What Is Sidonglobophobia

Sidonglobophobia is the fear of cotton. This condition is also referred to as Bambakophobia, taking its name from the Greek words ‘Bambaki’ and ‘Phobos’, translated into English as ‘Cotton’ and ‘Fear’, respectively. Sidonglobophobia is little mentioned in the literature, and as such, it is difficult to state with accuracy its prevalence within a population. The scarce mention of sidonglobophobia or bambakophobia in the literature also suggests that it is not extensively researched as a disorder in its own right.

Sidonglobophobia, however, comes under the umbrella term of ‘Specific phobias’ – the development of a significant level of fear and/or anxiety with respect to a certain object or circumstance, leading to avoidance behaviour.¹ As a collective, specific phobia is one of the most commonly known mental disorders, occurring in up to 15% of the world population.² Incidences of specific phobias are higher in females, high-income countries and on average present in childhood (approximately 8 years of age).³

Specific phobias tend to precede the development of further mental disorders and in some instances can be considered a risk factor for the onset of comorbidity.¹ Comorbidity occurs in approximately 61% of individuals with specific phobias. The most common of these are anxiety and mood disorders.³

Causes and symptoms

How a person acquires sidonglobophobia specifically is largely unknown. However, it is assumed that causes of sidonglobophobia are well aligned with causes of other specific phobias.

The most common cause of specific phobias like sidonglobophobia is fear conditioning. Fear conditioning can happen either by learned conditioning or unlearned conditioning.⁴ Learned conditioning often involves the individual having gone through a traumatic event or situational sensitisation. The latter typically involves the association of a specific stimulus with a frightful outcome. For example, the ringing of a bell prior to a person receiving an electric shock can lead to the development of a fear of the sound of the bell even without the outcome (electric shock).

In unlearned conditioning, the phobia is acquired as an intensification of an innate or evolutionary process and therefore does not require associated learning or a traumatic experience by the individual.⁴ 

Both methods of fear conditioning can lead to aversive conditioning, where the affected individual begins to exhibit avoidance behaviour, being particularly diligent at avoiding the source of their fear despite recognising that there is no real threat or danger.

While potential causes of sidonglobophobia and other specific phobias are environmental, there may also be a genetic predisposition for developing phobias.⁵ Non-experiential or ‘learning-independent’ phobias show a trend of dysfunction in the parts of the brain that determine defensive behaviour without any learned experience. A systematic review of neuroimaging studies used to further understanding of specific phobias revealed that neuronal networks associated with specific phobias (insula, anterior cingulate cortex, amygdala, prefrontal and orbitofrontal cortex) showed higher activity in the patient cohort when compared to a control group.⁶ While it is worth noting that consensus is yet to be reached on what the exact neurocircuitry of specific phobia comprises⁶, the study highlights a link between neuronal development and susceptibility to developing mental phobias.

Sidonglobophobia, like other specific phobias, can be a lifelong affliction,³ and this can be a severe impediment to maintaining normal day-to-day routines. Both physical and psychological reactions to the object of fear (cotton) can be intense, leading to avoidance behaviour in the patient. This progression tends to lead to the development of comorbidities like anxiety, panic attacks and substance abuse, increasing the complexity of the disorder.^2,7 

Physically, symptoms can manifest as the patient having an increased heart rate, sweating and tremors.

Diagnosis and treatment

The Diagnostic and Statistical Manual of Mental Disorders (DSM) is a taxonomic and diagnostic tool published by the American Psychiatric Association. The manual is used as a guideline for mental health practitioners when diagnosing mental disorders, especially in cases where disorder overlap can present as a complexity. Distinguishing specific phobia from other mental disorders that are clinically similar is also important for choosing the right treatment and management approaches. Conditions such as hypochondriasis and paranoid personality disorders are examples of disorders that present very similarly to specific phobias. Using sidonglobophobia as an example, the fear experienced by patients with hypochondriasis is driven by experiencing contact with cotton, whereas patients with sidonglobophobia are affected by the possibility of coming into contact with cotton (even the thought of cotton may be sufficient to cause an anxiety reaction). A very subtle but significant difference. Comparatively, patients with paranoid personality disorder suffer from general fears rather than the singular specificity of an object like cotton.¹

According to the DSM text revised fourth version (DSM-IV-TR), the listed criteria are used to diagnose specific phobia7, and this article is adapted for sidonglobophobia:

• Persistent and unreasonable fear triggered by the presence or anticipation of cotton
• The patient recognises that the fear experiences is irrational and excessive
• The patient actively avoids encounters with cotton
• Exposure to cotton causes immediate and intense anxiety, often in the form of a panic attack
• Avoidance behaviour or panic attacks have a significant impact on the patient's ability to navigate day-to-day tasks.

