Doctor phobia

Classification according to ICD-10
F40.2	Specific (isolated) phobias
ICD-10 online (WHO version 2019)

As a doctor phobia (also Iatrophobie called) refers to the long-lasting fear before doctors . It belongs to the phobic disorders and leads to avoidance or postponement of the doctor's visit. Since there is no single diagnosis of a doctor's phobia, the diagnosis is based on the determination of a specific phobic disorder (F40.2 according to ICD-10 ).

Demarcation

Doctor phobia exists in different medical fields. It can be situation-related, location-related or person-related. In a general fear of hospitals and clinics will also clinic fear spoken.

The differential diagnosis includes phobias of a disease ( Nosophobia ) or before specific diseases (eg. As the Da Costa's syndrome with heart disease or Kanzerophobie for cancer ) can be distinguished from the doctor phobia. Fear of doctors may arise because of general social or specific fears (e.g., claustrophobia or fear of contact ). These phobias are not only tied to the doctor's visit and are therefore not an independent doctor phobia. Fears that rarely occur in everyday life, such as fear of blood, can appear at the doctor's office. Not every fear of a doctor's visit can be classified as pathological according to ICD 40.2.

Causes of fear

The fear of doctors can have various reasons. Common reasons include:

• the fear of negative direct effects of a medical examination such as B. Pain (see also algophobia ).
• the assumption of possibly suffering from a serious illness and thus the fear of a confirmatory diagnosis. Information from the Internet and the associated misjudgments can have a reinforcing effect ( cyberchondria ).
• fear of negative consequences of treatment (e.g. intolerance , side effects , amputation , risk of complications or residual risk ).
• Specific fears such as fear of blood ( hematophobia ), fear of sharp objects such as syringes ( aichmophobia ) or fear of poor hygiene and the risk of infection from other diseases ( mysophobia ).
• Fear of financial or bureaucratic obstacles, e.g. B. that the costs are not covered by the health insurance .
• Shame , e.g. B. through nudity ( gymnophobia ), repulsive symptoms, treatment by the opposite sex ( gynophobia , androphobia ).
• Fear of losing control , e.g. B. from anesthesia , a faint .
• cultural, ethical or religious fears in cultures that reject certain medical methods. A visit to a doctor can lead to stigma or exclusion (e.g. psychiatry , psychotherapy )
• Science denial that leads to opposition to treatments, e.g. B. Opposition to vaccination .

Negative previous experiences from your own doctor's visits or corresponding negative reports can reinforce the doctor phobia. Often the fears are based on distorted memories , so that these fears often turn out to be excessive. A distorted memory can e.g. B. occur through a more pronounced pain perception in childhood.

Dangers and Risks

The fact that contact with the doctor is avoided ( avoidance behavior ) or delayed ( procrastination ) means that diagnosis or therapy is delayed or nonexistent . The disease persists, with possible contagion and risks, or even worsens. Depending on the disease, a more difficult to treat stage can be reached. In extreme cases, irreversible damage can occur. The patient's physical and mental suffering increases.

As with other phobias, the doctor's phobia can cause psychosomatic complaints and panic attacks . The associated increase in blood pressure upon contact with a doctor is known as " white coat hypertension ". A survey study showed higher mortality and a higher risk of cardiovascular complications in this group of patients.

Prevention and measures to reduce anxiety during the doctor's visit

Patients have the opportunity to use relaxation techniques and talk to the practice staff or the doctor about their fear so that it can be better addressed. Doctors can use the medical history or measurement of high blood pressure after organic exclusion to respond more specifically to patients with fears.

Since children and adolescents in particular suffer from fear of doctors due to an alienated and threatening situation, it is the task of pediatrics to approach children and adolescents with more sensitivity and empathy .

Through hypnosis or anesthesia fears can be reduced. Support from family and friends can also be helpful in coping with anxiety. With the help of video glasses , which the patient exposes during the treatment, an attempt can be made to isolate the fear through external perception and to distract the patient through the media content.

treatment

Like other phobic disorders, doctor phobia can be treated with psychotherapy or psychotropic drugs .

Prevalence and Statistics

Approx. 20% of the patients have a higher blood pressure due to the fear of the doctor (“white coat blood pressure”, white coat hypertension). About 20% of Germans are afraid of dentists. More than one in ten people avoid going to the dentist out of fear. Many patients are afraid of examinations and interventions in the fields of gynecology , urology , surgery , neurology , internal medicine and psychiatry . Men in particular have a tendency to play down symptoms and postpone an examination or check-up . According to a survey by the professional association of general practitioners , around two million people in Germany suffer from iatrophobia.

Special features in individual medical specialties

Dentistry

→ Main article : Dental phobia

The fear of dentists is also known as dentophobia or odontophobia . Delaying treatment encourages the spread of dental caries . Instead of a visit, painkillers and sedatives are used. The psychoanalyst Sigmund Freud compared the fear of tooth loss in his dream interpretation with the fear of castration .

