Thanatophobia refers to an excessive fear of death. Thoughts of death typically create a sense of worry and dread, but for those who have thanatophobia, the anxiety is extreme and panic-inducing. Though the condition may result in distress, the fear of death, like any phobia, is treated effectively with a combination of therapy, medication, and healthy lifestyle changes.
Defining Thanatophobia
Specific phobias are one group of mental health conditions that fall into the anxiety disorder category. All phobias are marked by an extremely powerful anxious or fearful response to a particular situation or object.1 People can have phobias related to almost any place, things, or scenario. People could have a phobia linked to harmless triggers like clowns, cupcakes, water bottles, or carrots. To people with a phobia, nothing is off limits.
For someone with Thanatophobia, the fear of death can be very specific to their own death, or:
- The process of dying
- The process of a loved one dying
- The actual death of a loved one
To reiterate, thanatophobia is not a mental health diagnosis on its own. Rather, someone who has a fear of death or a fear of dying would receive a diagnosis of specific phobia from a mental health professional with the understanding that thanatophobia was the issue of concern.
Signs of Thanatophobia
Depending on the person, the situation, and the stressors present, a person with a phobia of death could live a very typical life with very little signs of a problem. Other people with the condition could experience high levels of fear and anxiety on a daily basis that compromise their ability to complete daily activities, fulfill work duties, learn in school, and maintain healthy relationships.
Phobias tend to influence people in ways unique to that specific fear. People with a fear of vomiting could limit their eating and become severely underweight, and people who are afraid of doctors may avoid medical care, resulting in numerous health issues.1 A person with thanatophobia could spend each day thinking about death, whether their own or the death of a loved one. Because they are so focused on the issue, they could appear unable to do anything else.
Since people with phobias generally work hard to avoid their fears, a person with thanatophobia could avoid going anywhere, doing anything, or being around anyone if there is a chance of danger or injury.1 They may choose to stay in their home or a few areas they deem as “safe.”
Thanatophobia can appear to share symptoms with other conditions like illness anxiety disorder or somatic symptom disorder because it creates excessive anxiety related to physical health conditions, but thanatophobia is grounded in the irrational fears of a phobia.
Children with thanatophobia and other specific phobias may appear to be more defiant and disobedient. As they try to avoid triggers that may refuse to follow through with directives from parents and teachers. They may tantrum often or cling closely to their parents for reassurance.1 With older adults, identifying thanatophobia may be more challenging as issues of death and dying become more common and expected. As with other age groups, the excessive levels of fear will stand out.
Is the Fear of Death Normal?
Death is a topic that tends to stir up a strong emotional reaction in people, no matter their age or background, so in this way, the fear of death is normal. What is not normal, though, is a level of fear that produces high stress, significant anxiety, distress, and panic.
The situation is similar to someone who sees a snake. Most people experience some level of psychological or physiological fear when they encounter a snake, and this fear is part of the body’s response to maintain safety. This reaction only becomes problematic when a person avoids going outside completely or cannot even see a picture of a snake without an intense reaction.
Because there is a fine line between a healthy fear of something dangerous and a mental health disorder, experts are needed to appropriately access and address the symptoms. Specific fears in children are also normal with as many as 90% of children having at least one. A child could worry about death and dying, but unless it begins to drastically impair their life or functioning, it is an acceptable childhood behavior.2
Symptoms of Thanatophobia
The mental health experts and clinicians tasked with differentiating typical worrying about death from thanatophobia will look carefully at the symptoms of specific phobias, like extreme fear and active avoidance.
Some of the most common symptoms of thanatophobia include:1
- Notable fear or anxiety about a certain situation, object, or item related to death and dying. For some, it could be going to hospitals, hearing about another’s illness, or reading the obituary section in the newspaper.
