Revolving Around Death Anxiety
“Fear of death features heavily within illness anxiety and psycho-somatic disorders, with body checking, frequent medical appointments and reassurance seeking, and requests for medical testing being key behaviors in these conditions.”
Adapted from a MAPS Publication: Rachel E. Menzies and Associate Professor Ross G. Menzies
Thoughts of death have the ability to create a sense of powerlessness, loneliness, and meaninglessness, and for some individuals, may seriously undermine their experience of happiness or peace. Although people may develop helpful methods of managing their fears of death, such as building relationships and working towards meaningful goals, they may equally engage in maladaptive coping strategies, such as avoidance and addiction. As a result, death anxiety has been argued to be a transdiagnostic construct, contributing to the development and maintenance of numerous mental health conditions (Iverach, Menzies, & Menzies, 2014).
For example, fears of death feature heavily within illness anxiety and the somatic disorders, with body checking, frequent medical appointments and reassurance seeking, and requests for medical testing being key behaviours in these conditions. In a similar vein, individuals with panic disorder may frequently worry that they are having a heart attack, and consult with cardiologists in order to keep such fears of death at bay.
Most, if not all of common phobias can be seen as having death anxiety at the root. Fear of flying, water, spiders, snakes, and enclosed, high places all having the potential to occasion death. In obsessive compulsive disorder, patients often explicitly describe their compulsive washing as an attempt to protect themselves and their family from germs and fatal illnesses, while others ascribe their compulsive checking of stovetops, power outlets or door locks to a means of preventing household fires, electrocutions, and invasion.
Further, exposure to life-threatening events such as the loss of a loved one or physical threats to the self often precede the onset of both agoraphobia and post-traumatic stress disorder. Within depressive disorders, existential concerns such as meaninglessness and death anxiety have been argued to play a significant role. Even disorders for which the relevance of death anxiety appears less clear, such as social anxiety disorder or eating disorders, there appears to be preliminary evidence suggesting death fears may be at the root. For instance, reminders of death have been shown to increase social avoidance (Strachan et al., 2007), and lead to restricted consumption of high-calorie food (Goldenberg, Arndt, Hart, & Brown, 2005).
If death anxiety is truly at the center of so many of these disorders, this may explain the ‘revolving door’ often seen in clinical practice. That is, it is commonplace for an individual to present for treatment in childhood with one disorder, such as separation anxiety, only to return in adolescence, and later in adulthood, with conditions that appear on the surface fundamentally different, such as OCD or panic disorder.
If this ‘revolving door’ is driven by underlying fears of death, the implication is that until such fears are directly addressed, psychopathology will continue to return, albeit manifested in a superficially different presentations. While crippling death anxiety may have once led an individual to attend his local emergency department several times each month, after an apparently successful course of exposure therapy for panic disorder he may now resort instead to washing his hands for several hours each day in an effort to ward off death, resulting in the mainstream diagnosis and treatment that perceives an apparent need for exposure and response prevention with a focus on contamination concerns.
However, if treatments focus on the symptoms on the surface – such as the avoidance of spiders, the checking of locks, or the repeated requests for brain scans – rather than the existential concerns that lie at the root, are these treatements failing to ensure long-term wellbeing? Particularly when the numbers suggest that clients are likely to return to treatment with a different, more deeply embedded/embodied disorder?