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Needle Phobia or Trypanophobia and it’s Use in Criminal Defence

by | Jan 5, 2023 | Articles, Crime, Driving Offence Advice

In this article Consultant Psychiatrist and Medical Director Dr Behrouz Nabavi (MD, MSc, FRCPsych) talks in detail about Needle Phobia (otherwise known as Trypanophobia) and also it’s use as a “reasonable excuse” in rare occasions for Criminal or Motoring offences such as Failing to Provide a Specimen.

Needle Phobia or Trypanophobia

Fear of needles is a common barrier to initiating or adhering to medical treatment. Many of us feel uncomfortable having needles inserted in our body, be it for taking blood samples or when we have an injection. Fear of needles exists on a continuum of severity, ranging from discomfort through to phobia.

Contrary to popular belief, needle phobias are not confined to children. It is not an emotion-driven or transient phenomenon, and is not a rare condition. The estimated lifetime prevalence of blood-injection-injury phobia, including needle phobia, is 3.5%. The median age of onset is 5.5 years. However, for some of us, these fears are more severe, which will remain persistent during adolescence and adulthood; and these fears are best described as phobias. Individuals with this condition also have higher number of experiences of fainting and seizures.

The essential feature of this disorder is an extensive fear of a specific object, circumstance, or situation. Needle phobia by definition is a persistent, intense, and pathological fear of receiving an injection, or needle insertion.

The diagnosis of needle phobia requires the development of intensive anxiety, even to the point of panic, when exposed to the feared object or situation. People with a needle phobia may anticipate harm; or may panic at the thought of losing control, such as fainting.

Needle phobia is characterised by the arousal of severe anxiety when patients are either  exposed to specific situations or objects, anticipate exposure to the situations or objects, when a needle is inserted in their body, or blood is taken or exposed to scenery of blood.

Needle Phobia
In order to satisfy the ICD-10 classification criteria for the diagnosis of specific phobia, including needle phobia, the following criteria should be fulfilled:

  • The psychological or autonomic symptoms must be primary manifestations of anxiety, and not secondary to other symptoms such as delusion or obsessional thoughts;
  • The anxiety must be restricted to the presence of the particular phobic object or situation; and,
  • The phobic situation is avoided whenever possible.

The aetiology of needle phobia is rooted in an inherited vasovagal reflex (fainting) that caused shock with needle puncture. With repeated needle exposure, those with an intertied vasovagal shock reflex tend to develop a fear of needles. Unlike most other phobias, in which exposure to the feared object excites tachycardia (increased heart rate), victims of needle phobia typically experience a temporary anticipatory tachycardias and hypertension (high blood pressure), which on needle insertion turns int bradycardia (abnormally slow heart rate) and hypotension (low blood pressure), accompanied by pallor, sweating, lightheadedness, tinnitus, syncope or near-syncope, and sometimes asystole (a condition in which the heart ceases to beat) or even death.

If the police suspect that an individual has committed an offence of drink/illicit drug driving, then they are required to provide specimens for analysis, including blood specimen.

Needle Phobia use as “Reasonable Excuse” in Motoring and Criminal Defences

In law, failing to provide the police with a sample of blood whilst in police custody can be considered more serious than the original drink/drug driving alleged offence, unless there is a ‘reasonable excuse’.

A valid diagnosis of needle phobia (not simply a fear of needles) can be considered as a defence of ‘reasonable excuse’ to failure to provide specimen. The presence or absence of such diagnosis is usually confirmed by a psychiatrist expert, who psychiatrically examines the individual and provide a court report.

About the Author

Dr Behrouz Nabavi (MD, MSc, FRCPsych) is a Consultant Psychiatrist and Medical Director, working at Priory Hospital Barnt Green, in Birmingham. He also holds an honorary position of Senior Lecturer at Aston Medical School, and is a Section 12(2) approved psychiatrist.

Dr Nabavi was awarded with the ‘Research Presentation Prize of 2014’ from the Royal College of Psychiatrists, West Midlands Division, for his research into comorbidity between bipolar affective disorders and anxiety disorders. He has also published several peer-review papers, as well as presenting research and clinical audits in national and international congresses.

Dr Nabavi has provided medico-legal psychiatric reports over the past 18 years, covering most areas of the law. He has completed several hundred reports, including Criminal, Civil, Immigration, and family cases. His psychiatric reports for criminal cases include fitness to plead and stand trial, and disposal.

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Needle phobia or Trypanophobia and it's use in court for criminal of driving offences

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