What is Apotemnophobia? (An Overview)

In this blog, we will discuss the symptoms, causes and treatment of Apotemnophobia. 

An intense fear of people with amputations is called Apotemnophobia.

It is a type of specific phobia which comes under the category of anxiety disorders in the DSM-V. A sufferer will experience extreme anxiety when they see someone with amputations. 

Not just the sight, but the very thought of encountering an individual with this can instigate anxiety.

If the condition worsens, one can even have full-blown panic attacks. Therefore, sufferers try to avoid their fear stimuli in order to eliminate these unpleasant feelings. 

Amputation is the removal of one’s limb (the entire limb or parts of it).

This is a result of, either an accident which resulted in one’s limbs being severely affected and or if someone is born with a deformed limb and gets it removed later in their life. 

Amputations can be uncomfortable to look at. Normally people do feel a bit uneasy when they see an amputated limb.

However, someone who suffers from Apotemnophobia will undergo excess anxiety and trauma if they see someone with an amputation.

They therefore, avoid coming in contact with a person like this. 

This avoidance leads to one being calm and feeling safe. Though, in the long run, one can develop OCD.

This is because one feels safe when they aren’t around their fear stimuli and this validates their fear.

This sense of security to the sufferer that people with amputations are harmful and need to be avoided. The acts of avoidance therefore, turn into compulsions. 

According to the DSM-V, someone suffering from Apotemnophobia will suffer from  a social and occupational dysfunction because of the anxiety and acts of avoidance one experiences.

For example, they might not go to school or office because they saw someone with an amputation there.

Some might refuse to live with their own family members who have this condition. 

Sufferers will refuse to leave their house r visit public places because of the fear that they might encounter a person with amputation.

To someone, this act of avoiding or getting anxious when seeing people with amputation might look offensive and inappropriate.

But, sufferers of Apotemnophobia are unable to control their emotions/negative thoughts when they encounter one.

The behaviour they show, when in this situation is not in their hands because they themselves are unable to control their anxiety.  

Apotemnophobia is the irrational fear of people with amputations.

The name originates from the Greek word ‘apo’ meaning away from, ‘temno’ meaning piece cut off and ‘phobos’ meaning fear.   

Symptoms of Apotemnophobia 

Like in the case of all other specific phobias, Apotemnophobia too has anxiety as its focal symptom.

Individuals suffering from an irrational fear of people with amputations suffer from extreme anxiety which, as mentioned earlier, can result in one having panic attacks. 

When one undergoes extreme anxiety, the body experiences other physiological symptoms as well. Such as increased heart rate or palpitations. 

When the sufferer thinks about encountering people with amputations, he goes into flight or fight mode because of an adrenaline rush.

In this state, the body’s physiological responses help one make decisions when in fear causing situations.

They either decide to escape the situation (flight)-faint or suffer from panic attacks or stay and combat their fear (fight)-by taking counterproductive actions.

Sufferers of Apotemnophobia experience symptoms in different ways. One might have more severe symptoms than the other, based on their past experiences and intensity of the phobia.

Though, as the DSM-5 suggests, one must experience anxiety lasting for at least 6-months.  

Symptoms one experiences in Apotemnophobia are: 

• Excessive anxiety upon encountering someone with an amputation 
• Excessive anxiety when thinking about people with amputation 
• Inability to manage anxiety 
• Full-blown panic attacks 
• Avoiding people with amputation 
• Increased heart beat 
• Breathlessness 
• Muscle tension 
• Nausea 
• Feelings of dizziness/fainting 
• Feeling depressed 
• Fear of an impending doom 
• Excessive sweating 
• Tremors 
• Hot/cold flashes 
• Butterflies in the stomach 
• Drying up of the mouth 
• Disorientation 
• Migraine 
• Insomnia 

For one to be diagnosed with Apotemnophobia, a person should experience at least 3-5 of these symptoms (including anxiety). 

Causes of Apotemnophobia 

Like every other specific phobia, Apotemnophobia is a result of either genetics or a past traumatic experience. 

Someone who has a family history of anxiety disorders or specific phobias has a higher chance of developing Apotemnophobia than someone who doesn’t.

This is because they are genetically predisposed to develop it.  

Genes and neurotransmitters also play a significant role in this genetic predisposition. 

This genetic tendency to develop a mental disorder/specific phobia can also be referred to as a Diathesis-stress relationship.