The phobia of dental treatment is recognized as a mental illness (ICD-10 GM 2006 F40.2), therefore the health insurance companies cover the costs for psychotherapy with a contract psychotherapist or contract doctor with appropriate additional training. A dentist may only provide psychotherapeutic services at the expense of the health insurance companies if he is also licensed to practice medicine as an appropriately trained doctor. According to an examination, the fear of dentists could be treated with behavioral therapy in around 80% of patients in Germany.

Veterinary medicine

Animals too often suffer from fear and panic due to the unfamiliar and threatening environment at the vet . Their fear can include intimidation, attempts to escape, scratching their paws, wagging their tails (in cats) and yelling. Since animals out of fear could try to flee or to defend themselves and thus result in personal injury and / or property damage, it is the task of veterinary medicine to calm the animal down, fix it if necessary and possibly put it under anesthesia .

Clinical anxiety

According to a Forsa survey, 32% of women and 25% of men are afraid of hospitalization . 81% of the fears can be traced back to the fear of being infected by germs ( mysophobia ). In addition, fears about complications from a complex operation can arise. Every third person concerned worries about drug intolerance and side effects.

Individual evidence

1. ↑ ^{a b c} Fear of the doctor: "Pulling it together is not enough". In: Spiegel Online. June 18, 2018, accessed September 18, 2019 . 
2. ↑ Phobia of doctors. In: PSYLEX. Retrieved September 18, 2019 . 
3. ↑ Eva Fiedler Iatrophobia: What helps against the fear of the doctor . In: Berliner Zeitung , May 9, 2013
4. ↑ M. Hollander, M. Greene: A conceptual framework for understanding iatrophobia . In: Patient Education and Counseling . Elsevier, July 10, 2019.
5. ↑ Panic before the prick. In: Focus Online. Retrieved September 18, 2019 . 
6. ↑ Anxiety in the hospital: the unpleasant feeling. In: Deutsches Ärzteblatt. September 17, 2010, accessed September 23, 2019 . 
7. ↑ The fear of the doctor. February 17, 2011, accessed September 23, 2019 . 
8. ↑ Jordana B. Cohen, Michael J. Lotito, Usha K. Trivedi, Matthew G. Denker, Debbie L. Cohen, Raymond R. Townsend: Cardiovascular Events and Mortality in White Coat Hypertension: A Systematic Review and Meta-analysis . In: Annals of Internal Medicine . tape 170 , no. 12 , June 11, 2019, p. 853-862 , doi : 10.7326 / M19-0223 .
9. ↑ ^{a b c} The fear of the doctor. February 17, 2011, accessed September 18, 2019 . 
10. ↑ ^{a b} Iatrophobia - pain rather than see a doctor. WDR, January 25, 2017, accessed on September 18, 2019 . 
11. ↑ Don't be afraid of the pediatrician! In: kinderaerzte-im-netz.de. Retrieved September 18, 2019 . 
12. ↑ Thomas Hoek, C. Rosenfeld, Heinrich Günther Willital: Tips and tricks for pediatricians: Problem solutions from A to Z . Springer-Verlag, 2006, ISBN 978-3-540-31249-9 ( google.de [accessed on September 18, 2019]).
13. ↑ With fear in the waiting room. netdoktor at GmbH, accessed on September 18, 2019 . 
14. ↑ B. Bandelow et al .: S3 guidelines for the treatment of anxiety disorders . Ed .: Working Group of Scientific Medical Societies. April 15, 2014.
15. ↑ Thomas G. Pickering, Gary D. James, Charlene Boddie et al .: How Common Is White Coat Hypertension? In: JAMA - Journal of American Medical Association . tape 259 (2) , Jan. 8, 1988, pp. 225-228 , doi : 10.1001 / jama.1988.03720020027031 .
16. ↑ Are you afraid of the dentist? In: Statista. 2019, accessed September 22, 2019 . 
17. ↑ Gudrun Sartory: Dental phobia: How the fear of the dentist disappears. In: Spiegel Online. Retrieved September 22, 2019 . 
18. ↑ ^{a b} Fear of Doctors - Iatrophobia. Retrieved September 18, 2019 . 
19. ↑ Cold hands, racing heart, restlessness: This is where the fear of the doctor comes from. In: RP Online. Retrieved September 18, 2019 . 
20. ↑ ^{a b} Dental phobia, dental fear • PSYLEX. Retrieved September 18, 2019 . 
21. ↑ Gisela Sonnenburg: Iatrophobia: The doctor's visit is omitted for fear (new Germany). Retrieved September 18, 2019 . 
22. ↑ Sabrina Reichel: Don't worry about the vet: Medical training for dogs . Kynos Verlag, 2016, ISBN 978-3-95464-115-4 ( google.de [accessed on September 18, 2019]).
23. ↑ Fear of complications: Many women and men are afraid of the hospital. In: Westdeutsche Zeitung. Retrieved September 18, 2019 . 

This article is about a health issue. It is not used for self-diagnosis and does not replace a diagnosis by a doctor. Please note the information on health issues !