Abstract

Blood-injection-injury (BII) phobia can lead to avoidance of crucial medical procedures and to detrimental health consequences, even among health workers. Yet unlike other specific phobias, BII phobia has been understudied. Specifically, while cognitive biases have been extensively investigated in other anxiety disorders, little is known about the same biases in BII phobia. The current article reviews cognitive biases in BII phobia and suggest future directions for further study and treatment. The reviewed biases include attention, expectancy, memory, perception, and interpretation biases. The investigation of these biases is highly relevant, as cognitive biases have been found to interact with anxiety symptoms. Results showed that attention, expectancy, and memory biases are involved in BII phobia, while no studies were found on interpretation nor perception biases. Mixed results were found for attention bias, as different studies found different components of attention bias, while others found no attention bias at all. Similarly, some studies found a-priori/a-posteriori expectancy biases, while other studies found only one type of bias. A better understanding of the cognitive particularities of BII phobia may lead to better treatments and ultimately reduce avoidance of needles and blood-related situations, thereby enabling individuals with BII phobia to undergo potentially life-saving medical procedures.

Highlights

  • Being afraid of blood, injections, and injuries seems intuitive

  • The included studies encompassed a total of 1,201 participants: 506 participants with BII phobia/high BII fear levels, 538 healthy control participants, and 157 participants with other specific phobias or anxiety disorders

  • The aforementioned studies suggest that attention, expectancy and memory biases are involved in BII phobia

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Summary

Introduction

As in the case of spiders, snakes, heights, and closed spaces, blood-related stimuli are generally aversive and potentially phobia-inducing. Being extremely fearful of or disgusted by blood-related stimuli is considered a mental disorder known as blood-injection-injury (BII) phobia [1]. Most people who are afraid of needles experience needle-related bodily symptoms, such as dry mouth, shortness of breath, sweat, nausea, and feeling faint or dizzy [4]. Fear of BII-related stimuli and events can lead to dire health consequences such as avoidance of vital vaccines, even among healthcare workers [3], in addition to avoidance of blood tests, pain relief measures, and blood donation [4]

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