Up to 92% of patients with specific phobias go on to develop a secondary mental disorder³. Correct early diagnosis of a specific phobia not only serves as an important indicator for a patient's predilection to further mental disorder, but effective management and treatment could reduce the severity and prevalence of the disorder.²  

Treatment options for specific phobias encompass behavioural therapies, drug therapies and some alternative measures like dietary supplements or physical activity.

Exposure therapy   

Exposure therapy is a type of behavioural therapy that aims to assuage the fear experienced by an individual when they interact with a specific object. Patients are gradually socialised to their specific object of fear in a variety of situations until they no longer have a fear response. Exposure therapy can be performed either in-vivo (real-world exposure) or can make use of virtual reality as a way to create controlled environments for exposure.⁷

Exposure therapy is thought to be the most effective approach for treating specific phobias, including sidonglobophobia. In general, there is a preference for in-vivo exposure therapy over virtual reality exposure therapy, as in-vivo exposure is thought to be the more effective option. Virtual reality exposure therapy, therefore, is often used to enhance or escalate in-vivo therapy rather than as a singular treatment approach.⁷

A promising utility of exposure therapy is that it can actively disrupt phobia progression into avoidant behaviour by teaching the patient to manage or assuage their fear. However, some recent studies have shown that for long-term treatment of specific phobias, exposure therapy may not be as effective as is assumed.²

Cognitive behavioural therapy       

In cognitive behavioural therapy, patients are taught to be aware of the intrusion of anxious thoughts and actively replace them with more pragmatic or credible thoughts. Cognitive behavioural therapy is typically used in combination with exposure therapy. As a singular treatment, it is not as effective as exposure therapy.² However, it is known to have a significant effect in reducing fear and avoidance when compared to untreated patients.⁸ 

Pharmacotherapy   

In general, the treatment of specific phobias with drug therapeutics is less effective compared to behavioural therapy.⁷ Drugs for treating specific phobias are mainly aimed at a subset of specific phobias: ‘situational phobias’ such as a fear of flying and ‘blood-injection-injury’, which can induce fainting.⁹ As such, pharmacological treatment of object phobias, like cotton, is not an approach that is well adopted by mental health practitioners. While research trials treating specific phobias with drugs are few, most report that this approach is less effective compared to using behavioural treatment options. Drugs such as selective serotonin reuptake inhibitors (SSRIs) and benzodiazepines may decrease anxiety and panic, but they also have the disadvantage of patient dependency (fear intensity returns on drug discontinuation).⁷

Alternative therapies   Adopting relaxation techniques such as controlled breathing or taking up exercise can play an important part in how a person with a specific phobia copes with the physical symptoms. Natural remedies that can be ingested, such as chamomile and ginseng, can also serve as a treatment supplement for some patients.⁷ Hypnotherapy and homoeopathy are also additional options, which have had some benefit in alleviating symptoms for patients.

Although these treatment options reduce symptom severity, a significant number of treated patients (40%) only have partial success in the long term, and most treatment options do not lead to complete alleviation of the patient’s phobia.¹⁰

Summary

Sidonglobophobia is a fear of cotton. It is categorised under the broader term of ‘specific phobia’: where coming into contact, or the thought of being around a certain object, or in a certain situation induces intense anxiety or panic attacks in an individual. Phobias like this are commonly thought to develop after a particularly traumatic experience. Left untreated, sidonglobophobia, like other specific phobias, can progress into avoidant behaviour, becoming a significant burden to normal life. While there is currently no sure method of curing phobias, behavioural therapies are an effective way to manage the onset of anxiety and panic brought on by fear, allowing a person suffering from a specific phobia to lead a relatively normal life.