Selective association of fainting with blood-injury-illness fear

doi:10.1016/S0005-7894(76)80214-6

Behavior Therapy

Volume 7, Issue 1, January 1976, Pages 8-13

https://doi.org/10.1016/S0005-7894(76)80214-6 Get rights and content

Patients phobic of blood or injury situations reported frequent past fainting in those situations and repeatedly fainted during exposure treatment. Other phobics had rarely fainted previously and never fainted in treatment. The hypothesis that fainting is an autonomic response specific to blood, injury, or illness (BII) rather than other situations was tested in 62 phobics by examining the relationship between current fear of such situations and past history of fainting. Patients with high BII fear had fainted more frequently to BII situations in the past. Phobics who had fainted in non-BII situations were just as likely to have low as high current BII fears. Whatever the contributions of phylogenesis and learning to vasovagal fainting in BII circumstances, it can be extinguished by such psychological means as graded exposure.

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Cited by (73)

Blood-Injection-Injury Phobia and Dog Phobia in Youth: Psychological Characteristics and Associated Features in a Clinical Sample
2016, Behavior Therapy
Blood-Injection-Injury (BII) phobia is a particularly debilitating condition that has been largely ignored in the child literature. The present study examined the clinical phenomenology of BII phobia in 27 youths, relative to 25 youths with dog phobia—one of the most common and well-studied phobia subtypes in youth. Children were compared on measures of phobia severity, functional impairment, comorbidity, threat appraisals (danger expectancies and coping), focus of fear, and physiological responding, as well as vulnerability factors including disgust sensitivity and family history. Children and adolescents with BII phobia had greater diagnostic severity. In addition, they were more likely to have a comorbid diagnosis of a physical health condition, to report more exaggerated danger expectancies, and to report fears that focused more on physical symptoms (e.g., faintness and nausea) in comparison to youth with dog phobia. The present study advances knowledge relating to this poorly understood condition in youth.
Syncope in Children and Adolescents
2015, Cardiology Clinics
Citation Excerpt :
Most phobias usually lead to a hyperadrenergic state and patients with BIP usually have tachycardia. A specific group of children who suffer from blood injury phobia (BIP), however, have a paradoxic bradycardia or a severe asystole in response to an initial transient tachycardia,47,48 which often leads to presyncope or syncope. These children, over a period of time, like other children who suffer from phobic disorders, learn to avoid such situations, because they perceive these injury or blood scenes as unpleasant.
Approaching blood phobia and its different research lines
2014, Clinica y Salud
La hematofobia se podría definir por la presencia de miedo y una serie de conductas de evitación y/o escape ante lugares, objetos y situaciones relacionadas con la visión de sangre, agujas y heridas, existiendo un historial de desmayos en casi el 80% de los casos. Esta fobia tiene una prevalencia de 31‰ y genera un gran impacto en la vida del individuo. En el presente trabajo se han revisado las investigaciones más relevantes que han abordado tanto las distintas variables que pueden explicar el problema como los desmayos, junto con los tratamientos que han demostrado mayor eficacia en el campo. Para ello, se han agrupado los diversos estudios en tres líneas de investigación: la sensibilidad al asco, el rol de la hiperventilación y el sesgo atencional. Asimismo, también se han revisado los procedimientos de mayor eficacia probada en el campo. Los resultados obtenidos a través de la revisión apuntan que no hay diferencias significativas en cuanto a la eficacia de la tensión aplicada (TA) y la exposición (E) por sí sola, siendo estas técnicas las más eficaces para trabajar esta fobia. Respecto a las vías de investigación, en los últimos años las más significativas han sido la hiperventilación y el sesgo atencional. Finalmente, se proponen una serie de directrices encaminadas a orientar el tratamiento de estos pacientes en relación con estos resultados.
Blood phobia could be defined by the presence of fear and a number of avoiding or escaping behaviors regarding places, objects and situations related to the sight of blood, needles or injuries, with nearly an 80% of cases having a history of fainting. This phobia has a prevalence of 31‰ and usually implies a great impact on the subject's life. The present study is a review of the most outstanding literature in the field, addressing the explanatory variables along with the most effective treatments. Then, literature has been searched along three research lines: sensitivity to disgust, the role of hyperventilation, and the attentional bias. Also, the most effective procedures in the field have being reviewed. The results show that there is not a significant difference between the Applied Tension (AT) and the Exposure (E) alone – the most efficient techniques to treat this phobia. Regarding the three research lines mentioned above, the more significant procedures used over the last few years have been the role of hyperventilation and the attentional bias. Finally, a set of guidelines to work with these patients are put forward regarding these findings.
Syncope in children and adolescents
2013, Cardiac Electrophysiology Clinics
