Thanatophobia commonly referred to as death anxiety, is an intense fear of death or the process of dying.
The word comes from the Greek words ‘Thanatos,’ meaning death, and ‘Phobos,’ meaning fear.
While it is normal that many people will have some worries about death, for some, thinking about death or the process of dying can cause extreme fear and anxiety.
In extreme cases, thanatophobia can stop people from leaving their homes or completing their regular daily activities, causing a lot of disruption to normal functioning.
Freud was believed to be the first to coin the term thanatophobia in 1915 in his essay titled ‘Thoughts for the Time on War and Death’.
Freud suggested that death-related fears reflected unresolved childhood conflicts rather than a fear of death itself.
He believed that the fear of death was related to one’s unconscious belief in immortality, stating: ‘our unconscious does not believe in its own death; it behaves as if immortal.’
Research over the years has demonstrated that there are two separate but connected constructs to death anxiety: the fear of death and the fear of the dying process (Depaola et al., 2003).
Death anxiety has also been characterized as a conscious fear of the unknown, fear for the body after death, a fear of lost time, a fear of suffering, and a fear of loneliness.
Becker (1973) suggested that death anxiety is a real and basic fear that underlies many forms of anxiety disorders and phobias.
Becker argued that humans might manage this anxiety by living with the cultural view that offers immortality either literally (e.g., a belief in the afterlife) or symbolically (e.g., life achievements or through families).
His view was that much of people’s energy is focused on denying death as a strategy to keep death anxiety under control.
In This Article
Symptoms and Diagnosis
Thanatophobia is not defined as a distinct disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).
However, it falls under the category of phobias, particularly under the type of specific phobias.
It can also coexist alongside other mood or anxiety disorders, such as posttraumatic stress disorder (PTSD), panic disorder, and illness anxiety disorders.
The DSM-5 diagnostic criteria that must be met for a specific phobia to be diagnosed are as follows:
A marked fear or anxiety about a specific object or situation.
The phobia object or situation almost always provokes immediate fear or anxiety.
The fear or anxiety is out of proportion to the actual danger posed by the specific object or situation and to the sociocultural context.
The phobic object or situation is actively avoided or endured with intense fear or anxiety.
The fear, anxiety, or avoidance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
The fear, anxiety, or avoidance is persistent, typically lasting six months or more.
The disturbance is not better explained by the symptoms of another mental disorder, including fear, anxiety, and avoidance of situations associated with panic-like symptoms; objects or situations relating to obsessions (as in obsessive-compulsive disorder); reminders of traumatic events (as in PTSD); separation from home or attachment figure (as in separation anxiety disorder); or social situations (as in social anxiety disorder).
People who are experiencing thanatophobia may endure some of the following cognitive symptoms:
Experiencing intense anxiety or worry when encountering or thinking of death or dying.
Having excessive fear of death that gets in the way of their life.
Immediate fear or anxiety when thinking about dying or the process of dying.
General feelings of anxiety or depression.
Feelings of guilt
Feelings of agitation
Since phobias are part of an anxiety disorder, there may be physical symptoms that are experienced when faced with anxiety:
Shortness of breath
Fatigue or insomnia
Sensitivity to hot or cold
Due to the above symptoms, someone with thanatophobia may behave in certain ways to cope with their anxiety, such as:
Actively avoiding any situation that involves death or dying – this could include avoiding movies or TV shows which involve a character’s death or avoiding talking about funeral plans.
Isolating oneself from friends and family for an extended period.
Reassurance seeking from others.
Body checking behaviors such as checking heart rate or excessive checking for body abnormalities.
Death anxiety is often believed to be a basic fear for many with different mental health disorders.
Those with panic disorder may frequently fear collapsing, dying, or suffering a medical emergency due to a panic attack.
People with panic disorder tend to report substantially greater anxiety about death than those with conditions such as social anxiety disorder (Furer and Walker, 2008).
Individuals with generalized anxiety disorder have extreme and persistent worries about multiple things, including patterns of anxiety around the death of the self and family members.
Likewise, people with PTSD often have high levels of concern about their physical safety and health. Hence, it is unsurprising that positive relationships have been found between PTSD and death anxiety.
Phobias are often triggered by a specific event; thus, a fear of death could have resulted from an early traumatic event related to almost dying or experiencing the death of a loved one.
Also, people who suffer from serious illnesses may be more likely to develop thanatophobia if they are extremely anxious about death.
There also appear to be some individual differences in how people fear death. In a study, it was found that elderly people tend to fear the dying process rather than death itself, while younger people would commonly report a fear of death itself (Sinoff, 2017).
Another study found that females reported higher levels of death anxiety compared to males, as well as those from a lower socioeconomic background having moderately higher levels of death anxiety (Kastenbaum, 2000).
Russac et al. (2007) found that death anxiety was high in the young adult population in both males and females. This anxiety declined over time before spiking again at around 50, particularly for women.
According to Balasubramanian et al. (2018), death anxiety is more common for people who do not have the following:
A sense of fulfillment in life
Intimacy with friends and family
A fighting spirit
Another factor contributing to a fear of death can be beliefs about what will happen after death. For some, religion can be a source of comfort in providing answers to questions about the unknown.
However, religion could also contribute to fears that any deviations or mistakes may cause individuals to be eternally condemned, causing more anxiety.
