Understanding Thanatophobia: The Fear Of Death

Thanatophobia is the fear of death or the dying process. While it is not an officially recognized disorder in the DSM-V (the Diagnostic and Statistical Manual of Mental Disorders), research indicates that it impacts approximately 3% to 10% of Americans at some point throughout their lives. As with any phobia, thanatophobia is understood as an inherently irrational fear that can affect those who experience it daily. While it is normal to have some trepidation or anxiety about death and dying, it may become an issue when it evolves in intensity and affects us so that it can make even the most basic, everyday tasks difficult.

What causes thanatophobia and who is at risk?

Many cases of thanatophobia arise due to exposure to a specific experience or event, such as the loss of a loved one, witnessing someone have a difficult death or die painfully, or experiencing firsthand trauma associated with dying or death. 

Anyone can develop thanatophobia at any age, but it may be more common in certain groups of people:

• People with mental health disorders such as anxiety or depression
• People with jobs that include regular contact with death or dying, such as first responders, medical staff, or social workers. 
• People with other existing phobias
• Those without close connections to family or friends or who don’t hold religious beliefs that address issues of death and dying.
• People who have been diagnosed with a terminal illness or are in poor health. 
• People experiencing feelings of low self-esteem or life dissatisfaction. 
• People with friends or loved ones who are ill, dying, or elderly.

Studies suggest that people with thanatophobia in their 20s feel its effects more intensely, with its symptoms declining with age. The same research indicates that women tend to experience a second spike of thanatophobia in their 50s, while men typically do not. 

Symptoms of thanatophobia

Some people with thanatophobia experience intense dread, panic, depression, and anxiety, often avoiding seemingly dangerous situations or places. Some develop comorbidity with hypochondriasis, causing a preoccupation with illness. 

Symptoms of thanatophobia are often similar or the same as other phobias and often resemble a panic attack. They may include:

• Racing heart/Shortness of breath
• Excessive sweating
• Shaking/Trembling
• Dizziness/Disorientation
• Gastrointestinal problems/Nausea
• Dry mouth
• Restlessness
• Sense of impending doom
• Persistent worry/Agitation
• Feelings of anger, guilt, or sadness without a detectable cause.
• Avoidance of social situations or friends and family.

Diagnosing and treating thanatophobia

If you suspect you may have thanatophobia, it’s vital to seek help from a professional. If you choose to speak to your general practitioner first, they may wish to run some lab tests to determine if your symptoms are caused, or partially caused, by a physiological issue. Once they’ve interviewed you about the symptoms and received the results of your tests, they may refer you to a mental health professional for treatment. 

From there, your therapist will discuss with you the history of your symptoms as well as thoughts, feelings, behaviors, and other pertinent information you’d like to share. They’ll then cross-reference the information with the diagnostic guidelines in the DSM-V to develop a treatment plan. Like other phobias, your therapist will likely diagnose your thanatophobia as concurrent with an anxiety disorder and treat it as such. 

Typical treatments for anxiety and phobia 

Cognitive behavioral therapy (CBT)

The process of CBT centers around identifying the thought distortions that cause a patient’s anxiety and, in the case of those with thanatophobia, their fear of death. The patient and therapist then work together to expose the disparities between reality and the patient’s unrealistic thoughts and beliefs that create anxiety and phobia. The goal of CBT in cases of thanatophobia is to help patients reframe how they think about death to make it less frightening, decreasing anxiety symptoms until the phobia has subsided. 

Exposure therapy

This is a standard treatment for phobias that involves gradually exposing the patient to the source of the phobia. In cases of thanatophobia, for example, the therapist may begin by asking the patient to communicate their feelings about their death or the death of a loved one. When the patient is ready to cope with less moderate exposure, they may ask them to describe how they visualize death for themselves or others. From that point, the exposure becomes more intense until the patient is eventually comfortable confronting death.

Medication

While most mental health professionals recommend psychotherapy above medication, there may be times when a psychiatrist will prescribe anti-anxiety medications for “emergency” situations that could trigger a panic attack, such as attending a funeral. 

Mindfulness and relaxation exercises

Mindfulness exercises are a common technique therapists use to help patients become centered and more relaxed in the present moment. Mindfulness has been shown to reduce rumination, stress, and anxiety- and in addition to practicing it during sessions, therapists often give their patients “homework” to practice mindfulness techniques in between sessions. Not only does a mindfulness practice help relieve some of the anxiety-inducing thoughts about death, but it also helps those with a fear of death live in a present state so they may focus on living life in the moment rather than fear what is to come.  

Constructive distraction

Based on the concept of  Terror Management Theory, constructive distraction operates with the thought that, when faced with the possibility of death, constructively turning to distraction can help us cope. For example, when a patient with thanatophobia thinks about death, they may try doing something that helps them feel “alive” in response, such as going for a walk in nature or engaging in a creative activity. If a loved one dies from a health problem, one may find it productive to take up swimming or learn to create healthy recipes.

Constructive distraction can also exist on a larger, communal scale. For example, some people find that support from their religious community helps them feel more at ease with the idea of death, partly because many religions offer a concept of an afterlife. One may find the same support within non-religious communities as well- any group supporting an individual to find meaning and learn to make meaningful choices can help. This can provide a sense of achievement and self-confidence that may bring some relief from the fear of death. 

Work through phobias in online therapy

The reasons people fear death can vary between individuals; however, fear of the unknown and discomfort about a lack of control around death often contribute. Even though we know death is a natural part of life, it’s sure to happen, and it isn’t preventable; those root fears essentially make thanatophobia an irrational (yet understandable) condition for many. 

If you experience severe discomfort around the concept of death and dying such that it interferes with your daily life and well-being, you may benefit from working with a mental health professional. While traditional therapy is an option, many people choose online therapy for its convenience, accessibility, and affordability. 

Online platforms like Regain connect people with licensed mental health professionals experienced in working with people experiencing phobias, anxiety, depression, and more. You can book appointments with your therapist according to what’s convenient for your schedule, and you can speak with your therapist anywhere with an internet connection via online chat, video chat, text, and phone. Not only is it convenient and accessible, but online therapy is often less expensive than conventional therapy without insurance. 

A growing body of research indicates that online therapy is as effective as traditional therapy for treating anxiety, phobias, trauma, depression, and other mental health challenges. For example, a 2018 meta-analysis posted in Science Direct provides updated information on a previous study measuring the efficacy of online treatment for anxiety and depression. The study included analysis of 64 CBT trials and found the results “generated large effect size superiority over control groups, with maintenance of benefit at follow-up, acceptable patient adherence and high rates of satisfaction and now with evidence of effectiveness in routine practice.”

Takeaway

Anxiety and thanatophobia are highly treatable. With the support of a mental health professional, you can learn to understand the roots of your thanatophobia, how to cope with difficult symptoms, and eventually, overcome fear and anxiety.