms, all other phobias cause the heart to beat faster as part of the 'fight or flight' response; trypanophobia and haemophobia can cause the heart to slow down. I once put together the brilliant combination of a knife, a knife sharpener, and my thumb. As my blood poured down my arm and dripped onto my kitchen linoleum, I sighed the deep, resigned sigh of a person who knows they've inconvenienced themselves slightly and that they've only got themselves to blame. Then I heard a light, breathless sigh, and looked up in time to see my friend who'd been talking to me a few seconds before roll their eyes up and crumple onto the floor. Not the most productive reaction to the situation, but there you go.
Types of trypanophobia
Trypanophobia is now an officially recognised psychiatric condition. Well, it's been listed in the DSM-IV, anyway. By the way, these guys used to list 'homosexuality' as a disease, so I wouldn't trust it any further that I could throw it. But enough of my bitching.
The main manifestation of trypanophobia is the vaso-vagal response. This is the manifestation that causes a person to faint at the sight of a needle; vaso-vagal is the name used to describe fainting (syncope) due to a sudden loss of blood pressure, reducing the flow of oxygenated blood to the brain. It is caused by the parasympathetic nervous system getting all over-excited about the situation, wresting control away from the sympathetic nervous system and telling the heart to slow down while at the same time relaxing the tone of the blood vessels of the body. This causes all your blood to fall into your boots, and your heart is able to do little about it because it's been told to take it easy for a while.
Now, this is actually a phobia that can kill you.... well, trypanophobia in general is pretty dangerous condition to have to begin with, as it means a person is less likely to seek a doctor's advice in the event of an illness, meaning that by the time they do present to a hospital they're going to be in pretty poor shape. However, vaso-vagal trypanophobia in itself carries a risk of death because of the loss of blood pressure during a severe vaso-vagal attack due to blood being unable to perfuse the heart or the brain, causing a heart attack or stroke, respectively. No need to say that this is very rare indeed. There's also an association between trypanophobia and malignant vaso-vagal syndrome (Hart, Yanny, 1998) which is a rare condition that carries a very high mortality.
Interestingly, 80% of patients who report a needle phobia have a first degree relative who also has a trypanophobia; this raises interesting questions with regards to nature vs. nurture. But not interesting enough for me to bother to discuss them.
Alongside the vaso-vagal manifestation, there will be patients who display the more usual manifestations of phobias, i.e. a fight or flight response. On seeing a needle or being told that they need an injection, the patient will become anxious and resistant, to contrast with the passive state of the vaso-vagal reaction.
Cure?
Trypanophobia can be controlled in different ways, depending on the patient's symptoms. Patients who have a fear of the pain of injections can have a topical local anaesthetic put on their skin to numb the area first. They've also got these fancy Star Trek jet injectors that use a high pressure gas to push the substance through the skin, though some people report that this is more painful than having a needle stuck in you. Patients who have a vaso-vagal reaction will benefit greatly from cognitive behavioral therapy to teach them to counteract the slowing of their heart rate and other symptoms that they expereince. Those who have a fight/flight response to injections will also benefit from CBT, but there is no guarantee as to its efficacy.
Or you could try just not ever getting ill.
Thank you to everyone who's sent me a message telling me of their fear of needles / blood. However, I request no more unless you can top the ultimate reaction:
Matthew says: re trypanophobia: I hate needles. I broke a nurse's arm when she surprised me with the needle and I reacted with the Krav Mat training that I had been foolishly given as a midshipman. There's a note in my immunizations record now, so before any needlework, the doctor usually invites me to lay down and take a couple of these here pills. I think they're some sort of sedative, but they could just be placebos for all I know.
Nice one, brother. I'm not going to be going near this guy with a needle anytime soon.