La phobie du sang-injection-accident : spécificités psychophysiologiques et thérapeutiques Blood-injection-injury phobia: Physochophysiological and therapeutical specificities

Summary Introduction. — Seventy-five percent of patients with blood-injection-injury phobia (BII-phobia)report a history of fainting in response to phobic stimuli. This specificity may lead to medicalconditions remaining undiagnosed and untreated, incurring considerable cost for the individualand society. The psychophysiology of BII-phobia remains poorly understood and the literatureon effective treatments has been fairly sparse.Aims of the systematic review: to synthesize the psychophysiology of BII-phobia and to pro-pose a systematic review of the literature on effectiveness of different treatments evaluatedin this indication. Results. — Firstly, the most distinct feature of the psychophysiology of BII-phobia is its culmi-nation in a vasovagal syncope, which has been described as biphasic. The initial phase involvesa sympathetic activation as is typically expected from fear responses of the fight-flight type.The second phase is characterized by a parasympathetic activation leading to fainting, which isassociated with disgust. Subjects with syncope related to BII-phobia have an underlying auto-nomic dysregulation predisposing them to neurally mediated syncope, even in the absence ofany blood or injury stimulus. Many studies report that BII-phobic individuals have a higher levelof disgust sensitivity than individuals without any phobia. Secondly, behavioral psychotherapytechniques such as exposure only, applied relaxation, applied tension, and tension only, havedemonstrated efficacy with no significant difference between all these techniques. The disgustinduction has not improved effectiveness of exposure.