Blood-Injection-Injury Phobia in Children and Adolescents

Abstract

Blood-Injection-Injury (BII) phobia is a complex and debilitating condition that is associated with excessive fear and avoidance of seeing blood or injuries, receiving injections or invasive medical procedures (American Psychiatric Association (APA), 2013). It effects 3 to 4% of adults and 0.8 to 1% of children and adolescents, and can lead to serious health consequences as sufferers may avoid seeking assistance from health professionals or receiving medical treatments for diagnosed illnesses (Depla, ten Have, van Balkom, & Graaf, 2008; Essau, Conradt, & Petermann, 2000; Ost & Hellstrom, 1997). BII phobia has largely been neglected in the child and adolescent literature. To date the majority of the research relating to this disorder has been conducted with adults. From the adult literature it is evident that BII phobia has a complex clinical presentation that is characterised by a unique physiological (e.g., fainting) and emotional (e.g., disgust) response. Behavioural and cognitive behavioural therapies (CBT) have received the strongest empirical support for the treatment of adult BII phobia. The efficacy of CBT approaches with children and adolescents however is less clear, as these youth have been excluded from a number of the large randomised controlled trials (RCT) for childhood specific phobia (Ollendick et al., 2015; Ollendick et al., 2009), owing to their unique physiological response (e.g., fainting), difficulties associated with the delivery of treatment (e.g., the involvement of medical professionals) and their arguably poorer treatment response (Ost, Svensson, Hellstrom, & Lindwall, 2001).