Blood-injection-injury (BII) type phobia is a type of specific phobia characterized by the display of excessive, irrational fear in response to the sight of blood, injury, or injection, or in anticipation of an injection, injury, or exposure to blood. Blood-like stimuli (paint, ketchup) may also cause a reaction. This is a common phobia with an estimated 3-4% prevalence in the general population, though it has been found to occur more often in younger and less educated groups. Prevalence of fear of needles which does not meet the BII phobia criteria is higher. A proper name for BII has yet to be created. When exposed to phobic triggers, those with the phobia often experience a two-phase response: an initial increase in heart rate and blood pressure, followed quickly by bradycardia (decreased heart rate) and hypotension (decreased blood pressure). This diminishes cerebral blood supply, and will often result in a fainting response. In an individual with BII phobia, expression of these or similar phobic symptoms in response to blood, injection, or injury typically begins before the age of ten. Many who have the phobia will take steps to actively avoid exposure to triggers. This can lead to health issues in phobic individuals as a result of avoidance of hospitals, doctors’ appointments, blood tests, and vaccinations, or of necessary self-injections in those with diabetes and multiple sclerosis (MS). Due to frequent avoidance of phobic triggers, BII phobics personal and professional lives may be limited.
Therapists may use a combination of physical and psychological measures, such as cognitive-behavioral-therapy and applied tension (AT), in order to aid in extinguishing the individuals fear response.Early studies of methods to combat vasovagal fainting found that certain leg exercises and that individuals making themselves angry over imagined scenarios could increase blood pressure, thus elevating cerebral blood flow and preventing fainting upon exposure to a phobic trigger. A later study tested applied muscle tension as a way of preventing fainting when an individual with a fear of injuries was exposed to triggering visual stimuli. Lars-Göran Öst expanded upon this research, having BII-phobic individuals engage in applied muscle tension while shown blood stimuli. Those who were trained in the technique showed notable symptom improvement over the course of five one-hour treatment sessions.An AT treatment program most often involves an individual being instructed to clench their arm, leg, and chest muscles in 10 to 15 second intervals as they are systematically exposed to triggers of increasing likeness to real blood or needles. This program is designed to increase heart rate and blood pressure, counteracting vasovagal response.The method of applied tension remains popular — it is the most common BII phobia treatment suggestion, and has been found to be highly effective in a majority of BII-phobics. However, exposure-only cognitive-behavioral therapy (CBT) can also be effective, as can the method of applied relaxation (AR).CBT is a technique which promotes fear extinguishment by way of gradual, repeated exposure to feared stimuli.