Obsessive compulsive disorder - OCD treatment and therapy from NOCD

Afraid of needles? It could be a mental health concern

By Jessica Migala

Oct 17, 20239 minute read

Reviewed byApril Kilduff, MA, LCPC

Whether you’re going in for a routine blood draw or getting your flu shot, it’s normal to feel nervous around needles. They give you an uncomfortable pinch and the sight of a long skinny needle can make many people queasy. You might encounter the stray needle elsewhere in life, too, spying a used syringe on the subway seat and looking for another place to sit.

It’s unlikely that anyone actually enjoys the sensation of getting an injection or coming across a used needle in a public space. But for some people nerves around needles are significantly more serious—they’re an intense fear. In fact, it’s incredibly common. One in four adults and two in three children have “strong fears” about needles, reports the Centers for Disease Control and Prevention (CDC). 

Maybe you count yourself as part of that one in four if you feel dizzy, your heart rate increases, or you feel nauseous, which are all symptoms of this fear, says the Cleveland Clinic. In extreme cases, you may have a panic attack or faint, adds the CDC.

These fears can lead to potential repercussions on your health, says Melanie Dideriksen, LPC, CAADC, licensed therapist at NOCD. You may avoid getting vaccines that you need, skip important blood tests that assess the state of your health, or may even avoid giving yourself needed medication, such as insulin injections to treat diabetes. 

These fears can stem from several potential mental health conditions, including having a needle phobia or possible obsessive compulsive disorder (OCD), or a closely related condition known as illness anxiety disorder. We’ll dive into all three of these below.

The fortunate news is that no matter why you’re afraid of needles, there are steps you can take to manage and relieve that fear, so you can feel more in control day-to-day and stay on top of your health needs. 

Why am I afraid of needles?

While there can be many reasons around your fear, three main mental health conditions clinicians may consider include a specific phobia called trypanophobia, obsessive-compulsive disorder (OCD), and illness anxiety disorder. Here’s more on each:

Trypanophobia

Having a specific phobia around needles is called trypanophobia. “When I hear that someone has a fear of needles, one of the first things I think of is a specific phobia,” says Dideriksen. Specific phobia is a diagnosis that includes hundreds of different phobias, which all share an “intense, irrational fear of something that poses little or no actual danger,” according to the National Institute of Mental Health (NIMH). 

If you’re suffering from trypanophobia, you may even realize that you have nothing to worry about when getting a routine vaccine from a trained professional or encountering a used needle in the street—but still, you can’t shake the fear that occurs when you’re in sight of a needle. About 9% of U.S. adults have a phobia, with women being twice as likely as men to report having one, according to the NIMH. What’s interesting is how much these phobias can take hold of one’s life—the Institute also points out that a phobia creates “serious impairment” in one’s life.

What sets trypanophobia apart from other mental health conditions causing a fear of needles is that it tends to exist transiently. “Typically, you wouldn’t be thinking or obsessing about needles on a regular basis. However, these fears arise in situations where you’re faced with them—or the prospect of needles coming up—we call that a phobic stimulus,” says Dideriksen. Being presented with the needle (or the prospect of an upcoming appointment), is the stimulus that triggers your fear reaction. Other things and places that are adjacent to the original phobic stimulus can also activate this fear, like a doctor’s office. 

However, once the procedure or appointment is over, “you bounce back,” Dideriksen says. That doesn’t mean any of this was easy, only that the fear reaction ends when you’re no longer in the presence of a needle.

Obsessive compulsive disorder (OCD)

OCD is a chronic mental health condition that has two main features, according to the International OCD Foundation. One is obsessions, which are repeated, unwanted thoughts, feelings, images, sensations, or urges that one finds distressing. The second is compulsions, which are behaviors, physical or mental, that are performed in order to neutralize the distress of a compulsion or to prevent something from happening. Those behaviors may include behaviors like cleaning, checking, repeating, counting, mentally reviewing events, and praying, among many others. 

While there are many different types of OCD, one particularly common subtype is contamination OCD. If you have contamination OCD, you might obsess about contracting an illness or spreading germs that can make you or others sick, or even perhaps be fatal. This is where the well-known compulsion of hand washing most often appears, though not everyone with contamination OCD actually engages in this specific compulsion.

Here’s what this might look like when it comes to needle fears: “I’ve seen people with contamination OCD worry that they’ll encounter a dirty needle on the street or in the garbage when they’re taking out the trash,” explains Dideriksen. 

This fear could have begun rather organically. “One day, someone could have seen a needle on the ground while walking on the street. That was something that their contamination OCD latched onto. Now, their compulsion becomes scanning and looking out for needles when walking down the street. When they get home, they might perform cleaning rituals,” she says. Of course, this is just one example of what a fear of needles in contamination OCD might look like, but it can be triggered and show up in a variety of ways. 