Citation Excerpt :
Most phobias usually lead to a hyperadrenergic state and patients with BIP usually have tachycardia. A specific group of children who suffer from blood injury phobia (BIP), however, have a paradoxic bradycardia or a severe asystole in response to an initial transient tachycardia,47,48 which often leads to presyncope or syncope. These children, over a period of time, like other children who suffer from phobic disorders, learn to avoid such situations, because they perceive these injury or blood scenes as unpleasant.
The relation between disgust-sensitivity, blood-injection-injury fears and vasovagal symptoms in blood donors: Disgust sensitivity cannot explain fainting or blood donation-related symptoms
2012, Journal of Behavior Therapy and Experimental Psychiatry
Citation Excerpt :
Up to approximately 80% of blood-injection-injury phobics have a blood-injection-injury evoked positive fainting history (Öst, Sterner, & Lindahl, 1984; Thyer, Himle, & Curtis, 1985). Since fainting has rarely been reported in other anxiety disorders (Connolly, Hallam, & Marks, 1976; for descriptive studies see Freeston, 2000; Green, Antony, McCabe, & Watling, 2007), fear alone cannot explain vasovagal syncopes. It is still controversial which mechanisms are involved in the development of syncopes and vasovagal symptoms during, before or after the confrontation with blood-injection-injury stimuli.
Page’s (1994) prominent theory for the explanation of fainting in blood-injection-injury situations holds that disgust sensitivity contributes to syncopal reactions. We investigated if blood donation-related vasovagal symptoms (1) or fainting related to blood donations (2) are associated with disgust sensitivity.
In an online sample of 361 blood donors, we assessed blood-injection-injury fears, disgust sensitivity, history of blood donation related fainting and retrospective self-ratings of vasovagal symptoms. For the assessment of blood-injection-injury fears we used the BII-Q which has excellent psychometric properties and does not confound disgust and anxiety sensitivity. Vasovagal symptoms were measured by the Blood Donation Reactions Inventory (BDRI) which captures mild and strong vasovagal symptoms and has been used in previous studies with blood donors.
Disgust sensitivity did not significantly contribute to the explanation of self-reported vasovagal symptoms in a regression model with gender, blood-injection-injury fear and disgust sensitivity as predictors. We did not find any significant group differences in disgust sensitivity for blood donors with or without a fainting history (statistical power = 0.95) and a Bayesian model selection procedure showed that it is more likely that both groups are equally disgust sensitive than it is that the fainters are more disgust sensitive.
Further research is required to confirm the findings in prospective studies.
Our results indicate that disgust sensitivity is not relevant for the development of vasovagal syncopes.
Lack of startle blink potentiation to mutilation pictures irrespective of fearfulness
2010, Biological Psychology
Citation Excerpt :
Such abnormal response contrasts with the coherent sympathetic activation that in other specific phobics supports preparation for motor activity (i.e., avoidance or escape), and often leads to fainting upon exposure to blood-related stimuli (see Öst, 1992). Such reaction to the feared stimuli is virtually absent in other specific phobias (Connolly et al., 1976). In addition, growing evidence suggests that information processing of disorder-related stimuli is also different in blood phobia as compared with other specific phobias.
Previous research has shown that in healthy individuals blood-related stimuli elicit a distinctive autonomic response pattern and heightened processing as compared with other unpleasant and arousing visual stimuli. In addition, growing evidence suggests that information processing of disorder-related stimuli is also different in blood phobia as compared with other specific phobias. In the present study, the magnitude of the startle eyeblink reflex elicited during the viewing of mutilation, human attack, erotica and neutral pictures was recorded in 22 blood phobics and 25 healthy controls. Startle eyeblink responses were measured at 300, 1500, 3500 and 4500-ms time intervals after picture onset in order to assess the attentional/affective modulation and its temporal course. Reliable startle inhibition to erotic pictures and startle potentiation to human attack scenes were found relative to neutral pictures. However, while both groups rated mutilations as the most unpleasant and arousing content, no blink facilitation relative to neutral contents was found at either early or late probe times. Crucially, such effect occurred independently of fear levels, as no difference between phobics and controls was found in the size of the startle blinks elicited throughout the viewing of blood pictures.

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^*: This research was partly supported by a grant from the Department of Health and Social Security.

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Selective association of fainting with blood-injury-illness fear*

Vagotonicity of violence: Biochemical and cardiac responses to violent films and television programs

British Medical Journal

Physiological arousal as a function of imagined, vicarious and direct stress experience

Journal of Abnormal Psychology

Fainting, physiological and psychological considerations

Vasovagal fainting: A diphasic response

Psychosomatic Medicine