Do you experience overwhelming fear when someone tries to touch you? Does the mere thought of engaging in social interactions that involve handshakes, hugs, or physical contact trigger intense distress?
Haphephobia is characterised by an intense fear of physical contact with others. This condition belongs to a subcategory of anxiety disorders called specific phobias, which have not been well studied. For people with specific phobias, avoidance can reduce their experience of distress and impairment.1
The purpose of this article is to explore the specific phobia subcategory of anxiety disorders more deeply, in order to understand the causes, signs and symptoms, management and treatment, and diagnosis of haphephobia.
Haphephobia is the fear of being touched. It is not amongst the most diagnosed specific phobias. Even though treatment is available, many do not seek treatment for specific phobias. A specific phobia is defined, in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) as a fear or anxiety about a specific object or situation. The phobic situation or object almost always provokes immediate fear or anxiety and is actively avoided or endured. This fear or anxiety is a disproportionate response to the actual danger posed by the specific object or situation and to the sociocultural context.2 Specific phobias affect around 8% of children and young people in the UK population.3
Causes of haphephobia
There is no clear reason why haphephobia occurs. There could be many factors that might contribute to developing such a specific phobia. Here are a few potential causes:
- Bad experiences: If you have had an unpleasant experience with an object, animal, or situation, your brain can quickly learn to expect the same thing to happen again
- Genetics or learned behaviour: Childhood is a time when you learn beliefs and habits by observing the people around you. This affects how you see the world and react to different situations and objects. This means that if your parent has a phobia of an object, animal, or situation, you could learn to also react to it with fear
- Brain function and structure: A person with a phobia may differ in brain structure compared to someone without a specific phobia. The phobia triggers certain regions of the brain leading to a particular response
Signs and symptoms of haphephobia
The symptoms could typically last 6 months or more in individuals under the age of 18 years.2 Symptoms include notable, clinical distress or impairment in social, occupational, or other important areas of functioning, and cannot be explained by another psychiatric disorder such as obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD), separation anxiety disorder, or social anxiety disorder. Patients often present with complaints of poor physical health as their primary concern, and this may temporarily distract from the underlying anxiety symptoms.
Diagnosis of haphephobia
Haphephobia is not a commonly diagnosed phobia as many do not seek treatment. It is likely that presenting symptoms are commonly found in other specific phobias or anxiety disorders. Therefore, it is important that a specialist accurately diagnoses it by differentiating it from other anxiety disorders.
Seeing a General Practitioner (GP) would be the first start to getting an initial consultation.4 You may need to then be referred to a mental health professional, such as a psychiatrist or psychologist, who will diagnose and treat specific phobias.
To diagnose haphephobia, patients may be asked the following questions:
- When the fear arise?
- How long does the fear last?
- What symptoms are experienced when thinking about being touched?
- What are the symptoms you experience when being touched?
- Do these symptoms interfere with daily life?
Management and treatment for haphephobia
The treatment of specific phobia involves :
- Pharmacological therapy: Affected individuals may be given medications such as antidepressants by the doctor to take before certain events to temporarily manage symptoms
- Cognitive behavioural therapy (CBT): A therapist speaks to patients during sessions about their symptoms and fears to identify irrational thoughts and learn to replace them with rational ones
- Exposure therapy: Here the patient is gradually introduced to their specific fear in their thoughts or life
- Eye movement desensitisation and reprocessing (EMDR): Often effective for people who have experienced trauma. The therapy focuses on a trauma memory while being stimulated by specific rhythmic movements
These interventions have demonstrated varying levels of treatment success with different types of specific phobias.
How can I prevent haphephobia?
People will ask for help when the phobia begins to interfere with everyday life. All phobias are treatable, even haphephobia. Familiarising children with the things they are afraid of is a good way to prevent a phobia from developing. Some patients may require a more delicate and sensitive approach due to past childhood trauma.5
How common is haphephobia?
An estimated 10 million people have phobias in the UK. Specific phobias affect around 8% of children and young people (CYP) in the UK population.3 There has been only one case reported of haphephobia in the published literature to date and this was back in 2022 in Bangladesh. This involved a wife who with an intense fear of being touched by her husband. After an in-depth assessment session with the psychiatrist, the wife revealed that she had experienced sexual abuse early in life followed by a death threat by her stepfather at the age of 14 years. This then led to a diagnosis of haphephobia.
Who is at risk of haphephobia?
Phobias can affect anyone, regardless of age, sex and social background. Such phobias usually start during early childhood, often between the ages of four and eight. This is supported by large sample data, a total sample size of 124,902 participants obtained from the World Mental Health Survey, which showed a median age of 8 years for onset.6
When should I see a doctor?
Anyone concerned about their mental health can contact their local GP to speak to them about their concerns. If the GP feels that the condition may require a consultation with a specialist psychiatrist, they will refer you to them.
Anyone who is feeling distressed, in a state of despair, suicidal or in need of emotional support should also contact their local mental health and wellbeing service near their area.
Haphephobia is a type of specific phobia, characterised by an intense fear of physical contact with others. It is not commonly diagnosed due to the absence of individuals seeking help. Specific phobias can affect anyone at any age from any social background and are likely to have first onset in childhood. Causes can be complex and hard to define exactly, but the general signs will be an exaggerated fear of a specific object or situation that does not pose a real threat. There are interventions available, and those affected should consult their GP as a starting point.
- Eaton WW, Bienvenu OJ, Miloyan B. Specific phobias. The Lancet Psychiatry [Internet]. 2018 Aug 1 [cited 2023 Nov 22];5(8):678–86. Available from: https://www.sciencedirect.com/science/article/pii/S221503661830169X
- Administration SA and MHS. Table 3. 11, dsm-iv to dsm-5 specific phobia comparison [Internet]. 2016 [cited 2023 Nov 22]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK519704/table/ch3.t11/
- Wang HI, Wright B, Tindall L, Cooper C, Biggs K, Lee E, et al. Cost and effectiveness of one session treatment (Ost) for children and young people with specific phobias compared to multi-session cognitive behavioural therapy (Cbt): results from a randomised controlled trial. BMC Psychiatry [Internet]. 2022 Aug 12 [cited 2023 Nov 22];22:547. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9372970/
- Samra CK, Abdijadid S. Specific phobia. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 [cited 2023 Nov 22]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK499923/
- Nahar S, Inam M, Miah M. Haphephobia: a rare specific phobia of being touched. Eur Psychiatry [Internet]. 2022 Sep 1 [cited 2023 Nov 22];65(Suppl 1):S391. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9564330/
- Wardenaar KJ, Lim CCW, Al-Hamzawi AO, Alonso J, Andrade LH, Benjet C, et al. The cross-national epidemiology of specific phobia in the World Mental Health Surveys. Psychol Med [Internet]. 2017 Jul [cited 2023 Nov 22];47(10):1744–60. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5674525/