Clowns, Clown Doctors, and Coulrophobia: A Scoping Review

Abstract

INTRODUCTION Clown therapy in pediatric care settings is becoming increasingly popular. However, clown doctors encounter some children in their visits who are uncomfortable or express feelings of fear. This emotional state is also found among parents and health care personnel. The phenomenon, called coulrophobia, is little studied in the biomedical field, although it has been known for some time. It is deemed necessary to learn more about it to prevent anxiety and fear that is as harmful as it is unnecessary. OBJECTIVE To identify, analyze and synthesize the available literature focused on coulrophobia. METHODS Scoping review adhering to the framework of Arksey and O'Mally. Retrieval of studies by querying and consulting electronic databases and web resources. Screening of records, analysis of included studies, synthesis of data and information in narrative form and through tables. RESULTS Twenty-six studies met the eligibility criteria. The prevalence of coulrophobia among children ranges from 1.1 percent to 6.1 percent. Mostly female and preschoolers are exposed, due to cognitive immaturity that limits the ability to distinguish between fantasy and reality. In adults, the prevalence of coulrophobia is between 18.6 percent and 53.5 percent and mainly prerogative of the female gender. The condition may be the result of childhood trauma associated with an encounter with a clown or mass media promotion of the figure of the evil clown. With some measures, clown doctors can try to prevent children's discomfort or fear. CONCLUSIONS Coulrophobia is a specific phobia falling under anxiety disorders that can have a significant and lasting impact in childhood and adulthood and therefore deserves further research.