Tomophobia · What It Is, Causes, Signs and Symptoms, Diagnosis, and More

The exact underlying causes of tomophobia are poorly understood, but it’s 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., post-traumatic stress disorder) or specific phobias. 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. Prior traumatic experiences such as an accidental or iatrogenic (i.e., caused by medical treatment) injury from a procedure or surgery, may also contribute to the development of tomophobia.  

Sometimes, individuals who experience vasovagal syncope, a condition that occurs when the body overreacts to certain triggers, resulting in a sudden reduction in heart rate and blood pressure, can experience tomophobia.  

Signs and symptoms of tomophobia may vary between individuals, but the hallmark feature is an intense fear of surgery or overwhelming fear of undergoing medical procedures. Signs may include increased heart rate, diaphoresis, shortness of breath, and heightened anxiety levels when thinking about surgery or medical procedures; and avoidance of activities and people who may be involved in surgery or medical procedures. 

Tomophobia may cause unnecessary stress for an individual, and if not appropriately addressed, it can prevent the individual from receiving appropriate medical care.  

Diagnosis of tomophobia 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 surgery);

(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; and

(e) Another medical condition does not better explain the disturbance
 
Since tomophobia is a diagnosis of exclusion, other mental health disorders that may present with similar symptoms should be excluded. For example, trypanophobia is an extreme fear of needles or medical procedures involving injections or needles, therefore a detailed history can help differentiate whether the fear is from injections or the procedure itself. 

Treatment of tomophobia 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, which can be used in conjunction with psychotherapy for individuals with more severe symptoms. Additionally, beta-blockers (e.g., propranolol) may help reduce the physical symptoms of anxiety. Altogether, a multidisciplinary team of psychiatrists and mental health professionals can help manage tomophobia.