Daily Mail

Patients so terrified of taking pills they won’t even use painkiller­s


FOR five years, oliver neely, 31, has nursed swollen and painful hands, triggered by repetitive use of a computer mouse at work and gaming at home during his teens. Despite seeking medical advice, his hand remains swollen.

But that’s not because the antiinflam­matories he was prescribed haven’t worked. It stems from oliver’s extreme aversion to taking medication. as a child and young adult, oliver refused to take any pills — prescripti­on or over-the-counter — even if he was in excruciati­ng pain or felt so unwell he needed to take to his bed.

oliver suffers from pharmacoph­obia, as it is medically known: the extreme fear and mistrust of medicines.

at the opposite extreme is pharmacoph­ilia, where people like to take medication when they don’t really need it.

oliver, who lives in Folkestone, Kent, has been like this since adolescenc­e.

while other boys his age were obsessing about their favourite football team, for instance, he became obsessed with his health and the ways to treat it. He worried about medication­s and what they contained — so much so that when he got an infection and was prescribed antibiotic­s, he threw them away.

‘I became preoccupie­d with medicines and drugs,’ he says. ‘My fear is I just don’t know what’s really in these drugs and whether they’d affect me adversely. I’ve suffered headaches, ignored them; stomach pains, ignored them; got bugs, infections and the usual coughs and flu. But for many years I refused to take medication. I know it’s not best for me, but I fear medication so much that I won’t risk it.’

PHARMACOPH­OBIA can be triggered by various factors, explains Dr Becky spelman, a psychologi­st and founder of the Private Therapy Clinic in London. These include ‘negative past experience­s with medication’, fear of side-effects or addiction, or a general distrust of pharmaceut­icals.

‘People may have varying degrees of fear or aversion towards medication­s, ranging from mild discomfort to severe phobia,’ she says.

It is not uncommon for people to experience some level of apprehensi­on when it comes to taking medication, suggests Dr spelman — which is not necessaril­y a bad thing, as all medication­s come with potential side- effects, so should be taken prudently.

But pharmacoph­obia could help explain poor adherence to medication, which is a major problem, with between 30 and 50 per cent of patients thought to be not taking medication as directed. ‘Lack of adherence to medication is a complex puzzle and pharmacoph­obic beliefs will only be one contributi­ng factor to the high rates observed in the general population,’ says Dr Meg arroll, a psychologi­st and assessor for the British Psychologi­cal society.

other factors include poor communicat­ion between doctors and patients, and lack of trust in the healthcare system.

‘This is highly problemati­c, as non-adherence to treatment can lead to substantia­l worsening of an illness or condition, as well as increased healthcare costs with more visits to doctors and hospital, plus more tests or treatments needed,’ says Dr arroll.

However, for people with pharmacoph­obia, the fear of medication means they won’t take any even when it really is in their best interests. Dimple Bhatia, a pharmacist in Tollesbury, Essex, says pharmacoph­obia is more likely ‘if the patient has not had a condition fully explained, treatment discussed and potential side-effects explored’.

Pharmacist and Reading University lecturer gurinder singh Purewal adds: ‘Patients with fear of medicines feel judged, and feel scared of being told off.

‘often, they miss appointmen­ts. some of the common examples I’ve dealt with are vaccines, statins and antidepres­sants.’

oliver believes his fear may have stemmed from anxiety about taking liquid omega-3 capsules to help improve his concentrat­ion as a child. ‘I didn’t like the sensation of them going down my throat,’ he recalls. ‘I also could never swallow paracetamo­l and had to have the dissolvabl­e ones.’

Then other triggers added to it. ‘when I hit my teens, I began to question what was in these medication­s. I’d ask for the packet to read the back, then try to find out what all the ingredient­s were.

‘I began to worry how they’d affect my body and whether they’d interact with other things.’

as he got older, oliver recalls reading newspapers and watching Tv programmes 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 just didn’t like the idea of taking the medication. I never took it — not even a paracetamo­l,’ he says, even though his exasperate­d mother tried to comfort and reassure him.

There is a growing concern that pharmacoph­obia is ‘ on the rise’, explains Dr spelman. ‘ This is partially attributed to social media — where misinforma­tion and fear-mongering about medication­s are spread — and the increased influence of conspiracy theories, which exploit existing anxieties and promote distrust in pharmaceut­icals, contributi­ng to the developmen­t or reinforcem­ent of pharmacoph­obia,’ she says.

Dr Henk swanepoel, a neuropsych­ologist at the private Cygnet Health Care clinic in Bristol, adds that people with pharmacoph­obia ‘ may also experience intense anxiety, in the form of panic attacks, for example’.

‘often, people find it difficult to think of or even to see drugs in real life. This fear is irrational, but patients are still unable to change the behaviour.’

Talking therapy is the gold standard way to treat pharmacoph­obia (and other phobias).

one option is exposure therapy, which involves gradually exposing individual­s to their fear of medication, possibly through pictures of drugs, in a controlled environmen­t, helping ‘desensitis­e’ them and overcome their phobia.

Cognitive behavioura­l therapy (CBT) — a talking therapy where negative thoughts and beliefs are challenged and replaced with more positive thinking patterns — can also help, says Dr spelman.

Dr arroll advises people with pharmacoph­obia to talk to their doctor. ‘It can be helpful to see if there was point in your history when you started to feel a sense of fear about taking medication, for instance if a tablet became stuck when trying to swallow it during childhood, and this produced a phobic associatio­n,’ she says.

‘However, this isn’t the case for everyone, and so it is often helpful to tackle the immedia t e response: breathing and relaxation exercises can help to manage a fear response when taking medicines.

‘It can also be beneficial to take your first dose in a reassuring environmen­t, such as a chemist. as with any phobia, the key is to break what we call the “fear-avoidance pattern” so that you take care of your overall health.’

on numerous occasions, oliver saw his doctor because he was suffering from anxiety and depression linked to his pharmacoph­obia. He was prescribed antidepres­sant pills but says that he didn’t take them.

HHOWEVER, as the years passed and his symptoms worsened, he reluctantl­y accepted prescripti­ons for more antidepres­sants. ‘It was terrifying for me — I was scared they might harm me. But I needed help and I had to try something.’

In the first few weeks, oliver almost gave up, so terrified was he of the side- effects. ‘I felt all the initial things you get when first taking a new anti-depressant, plus many more symptoms generated by my fear of what the medication could do to me. But after a short while it settled and I began to feel generally much less anxious.’

He also sought help from the charity anxiety UK, the Headspace app (which focuses on mindfulnes­s and meditation), as well as doctors and a therapist, and was slowly able to accept more medication­s.

‘I know avoiding medication could one day harm my health and I have worked on finding ways to overcome it. I still avoid medication­s when I can, but now I have more of a balance.’

 ?? Picture: ALAMY ??
Picture: ALAMY

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