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Beyond 'White Coat Syndrome'

Fear of doctors and tests can hinder preventive health care.

Fainting Before the Needle

Although some medical procedures may make us nervous, fear of needles can evoke intense reactions. Fear of needles is a recognized phobia, listed in the American Psychiatric Association's DSM-IV manual within the category of blood-injection-injury phobia, according to a 1995 study in the Journal of Family Practice.

Needle-phobes experience panic attacks, lightheadedness, or fainting when exposed to a needle, according to the author, James G. Hamilton, MD. (Hamilton says that 80% of patients with needle phobia also report the fear in a close relative, suggesting the phobia has a genetic component.)

A 2006 study showed that 15 million adults and 5 million children reported high discomfort or phobic behavior when faced with a needle. Nearly a quarter of those 15 million adults said they refused a blood draw or recommended injection because of fear. (The study, which extrapolated from a survey of 11,460 people, was commissioned by Vyteris, Inc., a company that makes a patch, called LidoSite, designed to relieve needle pain.) Hamilton estimates that needle phobia "affects at least 10% of the population."

"Blood tests are one of the most important diagnostic tools modern medicine has at its disposal," Mark Dursztman, MD, a physician at New York Presbyterian Hospital, said in a news release announcing the study findings. Fear of needles, therefore, is "an important public health issue."

Hamilton says needle-phobic patients deserve to be recognized as suffering from an involuntary condition rather than being made to feel like "wimps" or "oddballs."

Fear's Silver Lining

Fear can also be your friend when it comes to health care, Consedine says. People who are more afraid of cancer or heart disease are more likely to get screened for those illnesses, studies show. In fact, many people face conflicting emotions about visiting a doctor, Consedine says. For example, a man may fear the discomfort of a colorectal exam, but also fear the consequences of missing a colon cancer diagnosis.

What determines whether we seek proper health care or avoid it? "Fear aroused in the absence of any sense of what to do -- of a coping procedure -- is more likely to lead to delay and avoidance," says Howard Leventhal, PhD, director of the Center for the Study of Health Beliefs and Behavior at Rutgers University. If a person feels that a diagnosis will doom him, or that the health care system is untrustworthy, or that he can't afford treatment, he is more likely to let his fears guide his decisions.

Fear of Doctors: How to Cope

Here are some tips experts suggest to cope with fear of doctors or medical procedures:

1. Identify what worries you. Or as Consedine puts it, deconstruct your anxiety. "Anxiety tends to be diffuse; people are not sure what they're really anxious about. But if you identify what it is, that makes it much easier to manage because you can evaluate your coping potential."

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