But here’s the rub: Not only does this type of contamination OCD affect your sense of safety and security while walking down the street, and may require a lot of time if you feel compelled to perform cleaning rituals, but it can actually compromise your health if you start avoiding needles in medical situations. 

“Someone going in to get a vaccine or blood draw might worry that there could be something on that needle that will harm them,” says Dideriksen. 

Even though the technician just took the syringe out of the packaging, there may still be a worry that it was contaminated during the manufacturing process, that you could be allergic to the packaging, or that you could react poorly to the injection. After all, you can’t possibly know everything that’s happened to that needle, or that could happen when it’s inserted. And very often, this sense of uncertainty feels impossible to deal with for people with OCD, which makes people continue to perform compulsions.

Illness anxiety disorder

Also referred to as health anxiety or hypochondriasis, illness anxiety disorder is defined as excessive worry about having or developing a serious undiagnosed medical condition. Even if testing shows that you are okay, you may not believe the results if you have illness anxiety disorder. In this case, you might experience intrusive thoughts about your health and the terrible things that could be wrong with you. 

The difference between illness anxiety disorder and OCD is the presence of compulsions. However, this is a very fine line, says Dideriksen, because some of the symptoms of illness anxiety disorder can look like compulsions. For example, you might repeatedly check your body for signs of illness, you might ruminate by reviewing how you felt that day, or do excessive online research about your symptoms. 

However, in contamination OCD, these behaviors differ from illness anxiety disorder because they will be more ritualistic in nature—you have to check your body or repeat a certain phrase a specific number of times to get rid of the anxiety, for example.

How to get help for a fear of needles

No matter the source of your fear of needles, know that there is help available. And that help is through exposure and response prevention therapy, or ERP. This is the gold standard treatment for OCD, but it’s also highly effective when addressing phobias and other anxiety disorders like illness anxiety. 

During ERP, your clinician will work to expose you to your fear or obsession—this is the exposure part of the treatment. As a result, you will probably feel increased anxiety or distress, and you’ll want to do something to make yourself feel better. Maybe that’s by gaining reassurance that you’ll be okay or checking your pulse until the discomfort dissipates. But the next crucial component of treatment, response prevention, means that you will resist doing any of that. 

In ERP you won’t jump immediately into, say, heading to your local CVS for a vaccine. You’ll work with your therapist in developing a hierarchy of fear as it relates to your phobia, anxiety, or OCD. You’ll begin at lower-level exercises and work your way up from there. 

For example, says Dideriksen, step one might be simply imagining a needle or multiple needles. This will likely trigger a lower level of anxiety. So, out of a score of 10 (with one being no big deal to ten being a panic attack), visualizing a needle might bring you to a 3 or 4 on the anxiety scale. That’s a good place to start. You’ll continue this step until you get used to thinking about needles and your anxiety begins to come down. 


In future visits, you might progress to looking at pictures of needles. This might be a step-up because it triggers your anxiety to a score of 5 or 6. Once you become accustomed to practicing this and your discomfort gets a bit better, you could move on to watching a video of someone getting a tattoo.

Before long, you might buy a syringe and have it with you during the visit with your therapist. You might look at it, touch it, and even hold it close to your vein, says Dideriksen. 

Remember, throughout this time, you will also be working with your clinician to not respond with compulsive behavior or avoidance—the goal is to develop a greater tolerance for your discomfort around needles, and to learn that your compulsions or avoidance weren’t actually necessary in order for you to be safe. 

“We want to make sure that you’re engaging with your fear trigger or phobic stimulus without doing a compulsion. You wouldn’t hold a needle and remind yourself that it’s brand new, out of the package, and has no germs on it or look away while holding it,” says Dideriksen. Instead, you’d hold it in your hand and say something to yourself like yes, this may have become contaminated in the packaging process. Facing that fear head-on is what will help it go away and have less influence on you.

Finally, if you have to give yourself medication like insulin as part of self-management for a condition like diabetes, one of the final steps may be to actually administer yourself insulin or doing a finger prick test to check your blood sugar. (If you are thinking about this with a lot of fear right now, know that doing the smaller steps first allows you to habituate to this process and the general fear level to go down gradually. Plus, your clinician will work with you throughout, so you won’t be alone.)

Eventually, you can gain freedom from your fear of needles, so you can take care of your health the best way possible. “The ultimate goal is to be able to go to the doctor and get a blood draw, or a vaccine—or to become comfortable walking in public places where you could find a contaminated needle somewhere,” she says.

Where to turn if you’re looking for help

If you are experiencing a fear of needles, NOCD can help. At NOCD, you can connect with licensed clinicians who are specially trained in ERP—whether for OCD or anxiety disorders—for live, face-to-face video sessions. To learn more about how you can take active steps to overcome your fear, read about NOCD’s evidence-based approach to ERP therapy. 

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