- Thoughts of death create this powerful reaction immediately and consistently
- The person goes to great lengths to avoid death, thoughts of death, knowledge of other people dying, and seeing death on TV
- The fear of death is not proportional to the actual situation with the person having strong reactions to minor stressors
With all specific phobias, these symptoms must continue for at least months to meet criteria for the condition. Additionally, the symptoms related to thanatophobia cannot be more strongly linked to other conditions like obsessive-compulsive disorder (OCD),post-traumatic stress disorder (PTSD), or separation anxiety.1
Something that may cloud the symptoms of thanatophobia is that most people with specific phobias will also present with other mental health symptoms and conditions. In clinical practice, people rarely seek treatment only for fear of death and dying.1
Some of the mental health disorder that regularly emerge alongside phobias include:1
- Depressive disorders
- Other anxiety disorders
- Substance use disorders
- Bipolar disorders
- Somatic disorders like illness anxiety disorder and somatic symptom disorder
- Personality disorders, especially dependent personality disorder
Each of these disorders has the power to shift and distort the symptoms of thanatophobia. They also complicate proper diagnosis and treatment.
Causes & Triggers of Thanatophobia
Even though a phobia of death is an individualized issue composed of unique thoughts, feelings, and behaviors, the condition is a specific phobia with the same causes and triggers of other phobias. Like other phobias, the causes and triggers of thanatophobia are a combination of biological and environmental factors with a focus on previous experiences with death.
Some of the risk factors that expose people to a higher risk of thanatophobia include:1,3
- Age: Specific phobias commonly emerge before age 10, but they may present at any age
- Personality and temperamental factors like being inhibited behaviorally and being prone towards anxiety
- Genetic and physical issues like having a family member with anxiety disorder or a similar type of phobia
- Environmental risk factors involving the person’s experiences and their reactions to these experiences
Environmental factors could drive the majority of specific phobias, especially thanatophobia. Some experiential issues that could influence thanatophobia include:1
- Physical, emotional, and sexual abuse
- Death of a parent
- The separation or divorce of parents
- Overprotective parents
The way a person learns and processes their life experiences will impact the symptoms of thanatophobia as well.
With direct, observational, and informational learning, fear of death symptoms can be caused by:2
- Having a scary or very negative experience with an illness or death
- Seeing loved ones react in extreme or excessively fearful ways involving loss
- Reading about the intense fear of death and dying other people have
Of course, avoiding triggers will decrease the risk of thanatophobia presenting, but the role of protective factors is invaluable. When a person is surrounded by strong supports, a safe environment, and uses healthy coping skills, phobias are less likely to occur.
Treatment of Thanatophobia
Phobia treatments may follow many paths, but one set of interventions involving a precise combination of therapy and medication can quickly and effectively resolve thanatophobia symptoms in children and adults. Even better, this form of treatment may help to address symptoms of co-occurring conditions like depression and anxiety.
Therapy
Therapy is a loosely used term that may apply to any form of psychotherapy delivered by a trained mental health professional to identify and resolve symptoms. Therapists may utilize various techniques, but they will always aim to reduce symptoms of thanatophobia and boost the client’s overall health and well-being.
Therapy for thanatophobia could include individual, group, and family sessions delivered by a psychologist, social worker, or counselor. Therapy is versatile and may take place in doctors’ offices, schools, community agencies, or in the home. A client should always feel comfortable communicating and speaking with their therapist. Honesty and trust are driving forces that work to create movement and change.
Common Type of Therapies
For almost any form of phobia, one therapy stands out as being highly effective, safe, and widely available. Cognitive behavioral therapy (CBT) addresses a person’s symptoms by looking at their thoughts, feelings, and behaviors surrounding death, dying, and the fear of death to understand the issue and treat the concern.4 When viewing a person through the lens of CBT, the therapist will inspect how a person’s thoughts about death and previous death-related behaviors will create feelings of intense anxiety and panic.
CBT can help people learn new ways to shift their thinking patterns and calm their bodies to prevent and reduce the phobic response. CBT therapists can also educate and support people throughout the entire recovery process.
More specific styles of CBT, like exposure and systematic desensitization, further aid the treatment process. These therapy techniques involve putting the client in increasingly close contact with the anxiety provoking situation. In this case, the therapist will use creativity to have the client confront their fear of death.5
Through pictures, videos, guided imagery, and in-person exposure, desensitization encourages the person to experience, not avoid, their fear while practicing relaxation techniques and positive self-talk. Exposure sessions can be very distressing, but the therapist will always supervise the experience to ensure safety and improvement.
