A Sententious Review Article on Thanatophobia: Perceptive Death Anxiety

Introduction

Thanatophobia came from the Greek word, ‘Thanatos’ meaning death and ‘Phobos’ meaning fear. Thus, thanatophobia generally means ‘fear of death’. Due to numerous reasons, most of the people feel frightened of death and dying at some point in their lives. If someone is suffering from phobia of death or dying that is tenacious and venerable, it causes distress or anxiety, and can be so extreme that it affects their daily life, due to anguish from thanatophobia. Specific phobias are a type of psychiatric condition that comes under anxiety disorder category. All phobias are marked by an enormously powerful, anxious or fearful response to a specific situation or object.¹

Definition

Death anxiety is anxiety disorder triggered by thoughts of one's own death. It is also denoted as thanatophobia (fear of death).²

Etiology

The actual cause of thanatophobia is unknown. However, the disorder is a specific phobia with focus on preceding experiences with death.

Some of the risk factors that expose people to an advanced risk of thanatophobia include (Table 1).

• Age: Various studies proved that anxiety about death emerged in people in their 20s and deteriorated significantly thereafter. Mainly young and old aged people suffer from this psychiatric problem.
• Sex: Though individuals of both genders can suffer death anxiety, women experience a secondary thorn of thanatophobia in their 50s.³
• Personality and temperamental factors: These are like being inhibited behaviourally and being prone to anxiety.
• Parents nearing the end of life: Offspring of aged and sick parents are more prone to thanatophobia. They are expected more to believe that their parents are frightened of dying because of their own feelings.⁴
• Personal health: People with prolonged illnesses are more at risk to experience extreme fear of death.⁵
• Traumatic event: Those who experienced deathrelated, traumatic events are more probable to develop death anxiety.⁶

Clinical features of Thanatophobia

• Unreasonable, undue fear: The person displays excessive or irrational, persistent, and intense fear triggered by a specific object or situation.
• Escaping of circumstances in which thinking about death or dying may be obligatory: In severe cases, this can lead to the person evading leaving home altogether.
• Life-limiting: The phobia significantly affects the individual’s work, school, or personal life.
• Duration: The duration of warning signs must last for minimum six months.¹ S

Some general symptoms of Thanatophobia are:⁷

• Shortness of breath
• Nausea
• Perspiration
• Racing heart
• Headache

Diagnosis

Thanatophobia does not have many specific clinical symptoms, so there is no exact diagnostic test for healthcare providers. But based on symptoms and severity, healthcare providers can have a greater understanding of the situation.

The important fact is, thanatophobia can be diagnosed by trained mental health professionals. They will try to find out whether the fear is part of a specific phobia, an anxiety disorder, or a related mental health problem.

Thanatophobia may be related to:

Specific phobias: Death anxiety can be linked to a range of specific phobias. The most common reasons could be anything that can cause harm or death, including heights, flying, animals, and blood.

Panic disorders: Throughout a panic attack, people may experience fear of dying or impending doom.

Illness anxiety disorders: Death anxiety may be related to illness, anxiety disorders, once recognized as hypochondriasis. A person with intense fear of becoming ill can unreasonably worry about their health.^8,9

Treatment of Thanatophobia

Dealing with Thanatophobia can be done in a number of ways, but a couple of interventions relating a precise combination of therapy and medication can quickly and proficiently resolve thanatophobia warning signs in children and adults. Even better, this form of treatment may help to report symptoms of co-occurring conditions like depression and anxiety

Therapy

Therapy means any form of psychotherapy delivered by a skilled mental health expert to classify and resolve symptoms. Therapists may explore various techniques, but will always aim to lessen symptoms of thanatophobia and enhance client’s complete health and well-being.

Thanatophobia therapy includes individual, group, and family sessions given by a psychologist, social worker, or counsellor. Therapy is multipurpose and can take place in doctor’s office, schools, community agencies, or at home. A client should feel relaxed interacting and speaking with their therapist. Morality and faith are the driving forces that work to create movement and change.

Common categories of therapies

Cognitive Behaviour Therapy (CBT) is a very effective therapy in treating various kinds of phobias. CBT indicates a person’s symptoms by looking at their opinions, moods, and behaviour surrounding death, dying as well as the fear of death to recognize the issue and treat the concern. When inspecting a person through the lens of CBT, the psychotherapist will inspect how a person’s thoughts about death and previous deathrelated behaviours create feelings of forceful anxiety and panic. CBT helps people to learn new habits, to shift their thoughtful designs, calm their bodies to avoid and diminish the phobic response. CBT therapists can also educate and support people during the complete recovery process.

