||This article needs attention from an expert in Medicine. (November 2008)|
Blood phobia (also AE: hemophobia or BE: haemophobia) is the extreme and irrational fear of blood, a type of specific phobia. Severe cases of this fear can cause physical reactions that are uncommon in most other fears, specifically vasovagal syncope (fainting). Similar reactions can also occur with trypanophobia and traumatophobia. For this reason, these phobias are categorized as "blood-injection-injury phobia" by the DSM-IV. Some early texts refer to this category as "blood-injury-illness phobia."
Blood phobia is often caused by direct or vicarious trauma in childhood or adolescence. Though some have suggested a possible genetic link, a study of twins suggests that social learning and traumatic events, rather than genetics, is of greater significance.
The inclusion of “blood-injury phobia” within the category of specific or simple phobias in classificatory systems reflects a perception that fear has a primary role in the disorder. Consistent with this assumption, blood-injury phobia appears to share a common etiology with other phobias. Kendler, Neale, Kessler, Heath, and Eaves (1992) have argued from data comparing monozygotic with dizygotic twins that the genetic factor common to all phobias (agoraphobia, social phobia, and specific phobias), strongly predisposes a person to specific phobias.
The recognition of an inherited vulnerability common to all phobias is consistent with the notion that elevated trait anxiety predisposes one to anxiety disorders. Trait anxiety provides a background of affective arousal that permits a more rapid activation of the fight or flight response. With respect to specific activating events, conditioning is one way that stimuli become able to elicit anxiety (Rachman, 1991).
Accordingly, painful experiences can condition fear to blood-injury stimuli. Investigators typically classify around 60% of self-reported onsets of blood-injury phobia as beginning with conditioning experiences (Ost, 1991; Ost, 1992; Ost & Hugdahl, 1985; Thyer et al., 1985). However, examinations of available case-by-case verbal summaries call into question the conclusion that conditioning episodes are as prevalent as reported (see Mattick, Page, & Lampe, in press). For example, Thyer et al. (1985) identified a conditioning episode when a “patient received an injection at age 13 and fainted” (p. 455), and in another person when ‘at age six she heard her elementary school teacher give a talk on the circulatory system. This frightened the patient to the point of syncope” (Thyer et al., 1988.)
The standard approach to treatment is the same as with other phobias - cognitive-behavioral therapy, desensitization, and possibly medications to help with the anxiety and discomfort. In recent years, the technique known as applied tension, applying tension to the muscles in an effort to increase blood pressure, has increasingly gained favor as an often effective treatment for blood phobia associated with drops in blood pressure and fainting. 
In popular culture
The fictitious Dr. Martin Ellingham, the main character of British television's Doc Martin, is a brilliant and successful vascular surgeon at Imperial College London who develops haemophobia, and as a result is forced to stop practicing surgery. Also, Peter Pan's archenemy, Captain Hook has as one of his principal fears, the sight of his own blood.
- The Merck Manual, retrieved 2007-05-19
- Lipsitz, JD; Barlow, DH; Mannuzza, S; Hofmann, SG; Fyer, AJ (July 2002), "Clinical features of four DSM-IV-specific phobia subtypes", The Journal of Nervous and Mental Disease 190 (7): 471–8, doi:10.1097/00005053-200207000-00009, PMID 12142850
- Thyer, Bruce A.; Himle, Joseph; Curtis, George C. (July 1985), "Blood-Injury-Illness Phobia: A Review", Journal of Clinical Psychology 41 (4): 451–9, doi:10.1002/1097-4679(198507)41:4<451::AID-JCLP2270410402>3.0.CO;2-O, PMID 4031083
- Ost, L.G.; et al. (1991), "Applied tension, exposure in vivo, and tension-only in the treatment of blood phobia", Behaviour Research and Therapy 29 (6): 561–574, doi:10.1016/0005-7967(91)90006-O, PMID 1684704.
- Ditto, B.; et al. (2009), "Physiological correlates of applied tension may contribute to reduced fainting during medical procedures", Annals of Behavioral Medicine 37 (3): 306–314, doi:10.1007/s12160-009-9114-7, PMID 19730965.
- Ayala, E.S.; et al. (2009), "Treatments for blood-injury-injection phobia: a critical review of current evidence", Journal of Psychiatric Research 43 (15): 1235–1242 REVIEW, doi:10.1016/j.jpsychires.2009.04.008, PMID 19464700.
- Peterson, Alan L. (Lt. Col.); Isler III, William C. (Capt.) (September 2004), "Applied tension treatment of vasovagal syncope during pregnancy", Military Medicine 169 (9): 751–3, PMID 15495734