“I just can’t do it”

“I can not make a single mistake”

“I fail at everything I ever try”

These are examples of some of the thoughts that might go through the mind of someone experiencing kakorrhaphiophobia. Pronounced /kak-or-raf-ee-oh-FOH-bee-uh/ this phobia is defined as an intense and constant fear of failure. 

Introduction

Failure is a normal part of life. We all experience the fear of failure at some point in our lives and can probably think of several times when we have, from learning a bike to starting a beginner’s Spanish class, however, for people with kakorrhaphiophobia, the fear of failure causes debilitating anxiety, stress and low self-esteem and even panic attacks. It can be all-consuming. 

According to the National Institute of Mental Health, phobias are one of the most common types of anxiety disorders and when looking at all phobias collectively, they affect 10-12% of the population.^1,2  The symptoms, causes, impact and treatment of kakorrhaphiophobia will be discussed in this article.

The symptoms of kakorrhaphiophobia

Physical symptoms

• Nausea and stomach upset: Anxiety can manifest physically in our gastrointestinal tract
• Sweating and fast heartbeat: Through activation of the flight or fight system
• Headaches and fatigue: Due to constant stress or lack of sleep

Emotional symptoms

• Depression: Losing interest in activities and low mood
• Low self-esteem: Self-loathing and negative self-talk cause a poor view of oneself
• Irritability: Excessive frustration at any small mistake

Behavioural symptoms

• Avoidance: Postponing starting tasks to avoid failure
• Perfectionism: Detailed planning at length to avoid failure
• Isolation: To reduce the risk of letting people down 
• Excessive checks: For example spending long periods when doing work-related tasks

Psychological symptoms

• ‘All or nothing’ thinking: For example, thinking that they are either a ‘failure’ or a ‘success’ with no regard for seeing progress or improvement
• Overwhelming anxiety: Uncontrollable worry and ruminating
• Imposter syndrome: Doubting abilities and achievements, feelings of inadequacies or identifying as a ‘fraud’

Causes of kakorrhaphiophobia

Trauma

A traumatic experience in the past may have been the root cause. For example, if a student consistently comes top of the class studying intensely and with significant pressure, unexpectedly fails an important university entrance exam. A setback such as this, especially if their identity was attached to success in school could trigger kakorrhaphiophobia. They may experience shame, guilt, shock and disappointment that is traumatic, setting off a fear of trying again in case of failure. 

Cognitive distortions

A cognitive distortion is a biased thinking pattern. For example ‘all or nothing’ thinking or ‘generalising’, where a person believes that failing once will mean that they will always fail. Catastrophising is another example, where a small mistake is seen as a disaster. Imagine our studious students above, let’s say they stumbled through a word or two during an otherwise impeccable oral presentation. They might think, “I’ve ruined the whole presentation now” 

Societal pressures

Some people may feel pressure from family or their culture. They may have grown up being told that failure is not acceptable. They may have been punished for small failures with unrealistic expectations. This pressure can also come from work environments. Work stress is a significant cause of mental health deterioration, from unsupportive managers to excessive performance targets and stringent monitoring. ³

Genetic and biological factors

Studies have shown that some people are more likely to develop phobias and anxiety due to their genes.⁴ Phobias are known to run in families because our genes produce the neurotransmitters in our brain. Neurotransmitters are chemicals that regulate our nervous system and control things like mood, attention and heart rate. They transmit signals across neurons (the cells found in the brain and nerves). Serotonin and noradrenaline are examples of neurotransmitters. 

The biology of kakorrhaphiophobia

Mental health is still stigmatised, and unfortunately, many people still think it’s not real because they can’t see it. It causes people to avoid seeking help or opening up about their difficulties. The psyche and the body are far more connected than we think. 

A structure in the brain that has a central role in phobias is called the amygdala, (pronounced "uh-MIG-duh-luh").⁵ The amygdala is small and almond-shaped, where we all process our emotions. When someone has a phobia, the amygdala creates a heightened emotion of fear. Research with MRI scans shows increased activity in the amygdala of people with phobias compared to people without phobias when exposed to their phobias.⁶

How is kakorrhaphiophobia diagnosed?