More specific styles of CBT, like exposure and systematic desensitization can further assist the action process. These therapies involve putting the person in progressively close connection with the anxiety provoking situation. The therapist will use originality to have the client provoke their fear of death.⁹

Overall, the videos, guided imagery, pictures, in-person exposure and desensitization can reassure and help the person to experience, not avoid, their fear while working relaxation techniques and optimistic self-talk. Exposure assemblies can be very distressing, but the therapist will always oversee the involvement to certify safety and enhancement.

Intended treatment outcome and timeline

Standard CBT can form desired results within 12 weeks, but exposure therapy can work more quickly.⁶ Studies have shown exposure-oriented actions which can produce symptom relief and permanent change in as little as one 4-hour session. Alike studies show progress in four 1-hour sessions.

Lifestyle variations

Phobias have the weird ability to affect with nearly every segment of an individual’s life and lower the quality of their routine. These causes play an active role in regulating the individual’s lifestyle to minimize the effects of thanatophobia and augment the effects of therapy.

Some of the best habits to change the lifestyle include (Table 2).

Repetition of physical health self-care

For the holistic health of the body, both mental and physical health are important. By increasing physical movements, setting aside sufficient time for sleep, and ingestion of balanced diet, people can put themselves in a condition to thrive.

Following treatment references

The therapy references for phobias may seem excessively stressful, causing people to not follow through with treatment. The client should listen to their strategies and plans for speaking out about the fear. Desensitization will lessen the symptoms, but if the client backs out of the treatment, the fear may grow stronger.

Focus on living

A fear of passing away and dying can shift the focus on the end of the life. When it occurs, one may lose vision in their life, their goals as well as the loved ones. It is important to dedicate time towards doing something special with or for the valued friends and family members each day to enjoy life.

Find the special purpose

Discovering the passion in life may appear unbearable in the face of excessive perturbing about death, but doing so could cut down stress, anxiety as well as fear. Look for the persons, places, belongings, and actions that make one feel productive, valuable, and satisfied so as to find the purpose in life.

Medication

Though therapy and lifestyle changes can contribute remarkably for symptom relief in the condition, psychiatrists, doctors as well as nurse practitioners also act as useful aids in the management of thanatophobia. A range of antidepressant and antianxiety medications can reduce the panic and anxiety that comes with the phobia.

All antidepressants have probable side effects, including having a black box warning, the most serious cautionary signs given by the FDA, for increased risk of selfdestruction in certain people. Consultation with the doctor or a healthcare provider about antidepressants and the associated risks is important to see if they are suitable for that particular individual.

Some of the frequently used medications include Selective Serotonin Reuptake Inhibitors (SSRIs), Serotonin and Norepinephrine Reuptake Inhibitors (SNRIs) These antidepressants aid in intensification of serotonin or serotonin and norepinephrine in the brain.

Some examples include Sertraline (Zoloft), Levomilnacipran (Fetzima), Venlafaxine (Effexor) Desvenlafaxine (Pristiq), Duloxetine (Cymbalta), Citalopram (Celexa), Escitalopram (Lexapro), Fluoxetine (Prozac), Paroxetine (Paxil), Other Antidepressants

Classically, older medications from opposing classes, some kind of antidepressants may be effective with thanatophobia as well. Some of the options include Tricyclics like clomipramine hydrochloride (Anafranil) and Imipramine hydrochloride (Tofranil). MAO inhibitors like phenelzine (Nardil) and selegiline (Emsam). Benzodiazepines and other antianxiety agents.

As medications with rapid onset of action, benzodiazepines are extensively prescribed for numerous anxiety disorders. They do present dangers of addiction and dependence, and therefore the individual and the treatment team should discuss the positive and negative aspects of the treatment.

Some examples of benzodiazepines include: Diazepam (Valium), Alprazolam (Xanax) Clonazepam (Klonopin), Lorazepam (Ativan), Other anti-anxiety medications, like buspirone (BuSpar), work inversely than benzodiazepines to efficiently manage nervous symptoms. It may take 2-3 weeks to produce fallouts, though.¹⁰

Conclusion

Mental health nurses play a critical role globally in preventing death, and help in counselling people with death anxiety, fear of death, nursing, health care, and thanatophobia. People who think about death and worry about their lives might become more cautious with their actions and can get anxious about the security of others too. Moreover, failing to contemplate mortality makes it challenging to comprehend life's significance.

Nevertheless, when people suffer illogical fears regarding death, and develop anxiety disorders like thanatophobia, their feelings dictate their lives. If people are over frightened and are preoccupied about death, they miss out on living.

Even if an individual has been suffering for long periods of time, thanatophobia can be overcome, and like treating other anxiety disorders and phobia, it requires change in opinions, behaviour, and sentiments, which can be done by working with a therapist with expertise in treating people using cognitive-behavioural therapy.

Conflict of Interest

Nil