Patients so terrified of taking pills they won’t even use painkillers
For five years, Oliver Neely, 31, nursed swollen and painful hands caused by repetitive use of a computer mouse at work and gaming at home during his teenage years. Despite seeking medical advice, his hand remains swollen.
But that’s not because the anti-inflammatories he was prescribed didn’t work. It stems from Oliver’s extreme aversion to taking medications. As a child and young adult, Oliver refused to take pills – prescription or over-the-counter – even when he was in excruciating pain or felt so unwell that he had to go to bed.
Oliver suffers from pharmacophobia, as it is medically known: the extreme fear and distrust of medicine.
At the other extreme is pharmacophilia, where people like to take drugs when they don’t really need them.
Oliver, who lives in Folkestone, Kent, has been like this since he was a teenager.
Oliver Neely, 31, suffers from pharmacophobia, as it is medically known: the extreme fear and distrust of medications
For example, while other boys his age were obsessed with their favorite football team, he became obsessed with his health and the ways to treat it. He was concerned about medications and what they contained – so much so that he threw them away when he developed an infection and was prescribed antibiotics.
“I became preoccupied with medicine and drugs,” he says. ‘My fear is that I just don’t know what is really in these medications and whether they are having a negative effect on me. I’ve had headaches, I’ve ignored them; stomach ache, she ignored; got bugs, infections and the usual coughs and flu. But for years I refused to take medication. I know it’s not the best thing for me, but I’m so scared of medication that I don’t want to take the risk.”
Pharmacophobia can be caused by several factors, explains Dr. Becky Spelman, a psychologist and founder of the Private Therapy Clinic in London. These include ‘negative past experiences with medications’, fear of side effects or addiction, or a general distrust of medicines.
“People can have varying degrees of fear or aversion to medications, ranging from mild discomfort to severe phobia,” she says.
It’s not uncommon for people to experience some level of anxiety when it comes to taking medications, Dr. Spelman suggests — which isn’t necessarily a bad thing, as all medications have potential side effects and so should be used with caution.
But pharmacophobia could help explain poor adherence, which is a major problem, with between 30 and 50 percent of patients not taking the medication as instructed. ‘Lack of adherence is a complex puzzle and pharmacophobic beliefs will be just one factor contributing to the high rates seen in the general population,’ says Dr Meg Arroll, psychologist and assessor for the British Psychological Society.
Other factors include poor communication between doctors and patients and a lack of trust in the healthcare system.
Pharmacophobia, as it is medically known, is the extreme fear and distrust of medications (stock image)
‘This is very problematic because non-adherence to treatment can lead to significant worsening of a disease or condition, as well as higher healthcare costs with more visits to doctors and hospitals, plus more tests or treatments needed,’ says Dr. Arroll.
However, for people with pharmacophobia, the fear of medications means that they will not take them even if it is truly in their best interest. Dimple Bhatia, a pharmacist in Tollesbury, Essex, says pharmacophobia is more likely ‘if the patient’s condition has not been fully explained, treatment discussed and potential side effects explored’.
Pharmacist and lecturer Gurinder Singh Purewal adds: ‘Patients with fear of medicines feel judged and fear rejection.
‘They often miss appointments. Some common examples I have dealt with are vaccines, statins and antidepressants.”
Oliver believes his anxiety may stem from a fear of taking liquid omega-3 capsules to improve his concentration as a child. “I didn’t like the feeling of them going down my throat,” he recalls. ‘I could never take paracetamol and had to take the soluble one.’
Other triggers were then added. ‘When I became a teenager, I started wondering what was in these drugs. I would ask for the package to read the back and then try to figure out what all the ingredients were.
“I started to worry about how they would affect my body and whether they would interact with other things.”
As he grew older, Oliver remembers reading newspapers, watching TV shows and learning about health. “I started to become more aware of my health and the control I could have over it,” he says.
‘I wanted to resolve the situation, but I just didn’t like the idea of taking the meds. I never took it, not even paracetamol,” he says, even as his irritated mother tried to comfort and reassure him.
There is growing concern that pharmacophobia is “on the rise,” Dr. Spelman explains. “This is partly attributed to social media – where misinformation and fear-mongering about medicines are spread – and the increased influence of conspiracy theories, which exploit existing fears and promote distrust in pharmaceutical products, contributing to the development or reinforcement of pharmacophobia,” says she. .
Dr. Henk Swanepoel, a neuropsychologist at the private Cygnet Health Care clinic in Bristol, adds that people with pharmacophobia ‘may also experience intense anxiety, for example in the form of panic attacks’.
‘People often find it difficult to imagine or even see drugs in real life. This fear is irrational, but patients still cannot change behavior.’
Talk therapy is the gold standard for treating pharmacophobia (and other phobias).
Oliver repeatedly visited his doctor because he suffered from anxiety and depression related to his pharmacophobia. He was prescribed antidepressants, but says he did not take them
One option is exposure therapy, in which individuals are gradually exposed to their fear of drugs, possibly through images of drugs, in a controlled environment, thereby ‘desensitizing’ them and overcoming their phobia.
Cognitive behavioral therapy (CBT) – a talk therapy that challenges negative thoughts and beliefs and replaces them with more positive thought patterns – can also help, says Dr. Spelman.
Dr. Arroll advises people with pharmacophobia to talk to their doctor. ‘It may be useful to see if there was a point in your history when you began to feel a sense of anxiety about taking medicine, for example if a tablet got stuck when swallowed during childhood, and this caused a phobic association,” she says.
‘However, this is not the case for everyone, which is why it is often helpful to address the immediate reaction: breathing and relaxation exercises can help control an anxiety response when taking medication.
‘It may also be helpful to take your first dose in a comforting environment such as a pharmacy. As with any phobia, the key is to break what we call the ‘fear-avoidance pattern’ so you can take care of your overall health.”
Oliver repeatedly visited his doctor because he suffered from anxiety and depression related to his pharmacophobia. He was prescribed antidepressants, but says he did not take them.
As the years passed and his symptoms worsened, he reluctantly accepted prescriptions for more antidepressants. “It was terrifying for me; I was afraid they would harm me. But I needed help and I had to try something.”
In the first few weeks, Oliver almost gave up because he was so afraid of the side effects. ‘I felt all the initial things you get when you first take a new antidepressant, plus many more symptoms that stem from my fear of what the medication might do to me. But after a short while things calmed down and I started to feel a lot less anxious overall.”
He also sought help from the charity Anxiety UK, the Headspace app (which focuses on mindfulness and meditation), doctors and a therapist, and was slowly able to accept more medication.
‘I know that avoiding medications could one day harm my health and I have been working on finding ways to overcome this. I still avoid medications when I can, but now I have more balance.”