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Blood-Injury Phobia With and Without a History of Fainting: Disgust Sensitivity Does Not Explain the Fainting Response

From the Department of Psychology, Institute I-Psychological Assessment and Clinical Psychology, Westfalian Wilhelms University of Münster, Münster, Germany (A.L.G., S.S., R.H.); the Department of Psychiatry, University of Münster, Münster, Germany (G.S., G.H., J.D.); Clinical and Health Psychology Research Centre, School of Human and Life Sciences, Roehampton University, London, United Kingdom (C.V.).

Address correspondence and reprint requests to Dr Rer Nat, Alexander L. Gerlach, Westfalian Wilhelms University of Münster, Department of Psychology, Institute I-Psychological Assessment and Clinical Psychology, Fliednerstr. 21, 48149 Münster, Germany. E-mail: agerlach{at}uni-muenster.de

Objective: Individuals diagnosed with blood-injury phobia respond to venipuncture with strong psychophysiological responses. We investigated whether disgust sensitivity contributes to the fainting response and is associated with parasympathetic activation, as suggested by previous research.

Methods: Twenty individuals diagnosed with blood-injury phobia (9 with a history of fainting to the sight of blood, 11 without such a fainting history) and 20 healthy controls were compared. Psychophysiological responses and self-report measures of anxiety, disgust, and embarrassment were monitored during rest, a paced breathing task, and venipuncture. In addition, trait disgust sensitivity and blood-injury fears were assessed.

Results: Blood-injury phobics reported enhanced anxiety, disgust, and embarrassment during venipuncture. They also experienced heightened arousal, as indicated by heart rate, respiration rate, and minute ventilation. Blood-injury phobics without a fainting history tended toward higher anxiety and disgust scores. There was no evidence for increased parasympathetic activation in either blood-injury phobic subgroup or of an association of disgust and parasympathetic activation.

Conclusion: The tendency to faint when exposed to blood-injury stimuli may suffice as a conditioning event leading into phobia, without specific involvement of disgust sensitivity and parasympathetic activation.

Key Words: blood-injury phobia • specific phobia • fainting • vasovagal syncope • neurocardiogenic syncope • parasympathetic activation • sympathetic activation • respiratory sinus arrhythmia

Abbreviations: BIP+ = blood-injury phobia with a history of fainting; BIP– = blood injury phobia without a history of fainting; RSA = respiratory sinus arrhythmia; PSD HR = log-transformed power spectral density of heart rate oscillations (0.15–0.50 Hz); CMTR LV-HR = coherence-corrected magnitude of the transfer function-relating lung volume oscillations to heart rate oscillations at the peak respiratory frequency; BIFQ = blood-injury-fear questionnaire; FEE = Fragebogen zur Erfassung der Ekelempfindlichkeit.