American Journal of Drug Delivery

, Volume 1, Issue 3, pp 215–221 | Cite as

Managing difficulties with adherence to injectable medications due to blood, injection, and injury phobia and self-injection anxiety

  • Darcy Cox
  • David C. MohrEmail author
Technology in Practice


Injection phobia has long been known to interfere with the successful delivery of medical and dental care. Increasingly, as new biological medications administered through regular injection are developed, the inability to self-inject due to anxiety is reducing initiation and adherence to treatment. The prevalence of injection phobia ranges from 7–22% of the general population, while the inability to self-inject may also be increasingly prevalent.

Specific phobia — blood, injection, and injury (BII) — is a diagnosis that is characterized by phobic reactions to exposure to injections, injury, or blood, leading to avoidance of such situations, or tolerating these situations only under extreme emotional duress. While the literature on health outcomes related to injection phobia is somewhat limited, injection phobia has been shown to contribute to poor adherence to treatment regimens, or to discontinuance of treatment altogether in diabetes mellitus and multiple sclerosis. Hypotheses about possible psychological and genetic mechanisms have been developed, as well as high psychiatric comorbidities that may contribute to injection anxiety and phobia, or complicate medical treatment. A number of psychological factors, including poor self-efficacy about self-injecting, beliefs about the benefits and risks associated with injecting, and feelings of disgust may contribute to injection phobia. Increased occurrence of vasovagal responses during or following injection may also increase the risk of injection phobia. Because injection phobia can prevent or interfere with the delivery of needed medications, it is believed that injection phobia and self-injection anxiety can have health consequences, however, research in this area is lacking. Cognitive behavioral therapies, including both exposure and cognitive restructuring, have been shown to be an effective treatment.


Multiple Sclerosis Migraine Specific Phobia Cognitive Restructuring Blood Glucose Testing 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



Dr Cox is supported in part by National Multiple Sclerosis Society grant FG-1376-A-1. Dr Mohr is supported by R01 MH59708-01 from the National Institute of Mental Health, and R01 HD043323-01 from the National Institute of Child Health and Human Development. The authors have no conflicts of interest that are directly relevant to the content of this manuscript.


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Copyright information

© Adis Data Information BV 2003

Authors and Affiliations

  1. 1.Department of NeurologyUniversity of California San FranciscoSan FranciscoUSA
  2. 2.Departments of Psychiatry and NeurologyUniversity of California San FranciscoSan FranciscoUSA

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