In medicine and psychology, the term “death phobia” indicates the phobia of dying. Since the simple “fear” of death is a very normal feeling, to fully understand the problem it is first necessary to understand the meaning of the word “phobia” and how a phobia differs from a normal “fear”.

What is a phobia?

A phobia is a disorder characterised by an irrational and very strong fear response when exposed to specific objects or situations, as well as a tendency to stubbornly and systematically avoid the feared objects or situations.

Thus, phobia encompasses both a fearful reaction in the presence (or expectation) of particular objects and situations, as well as a behaviour of avoidance of direct contact with the objects or situations themselves.

What is the difference between phobia and ‘normal’ fear?

The difference with ‘normal’ fear is that the latter is rational, whereas phobia is irrational.

For example, a person may have a phobia of sheep, which are peaceful and harmless animals that do not cause fear in the healthy person, but do in those who have a phobia of them.

Having a fear of a tiger, for example, is normal because a tiger is really dangerous.

Etymology of tanatophobia

The term ‘tanatophobia’ comes from the Greek ‘ϑάνατος’ (read ‘tànatos’) meaning ‘death’ and from ϕόβος (read ‘fòbos’) meaning ‘fear’.

Necrophobia or thanatophobia?

While in tanatophobia one is afraid of dying, in necrophobia one is afraid of everything that relates directly or indirectly to death and corpses.

Characteristics of the panic-phobe

Those suffering from tanatophobia have an extreme fear of dying.

However, in the case of tanatophobia, the fear of death is continuous, extreme and highly invalidating, since the person is so afraid of dying that he or she avoids actions that for others would be completely normal, such as walking on the pavement or swimming in the sea.

In the most serious cases, even imagining one’s own death can trigger panic attacks.

Movies, TV shows or stories containing references to death may be unbearable for a tanatophobe.

Other symptoms of tanatophobia, besides uncontrollable fear, often include:

• feeling of imminent death;
• tachycardia (increased heart rate);
• tachypnoea (increased respiratory rate);
• hyperhidrosis (increased sweating);
• decreased salivation;
• anorexia (decreased or total absence of appetite);
• dyspnoea (feeling of lack of air);
• nausea;
• vomiting;
• fainting;
• flight reaction (the subject literally runs away).

The result of this condition is that the person suffering from tanatophobia tends to stubbornly and systematically avoid all situations that might be hazardous to his or her safety.

Many jobs may be closed to them for this reason.

In the most serious cases, the subject completely avoids any activity that might be even slightly risky or not risky at all.

In the most extreme cases, the person isolates himself from the rest of the world.

Other pathologies

The sufferer of tanatophobia may simultaneously suffer from other pathologies of psychiatric interest.

The trypanophobic may also have other specific phobias, including:

• agoraphobia (fear of open spaces);
• claustrophobia (fear of enclosed spaces);
• central phobia (fear of crowded places in open spaces such as squares in the centre of a city);
• necrophobia (fear of things involving death and corpses);
• demophobia (fear of crowded places).

Not infrequently, the tanatophobe also suffers from obsessive compulsive disorder or obsessive compulsive personality disorder.

Frequently, a generalised anxiety disorder can also be observed.

The tanatophobe may also suffer from depression and dissociative (psychogenic) fugues in response to the stress of having been exposed to life-threatening situations.

Causes of tanatophobia

The causes of tanatophobia are not currently known.

One possible cause is post-traumatic stress disorder.

For example, having risked death as a child could increase the risk of suffering from tanatophobia.

Therapies

The treatment of tanatophobia involves several approaches, including:

• exposure therapy;
• narrative exposure therapy;
• psychotherapy;
• psychopharmaceuticals.

Several techniques can be used in synergy to increase the therapeutic effect.

Exposure therapy

Exposure therapy ‘forces’ the patient to face the situation that generates the phobia attack: the subject is invited to talk and/or write repeatedly about the worst traumatic event(s) he/she has faced, reliving in detail all the emotions associated with the situation.

Through this process many patients undergo a ‘habituation’ to the emotional response triggered by the traumatic memory, which consequently, over time, leads to a remission of the phobia symptoms when the situation reoccurs in reality.

Exposure therapy – practised for an appropriate period of time – helps about 9 out of 10 patients in our experience.

Narrative exposure therapy

Narrative Exposure Therapy (hence the acronym “NET”) is a short-term therapy for individuals suffering from post-traumatic stress disorder and in some cases from phobias.

The treatment involves emotional exposure to memories of traumatic events and the reorganisation of these memories into a coherent chronological life narrative.

Narrative exposure therapy can be used either alone or in combination with exposure therapy, psychotherapy, narrative medicine and/or drug therapy.

Psychotherapy in cases of tanatophobia

The psychotherapy that has been shown to provide good results with tanatophobia, and with phobias in general, is cognitive-behavioural therapy.

The standard cognitive-behavioural therapy for the treatment of phobias, in addition to behavioural interventions based on situational exposure, includes initial psychoeducation and cognitive interventions.

Within cognitive-behavioural psychotherapy, expositional techniques have proven useful in reducing anxiety-provoking behaviour.

Recently, strategies have been implemented to increase the ability of subjects to stay in touch with anxious activation without fearing its catastrophic consequences, favouring acceptance and decreasing the need to control anxiety symptoms.

Medications

In tanatophobia, as in all phobias, anxiolytic and antidepressant drugs can be used.

Among the anxiolytics, benzodiazepines (such as Valium) can be useful as they provide instant anxiolytic symptomatic relief, but side effects (if used for long periods) include the risk of drug dependence.

Among antidepressants, SSRIs (Selective Serotonin Reuptake Inhibitors) are particularly useful.

The drugs generally work well to control the phobia, however, symptoms tend to recur when they are discontinued.

Medications should be taken under close medical supervision.

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