Nosophobia

The exact underlying causes of nosophobia are poorly understood, but it is thought to be multifactorial, involving a combination of genetic, environmental, and social factors. There may be genetic factors that predispose the individual to develop mental health conditions (e.g., obsessive-compulsive disorder) or specific phobias, like nosophobia. For example, individuals with a known family history of a specific phobia have an increased risk of developing a phobia compared to individuals without a family history. Previous traumatic experiences with illness or illness-related hospitalizations may also contribute to the development of nosophobia. It has also been proposed that a person may develop a specific phobia through modeling, or observing a reaction from another person and internalizing this fear.  

Additionally, other risk factors for nosophobia include stress, certain personality traits (e.g., perfectionism), a history of obsessive-compulsive disorder, caring for a loved one with a serious illness, and those in the healthcare profession. Nosophobia may also be associated with other specific phobias including cardiophobia (i.e., fear of heart disease or heart attacks), pharmacophobia (i.e., fear of medications), and carcinophobia (i.e., fear of getting cancer), among others. 

Diagnosis of nosophobia begins with a thorough review of symptoms, medical history, and physical exam. The Diagnostic and Statistical Manual of Mental Disorders 5th Edition (DSM-5) criteria for diagnosis of a specific phobia include the following: 
(a) Marked fear or anxiety about a specific object or situation (e.g., fear of illness) 

(b) The fear or anxiety is out of proportion to the actual danger posed by the specific object or situation 

(c) The fear or anxiety causes significant distress that results in impairments of activities of daily living and other important areas of functioning 

(d) The disturbance has lasted 6 months or more 

(e) The disturbance is not better explained by another medical condition 
 
Since nosophobia is a diagnosis of exclusion, other mental health disorders that may present with similar symptoms should be excluded, such as hypochondriasis. Similar conditions that also involve excessive worries about illnesses without objective evidence of disease include illness anxiety disorder and somatic symptom disorder. Individuals with nosophobia are afraid of contracting a specific, life-threatening illness, while individuals with illness anxiety disorder may worry about contracting all types of diseases. Similarly, individuals with somatic symptom disorder constantly worry about their health, however, they also experience physical symptoms of illness without an identifiable cause. 

Treatment of nosophobia consists of a combination of psychotherapy, pharmacotherapy, and multidisciplinary support to ensure comprehensive, tailored care. Psychotherapy options include cognitive behavioral therapy (CBT) and exposure therapy. CBT is a structured, goal-oriented type of talk therapy that helps affected individuals address and manage problematic patterns of thinking. CBT usually requires multiple sessions with a psychotherapist or psychiatrist, who helps the affected individual gain a deeper understanding of the underlying problem and recognize problematic thoughts and behaviors related to identified triggers. Exposure therapy is another form of talk therapy in which the individual is gradually exposed to the trigger. During exposure therapy, a therapist creates a safe environment and gradually exposes the individuals to feared objects and situations. Individuals are taught to utilize relaxation techniques during the encounter. Similar to CBT, exposure therapy requires multiple sessions where individuals learn to cope and manage their fear responses.  

Pharmacotherapy options include selective serotonin reuptake inhibitors (SSRIs) such as fluoxetine and citalopram, and can be used in conjunction with psychotherapy for individuals with more severe symptoms. Altogether, a multidisciplinary team of psychiatrists and mental health professionals can help manage nosophobia.