Generally, firmer religious beliefs and participation in religious practice are not associated with lower death anxiety (Furer and Walker, 2008).
Types of Fears
There can be many reasons why people may develop thanatophobia, and there may be different types of fears which can trigger this:
Fear of the unknown
Intense fears of death could arise from the fear of not knowing what happens after death.
Naturally, humans want to know and understand the world and how it works, so when something that cannot be known, such as what happens after death, this could cause a lot of anxiety.
Fear of pain or illness
For some with thanatophobia, they may not actually fear death itself but the pain or illnesses that may lead up to their death.
Being in intense pain, suffering from a long illness, or losing one’s dignity could cause more anxiety than facing death. Some people with this type of fear may also suffer from a fear of a specific disease, illness, anxiety disorder, or other somatoform disorders.
Fear of a loss of control
Humans tend to like having a certain level of control over their lives. When it comes to death, this is something that is inevitable and thus cannot be controlled.
Since dying is outside of anyone’s control, this can cause a lot of anxiety for individuals.
Some people with this type of fear may use methods to try to have some level of control over death, such as continuously doing health checks or performing rigorous rituals, which they believe will postpone the inevitable.
Individuals with this type may be at a higher risk of developing an obsessive-compulsive disorder, illness anxiety disorder, or even delusional thinking patterns.
Fear of abandoning relatives
For some with thanatophobia, their fear may stem from not wanting to abandon loved ones.
They may fear never seeing loved ones again, being separated from them, or fear for how people in their lives will cope without them around.
Treatment for thanatophobia depends on the person’s personal goals: whether they want to treat their anxious symptoms, drop safety behaviors, find a healthy way to think about death, or be able to think about death without extreme anxiety, for instance.
Some treatments which work for other anxiety disorders could also be recommended for those with thanatophobia. To help with the symptoms of anxiety, medications may be prescribed:
Benzodiazepines – a medication that has a sedative effect, slowing down the body and brain’s functions.
These medications, such as alprazolam, diazepam, lorazepam, and clonazepam, are all used to treat conditions such as anxiety and panic disorders.
These can be taken in particularly anxiety-provoking situations, but they are quite strong with many side effects, so they are not usually recommended for long-term use.
Antidepressants – selective serotonin reuptake inhibitors (SSRIs) are the most commonly prescribed longer-term medications for anxiety.
They work by correcting the imbalance of serotonin in the brain and have been proven to be effective in relieving the symptoms of anxiety disorders and depression.
Examples of SSRIs, including citalopram, sertraline, and fluoxetine, are usually a lot more tolerable than stronger medications but can still come with side effects such as headaches, nausea, and sweating.
A common therapy for phobias and other anxiety disorders is cognitive behavioral therapy ( CBT ). This involves working with a therapist to identify negative thought patterns and behaviors.
Once identified, these can be challenged and worked through using different activities and methods to change these negative thoughts and behaviors into more realistic and healthy ones.
Dropping safety behaviors
Specifically for thanatophobia, CBT can help individuals to drop safety behaviors such as body checking, reassurance seeking, and other behaviors which are prominent in death anxiety.
Once these behaviors have been identified with the therapist, these could be monitored by using a diary, for instance. In the diary, individuals can report the antecedents or consequences of these behaviors.
The clients can record the situation and thoughts related to the behaviors and rate their anxiety levels.
With the therapist, the client can select target behaviors they want to be reduced – this could be to postpone target behaviors, gradually decrease their frequency, or stop them altogether.
When dropping safety behaviors, there may be an increase in anxiety initially. However, in the long-term, there should be a significant reduction in the preoccupation with these behaviors, and anxiety should be reduced.
Exposure therapy is a common type of therapy, especially for those with phobias. This involves gradually exposing someone to their feared object or situation so that they eventually become desensitized to it, with the goal of reducing anxiety over time.
For fear of death, exposure may be implemented through imaginal exposure focused on thoughts and memories related to death and revisiting the bodily symptoms that are cues for death anxiety.
The client could be encouraged to read obituaries, read literary accounts of death and loss, or watch TV shows with themes related to death to help with desensitization.
In therapy, the exposure would need to be repeated enough, at a comfortable pace for the client and for adequate periods, so that there is more chance of a significant reduction in anxiety.
Enhancing the enjoyment of life
When people fear death, their attention is often diverted from focusing on enjoying life – there is much less attention given to positive goals.
During therapy sessions, time can be spent on enhancing the enjoyment of life and moving towards personal goals.
People with thanatophobia could be encouraged to set aside time for enjoyable activities and less time focused on the possibility of future loss.
It has been found that often, those with death anxiety neglect the importance of a healthy lifestyle and so it can be important to ensure they are taking part in eating healthily and completing some exercise.
They may also find it useful to complete relaxation techniques such as deep breathing exercises, yoga, or practicing mindfulness to aid with anxiety symptoms.
Occasionally, setbacks can happen. In the case of death, anxiety, physical symptoms, a diagnosis of an illness, or life stress can contribute to relapses.
A helpful approach that can be learned in therapy is to prepare for the inevitable life changes and to develop healthy coping strategies.
These coping strategies can be tailored to each individual and can be encouraged to be used when experiencing death anxiety.
Coping strategies and action plans for anxiety can help individuals learn to maintain a focus on their goals in life.
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