It’s important for those suspecting they have the condition to seek help early. It can be difficult as their thoughts and emotions can be so overwhelming, and often people can become isolated due to low mood and low self-esteem. Talking to a trusted friend or a family member can be a great first step. Speaking to a GP or a mental health professional and having a thorough clinical assessment is crucial. Bringing a friend or someone close helps people feel more comfortable and adds further insight. The impact on work, relationships, sleep as well as triggers will be explored. 

The DSM-5, the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, ⁷ is a system used by mental health professionals to ensure correct classification, criteria and standards are upheld when a mental health diagnosis is made. To diagnose a phobia, the anxiety experienced would cause significant psychological distress and have an impact on many aspects of life, such as relationships, social life and career aspirations. For example, people may leave a partner or a job due to the anticipation of failure. 

Treatment options for kakorrhaphiophobia

• Cognitive-behavioural therapy (CBT)

CBT is a well-recognised and effective form of psychotherapy.⁸ It is based on the fact that our thinking (cognitive) affects our behaviour and vice versa. People will usually have sessions once a week and they can be online or in person. Together with a therapist, unhelpful thinking patterns i.e. cognitive distortions are identified and challenged. 

For example, if someone thinks “All I ever do is fail at everything”, the therapist would help identify this as the ‘all or nothing’ cognitive distortion. They might then ask you for evidence to help break down this negative belief. Initially, it might feel like an unshakeable fact that all they do is indeed fail. With gentle guidance from a CBT therapist, they might be able to remember a moment of success, for example having helped someone with directions recently. 

This realisation would then become evidence that proves their previous belief can’t be a fact lessening the intensity of this negative thought. This would then result in positive behaviour that they may have previously avoided. For example, they may think “I’m better at directions that I gave myself credit for” triggering them to look up directions to a park or a library, lifting their mood for the day.

• Exposure therapy

This involves gradual exposure to situations with a risk of failure. Triggers would be identified with a therapist. For example, public speaking, exams or going on dates. Triggers would then be ranked on a hierarchy of how severe the risk of failure is. Starting small is very important. The therapist might suggest role-playing before exposure. This exercise in itself may help the person feel relieved and help them rise to the challenge of exposure. 

• Self-help 

Strategies such as mindfulness, setting goals, self-compassion and positive reinforcement are very helpful in the process of treatment. Mindfulness, especially deep breathing can help relieve the physical symptoms and help with staying present. This results in less overthinking of the past or catastrophizing about the future. 

Setting SMART goals increases skills and achievements. SMART stands for goals that are specific, measurable, achievable, realistic and time-bound. For example, instead of a vague goal of ‘I want to exercise more’, a SMART goal might be ‘I want to walk for 30 minutes, 3 times a week’. Being kind to ourselves and celebrating small successes also reinforces recovery. 

• Medication

In some circumstances, a combination of medication and therapy might be best. Especially If there is a limited response to therapy or if symptoms are so severe that things like eating, sleeping or being able to engage in therapy are impaired. 

There are medications that increase the neurotransmitters in the brain to improve attention, mood and appetite. There are also medications that may help with reducing heart rate, shaking and physical symptoms. Creating an individualised treatment program is very important and will be discussed with your healthcare professional.

Summary

Kakorrhaphiophobia is the overwhelming fear of failure that can impact a person’s relationships, career and personal well-being. Symptoms are often intense and cause negative impacts on their physical, emotional and psychological health. Many forms of treatment are well established and can help people overcome the condition to thrive and live a life free of fear. If you or anyone you know are struggling with the things discussed in this article, talking to someone you trust can be the first step to reaching out for help.

FAQs

What causes kakorrhaphiophobia? 

Causes can be due to many different things, from past trauma, genetics and perfectionistic thinking to societal, cultural and family pressures.

Can kakorrhaphiophobia be cured? 

Yes, Cannabis therapy, exposure therapy and medication are just some of the ways that the condition can be treated. 

Is the fear of failure common? 

The fear of failure is something everyone experiences at some point in their life. Kakorrhaphiophobia is when the fear becomes debilitating, and constant and affects multiple areas of life like work, sleeping, relationships and mood.