According to this, one with a genetic predisposition will not develop symptoms of Apotemnophobia until and unless there is some trigger event, instigating anxiety or fear related to amputations. 

An environmental trigger event can be for example; a sufferer might’ve been in a situation where he was almost very close to having an amputation.

Or , maybe they know someone who had one and the unpleasant feelings and or consequences they face because of it can cause fear. 

Additionally, someone with very strict/overprotective parents are very likely to fear amputation because of the fact that they are told about the  negative impacts it has on one’s life.

Parents do this in order to warn and discipline their children. However, this can leave a lifelong effect on their minds in the form of Apotemnophobia.

On the other hand, movies show people with amputations mostly as the ‘bad guys’ or villians.

One of the biggest examples of this is Captain Hook in the film/story ‘Peter Pan’.

Apart from this, there are a number of other instances where amputations are used as a sign of evilness, pain, sadness and or poverty. 

Thus, Apotemnophobia is caused by both genetics and environmental factors. 

Treatment of Apotemnophobia 

Apotemnophobia, like all other specific phobias, has no exclusive type of treatment that is specifically designed to treat it.

Like all the other specific phobias, Apotemnophobia is treated by a number of different therapies including, Cognitive-behavioral Therapy (CBT) and or medications that lower downs the anxiety or other physical symptoms. 

• Exposure Therapy 

It is one of the most frequently used ways of treating patients with Apotemnophobia (or any other kind of specific phobia).

In this therapy, the patient is exposed to the source of his fear over a certain span of time.

To begin with the therapy, the therapist exposes the patient to the least triggering stimuli, a picture of someone with an amputated arm, for example. 

As the therapy progresses and the patient is able to control his anxious feelings, imagery can be used to take the treatment a step further.

In this part of the treatment the patient is asked to visualize/imagine a situation in which he is around someone with amputation.

During this process of imagery, one actually feels being in that particular situation or place, experiencing various senses.

 Once the person successfully, without feeling anxious clears this step of the therapy, he is then exposed to real people with amputations.  

While the patient is being exposed to different intensities of stimuli during the various stages of therapy, the therapist simultaneously teaches them coping exercises.

These include, breathing techniques or muscle relaxation methods to lower their anxiety, when in an actual fear/anxiety causing situation.

This teaches them how to remain calm when exposed to the fear stimuli.

Before actually starting the exposure therapy, the therapist needs to figure out the intensity of the patient’s fear, as to deduce whether they will be able to undergo this treatment, without any physical or psychological harm caused to them during the exposure processes. 

However, these steps desensitize one to their fear of people with amputations by exposing them to that stimuli repeatedly, until they learn to undergo the situation without anxiety/panic attacks.

• Cognitive-Behavioral Therapy (CBT) 

It is one of the most frequently used treatments for patients with almost all kinds of mental disorders.

Apotemnophobia is defined as the irrational fear of people with amputations.

Thus, the therapist helps the patient in replacing these irrational thoughts with more rational ones. 

The patients are helped out in analyzing and justifying the way they feel about their fear stimuli.

Therapists assist them in uncovering the reasons behind their fear and later they provide them with alternate, pleasant thoughts. 

The patient is told to maintain a thought diary (with ABCD column) which provides them a replacement for every irrational thought they have, when thinking about a particular situation.

The ABCD stands for: 

i. A (antecedents) a situation or triggering event.

ii. B (belief) the thought that comes to one’s mind when in that triggering situation.

iii. C (consequences) the symptoms/feelings caused by that event/thought 

iv. D (dispute) alternate, rational thoughts provided by the therapist in an attempt to        dispute/challenge those irrational beliefs.

This last section of the thought diary is what really plays a role in helping the person feel good/less anxious.  

• Neuro-Linguistic programming (NLP) 

It is a psychological approach that includes ways of trying to reach a personal goal.

It links language, thoughts and patterns of behavior learned through experience. 

The key elements of NLP are action, modeling and effective communication. It suggests that everyone has different ways of how they see the world.

By understanding a number of perspectives of others, patients who use NLP see the world through a combination of their personal views and that of others. 

NLP therapists treat patients with Apotemnophobia by making them understand their thoughts, behaviors and emotional state.

By having an insight of the patient’s own ‘personal’ view of reality, they assist them in forming new, positive thoughts. 