Intended Treatment Outcome & Timeline
Standard CBT can create wanted results in about 12 weeks, but exposure therapy can work more rapidly.6 Studies indicate exposure-oriented treatments can produce symptom relief and lasting change in as little as one 4-hour session. Similar studies show progress in four 1-hour sessions.4
Lifestyle Changes
Phobias have the uncanny ability to interfere with nearly every segment of a person’s life and lower the quality of their lifestyle. For this reason, taking an active role in adjusting your lifestyle can help minimize the effects of thanatophobia and enhance the effects of therapy.
Some of the best ways to change your lifestyle include:7
Practice Physical Health Self-Care
Mental health concerns, like an excessive fear of death, need mental health treatment, but no one should neglect the physical health side. By increasing physical activity, setting aside enough time for sleep, and eating a balanced diet, people can put themselves in a situation to thrive.
Follow Treatment Recommendations
The therapy recommendations for phobias may seem overly stressful, causing people to not follow through with treatment. If you trust your provider, listen to their strategies and plans for addressing the fear. Desensitization will reduce symptoms, but if you back out of treatment, the fear may grow stronger.
Focus on Living
A fear of death and dying can shift the focus on the end of your life. When it occurs, you may lose sight of your life, your goals, and your loved ones. Dedicate yourself towards doing something special with or for your valued friends and family members daily to enjoy the life you live.
Find Your Special Purpose
Finding your passion in life may seem impossible in the face of excessive worrying about death, but doing so could reduce your stress, anxiety, and fear. Look for the people, places, things, and activities that make you feel productive, worthwhile, and fulfilled to find your purpose in life.
Medication
Although therapy and lifestyle changes can create powerful symptom relief for the condition, doctors, psychiatrists, and nurse practitioners may also recommend medications for thanatophobia. A range of antidepressant and antianxiety medications can reduce the panic and anxiety that comes with the phobia.
All antidepressents have the potential for side effects, including having a black box warning, the most serious warning given by the FDA, for increased risk of suicide in certain people. Talk with your doctor or health care provider about antidepressants and the risks to see if they are a good fit for you.
Some of the medications commonly used include:4
Selective Serotonin Reuptake Inhibitors (SSRIs) & Serotonin and Norepinephrine Reuptake Inhibitors (SNRIs)
These antidepressants help to increase serotonin or serotonin and norepinephrine in the brain.
Some examples include:
- citalopram (Celexa)
- escitalopram (Lexapro)
- fluoxetine (Prozac)
- paroxetine (Paxil)
- sertraline (Zoloft)
- desvenlafaxine (Pristiq)
- duloxetine (Cymbalta)
- levomilnacipran (Fetzima)
- venlafaxine (Effexor)
Other Antidepressants
Typically older medications from differing classes, other antidepressants may be used with thanatophobia as well. Some options include:4
- 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 quick onset of action, benzodiazepines are widely prescribed for various anxiety disorders. They do present risks of addiction and dependence, though, so the individual and the treatment team should discuss the pros and cons of treatment.
Some examples of benzodiazepines include:4
- alprazolam (Xanax)
- lorazepam (Ativan)
- clonazepam (Klonopin)
- diazepam (Valium)
Other anti anxiety medications, like buspirone (BuSpar), work differently than benzodiazepines to effectively manage anxious symptoms. It may take 2-3 week to produce results, though.4
Dealing with a Thanatophobia-Induced Panic Attack
With any phobia, anxiety and panic attacks are a real concern, which means people with thanatophobia need to acknowledge the risk of panic attacks and take steps towards prevention. As it may be impossible to avoid all anxiety attacks, people can also benefit from exploring ways to quickly recover after they occur.