NLP helps the patient in improving his state of thoughts about other people (with amputations) by understanding their cognitive-behavioral patterns. Like CBT, this form of therapy is also very effective. 

• EMDR 

This another form of treatment used with patients suffering from specific phobia or anxiety disorders.  It is used with patients who know the cause of their phobia. 

First, the therapist collects the patients’ history of different fears. They then identify the real cause of the particular fear/phobia the patient has. 

They then discuss any new/latest event that triggered their anxiety and fear in the past few weeks.

People coming with specific phobias are told to imagine their distress causing stimuli. 

The therapist then works with the individual in order for them to overcome their fear. In the case of Apotemnophobia, the patient will be advised on how to overcome his fear of seeing people with amputations.

They do this by creating a positive imagery for the patients’ feared stimuli.

• Dialectical Behavior Therapy (DBT) 

This is another effective therapy used to treat Apotemnophobia.

It is more commonly used with people suffering from personality disorders, but is also useful with patients suffering from this type of specific phobia.

Coping skills are taught in the DBT group which lasts for about 6-months and can have a number of people (depending on how many join the group). 

            i.Half-smiling is the first module of DBT. It is a technique that is used with patients who are distressed because of their irrational thoughts.

The technique is known as ‘Half-smiling’ because the person is first advised to think about the stimuli that fears or upsets them, and while doing so they are told to lift the corners of their mouths by subtly smiling.

Smiling is not that will help one get rid of these unpleasant thoughts, it is the person’s ability to constrain itself from thinking about those thoughts while half smiling.

          ii.Mindfulness, the second module, is another technique used in DBT groups which helps the individual in getting rid of those negative thoughts.

Individuals are told to focus on the present and be attentive to what is going on around them at the moment.

This helps in breaking the link between their mind and any negative thought that might come to them then. 

For example, a person is told to focus on his breath or on the sound of the wind around them, making use of their auditory sense. 

         iii.The third technique or module of the DBT is distress tolerance skills. This module teaches people to calm themselves down in healthy ways when they are distressed or emotionally overwhelmed.

Individuals are allowed to make wise, rational decisions and take immediate action, rather than being captured by emotionally destructive thoughts that might make the situation worse.

Reality acceptance skills are also learnt under this model so that people fully accept reality and later make plans on how to address the problem.

• Mindfulness-Based Stress Reduction (MBSR) 

MBSR is a meditation therapy, used to manage stress or anxiety. It is an 8-week program which includes group sessions.

Mindfulness meditation and Hatha yoga are practiced in these sessions. Lectures and group discussions are also done to talk about mental health and increase interactivity.

In mindfulness meditation the person is told to, for example, focus on the sensations felt while breathing or the rhythm of the chest rising and falling during the process.

This distracts the person’s attention from something stressful to something which is neutral and soothing. 

For quick and effective treatment, patients are also given a set of home works, for example 45 minutes of yoga and meditation sessions for 6 days a week and to record their results/feelings in a book or diary for 15 minutes a day.

• Drug Therapy 

Drugs are used to reduce the physical symptoms caused by Apotemnophobia.

Drugs are very quick in effectiveness, as they start showing progress in the patients’ health at least 2 weeks after the medicine is taken. 

This type of biological treatment is usually more effective if the cause of the phobia is only genetic.

However, these drugs/medicines are not to be taken without a doctor’s prescription or consultation. 

Two types of drugs are used in the treatment of this phobia:

1.              Antidepressant Drugs

These drugs, as the name suggests don’t only treat depression but are also very effective in treating phobias.

Medicines like Paxil reduce the anxious feelings of a person and makes him feel calm. They need to be taken on a daily basis but not without a doctor’s advice.

1.           Anti-anxiety Drugs

Medicines like Klonopin are anti-anxiety drugs.

They are most commonly used with patients who experience panic attacks and also lowers their anxiety by binding to receptor cells of the brain that cause these unpleasant symptoms.

Whether the cause of Apotemnophobia, or any other type of specific phobia is genetics, environmental or both, the best and the most effective way of treating them is by using a combination of both biological treatments (drugs) with cognitive treatment (for example CBT/exposure therapy).

Frequently Asked Questions 

Citations 

• https://psychtimes.com/apotemnophobia-fear-of-people-with-amputations/
• https://fearof.org/apotemnophobia/
• https://common-phobias.com/apotemno/phobia.htm
• https://fearapy.com/phobias/apotemnophobia/