Panic attacks are marked by sudden and unexpected surges of:1
- Heart pounding and palpitations
- Sweating
- Shakiness
- Chest pain
- Nausea
- Feeling dizzy or light-headed
- Fear of dying
Panic attacks are scary episodes, and anyone who has had one or worries about having one should consult with their therapist to derive a treatment strategy designed for their needs. By combining relaxation techniques, self-talk changes, and an analysis of triggers, a person can gain some control over their panic attacks and work towards eliminating the unwanted symptoms.
How to Get Help for Thanatophobia
Often, the first step towards getting help for thanatophobia is to acknowledge that your fear and anxiety surrounding death are too extreme. If you notice your stress and worry are constantly elevated by the subject, you should consult with the nearest reputable health professional to schedule an evaluation as quickly as possible.
Mental health treatment can be located in numerous locations including doctors’ offices, community mental health centers, school, and private practices. All it takes is a phone call to start the process.
How to Get Help for a Loved One
The process of finding help for a loved one may be more challenging, but the basic principles are the same. It always starts with the person seeing the need for treatment.
If your loved one isn’t sure about the effects of their worry and stress, let them know kindly that you believe their fear is excessive, and they could really benefit from treatment. Let them know that you cannot help them properly with their concerns, professional treatment is the best answer. Offer to attend appointments and help with their therapy homework to show your support.
How to Get Help for a Child
Having a child with thanatophobia can create even more questions, but luckily, childhood phobias may resolve quickly. Let your child know what you see in them, and that you are invested in boosting their happiness.
Be sure to find a therapist who specializes in the unique needs and concerns of children. Engage in the sessions as much or as little as the therapist requests and get involved in at-home activities.
Thanatophobia Statistics
Phobias come in so many shapes, sizes, and names that keeping detailed statistics on each one would be impossible. Instead, experts tend to study the overall group of specific phobias to look for trends and applicable patterns.
Some of the most relevant specific phobia statistics include:1,4
- Each year about 8% of people in the U.S. have a specific phobia
- The average age of onset for specific phobias is 10.
- 16% of children ages 13-17 have a specific phobia
- 5% of younger children and adults has a specific phobia
- Specific phobia affects twice as many women as men
- Nearly 60% of people with phobias will make a suicide attempt
How to Overcome Thanatophobia
Having a mental health disorder does not mean that the condition must consume your life, your worldview, and your self-esteem. Thanatophobia is a serious condition, but by following through with positive coping skills, a person can live a fulfilling life while reducing the disorder.
Some of the most effective ways of coping with thanatophobia include:
Avoid Negative Coping
High levels of anxiety make people want to find immediate relief, and unfortunately, alcohol and other drugs may provide this relief temporarily. The problem comes when the body begins to depend on the substances to create symptom relief, and when no substances are available, anxiety will skyrocket.
Call in the Professionals
No one should assume that phobias will just go away on their own. In many instances, professional interventions involving therapy or a combination of therapy and medication will quickly and effectively reduce symptoms and improve well-being.
Avoid Avoidance
When a person has any specific phobia, their brain will convince them to avoid their triggers at any cost. Obituaries, cemeteries, and any other stimuli may lead to increased anxiety, but escaping from thoughts of death and dying is not the answer. Under the guidance of a professional, practice getting exposure to the stress and let it gradually fade.
Share Your Story
The stigma of mental health conditions may lead people towards feeling guilty or ashamed of their condition. Refuse to fall victim to this trend by letting the people that you care about know what’s on your mind. With their love and support, symptoms can improve.
Thanatophobia Tests, Quizzes, and Self-Assessment Tools
People are always looking for new ways to better understand themselves and their mental health symptoms. Unfortunately, though, pursuing sites online that promise thanatophobia tests, quizzes, and self-assessment tools could waste time and contribute to greater confusion about the condition.
As a person with fear, anxiety, stress, and worry about death and dying, it is not your duty to label your experience. That job is best left to the mental health professionals.
Your task is only to observe and communicate your thoughts, feelings, and behaviors. From there, the clinician will ask a series of questions to gain more information about your symptoms, their intensity, their frequency, and their duration.
For Further Reading
Specific phobias get a lot of attention and interest because they affect so many. For more information and helpful resources, visit:
