Death anxiety
Death anxiety is anxiety caused by thoughts of one's own death, and is also known as thanatophobia (fear of death).[1] Individuals affected by this kind of anxiety experience challenges and adversities in many aspects of their lives.[2] Death anxiety is different from necrophobia, which refers to an irrational or disproportionate fear of dead bodies or of anything associated with death.[3] Death anxiety has been found to affect people of differing demographic groups as well, such as men versus women, young versus old, etc.[4] Different cultures can manifest aspects of death anxiety in differing degrees.[5]
"Fear of death" redirects here. For the Tim Heidecker album, see Fear of Death. For the Chinese idiom, see Kiasi.Death anxiety
Thanatophobia
Clinical psychology, psychiatry
Psychotherapist Robert Langs (1928–2014) proposed three different causes of death anxiety: predatory, predator, and existential. In addition to his research, many theorists such as Sigmund Freud, Erik Erikson, and Ernest Becker have examined death anxiety and its impact on cognitive processing.
Anxiety caused by recent thought-content[6] about death is sometimes classified by a psychiatrist in a clinical setting as morbid or abnormal, or a combination of the two. This classification pre-necessitates a degree of anxiety which is persistent and which interferes with everyday functioning.[7][8] This high level of death anxiety in the elderly can cause lower ego integrity, and an increase in physical and psychological problems.[9]
Researchers have linked death anxiety with several mental-health conditions.[10] Common therapies that have been used to treat several mental-health conditions include psychotherapy and psychoanalysis. Users of these therapies explore the emotional processing and adaptations through patients' psychotherapy experience and how their mind is evolving to the emotionally affected experiences they have had in their life. Psychotherapies and psychoanalysis have been used to explore predatory death anxiety, as well as existential and predator death anxiety.[11]
One meta-analysis of psychological interventions targeting death anxiety showed that cognitive behavioral therapy can reduce death anxiety.[12]
Theories[edit]
Thanatophobia[edit]
The term thanatophobia stems from Thanatos, the personification of death in Greek mythology. Sigmund Freud hypothesized that people express a fear of death as a disguise for a deeper source of concern. He asserted the unconscious does not deal with the passage of time or with negations, which do not calculate the amount of time left in one's life. Under the assumption that people do not believe in their own deaths, Freud speculated it was not death people feared. He postulated one does not fear death itself, because one has never died. He suspected death-related fears stem from unresolved childhood conflicts.[13][26][27]
Thanatophobia is not only death anxiety, but can mean an intense fear, and feelings of overall dread in relation to one's thinking about death. Usually it relates to one's personal death. Death anxiety can mean fear of death, fear of dying, fear of being alone, fear of the dying process, etc. Different people experience these fears in differing ways. There continues to be confusion on whether death anxiety is a fear of death itself or a fear of the process of dying.
Those who are moving towards death will undergo a series of stages. In Kubhler-Ross's book On Death and Dying (1969), she describes these stages thus: 1) denial that death is soon to come, 2) resentful feelings towards those who will yet live, 3) bargaining with the idea of dying, 4) feeling depressive due to death being inescapable, 5) finally, acceptance.[28]
Wisdom: ego integrity vs. despair[edit]
Developmental psychologist Erik Erikson formulated the psychosocial theory that people progress through a series of crises as they grow older. The theory also proposes the concept that once an individual reaches the last stages of life, they reach the level he called "ego integrity". Ego integrity is marked by one coming to terms with both one's life and inevitable death and accepting it. It was also suggested that when a person reaches the stage of late adulthood, they become involved in a thorough overview of their life to date. When one can find meaning or purpose in one's life, one has reached the integrity stage. Conversely, when an individual views their life as a series of failed and missed opportunities, they do not reach the ego integrity stage. They instead experience despair; this variation of the stage is marked by feelings of disdain and unfulfillment. People who have attained the stage of ego integrity rather than despair are believed to exhibit less death anxiety.[13][26][27]
In a study performed in 2020, researchers tested to see if psychological need-based experiences affect their death attitudes and to see if ego integrity and despair greatly play a role in these death attitudes. The need-based experiences in this research study are the feelings of autonomy, relatedness, and competence. The researchers found that if the participants needs were satisfied, they would have higher ego integrity in relation to their attitude towards death. This allowed the participants to have an easier time accepting death. If the participants struggled to have their needs met, then they would experience higher despair in relation to death anxiety. This meant that they had more death anxiety overall.[29]
Death acceptance and death anxiety[edit]
Researchers have also conducted surveys on how being able to accept one's inevitable death could have a positive effect on one's psychological well-being, or on one's level of individual distress. A research study conducted in 1974 attempted to set up a new type of scale to measure people's death acceptance, rather than their death anxiety. After administering a questionnaire with questions regarding the acceptance of death, the researchers found there was a low-negative correlation between acceptance of one's own death and anxiety about death; meaning that the more the participants accepted their own death, the less anxiety they felt.[58] While those who accept the fact of their own death will still feel some anxiety about it, this acceptance could allow them to form a more positive perspective on it.
People who are exposed to those who are near death or who have already died seem to have a paradigm shift in their way of thinking about death.[59]
A more recent longitudinal study asked cancer patients at different stages to fill out different questionnaires in order to rate their levels of death acceptance, general anxiety, demoralization, etc. The same surveys administered to the same people one year later showed that higher levels of death acceptance could predict lower levels of death anxiety in the participants.[60]
Children[edit]
Death anxiety typically begins in childhood.[63] The earliest documentation of the fear of death has been found in children as young as age 5.[64][63] Psychological measures and reaction times were used to measure fear of death in young children. Recent studies that assess fear of death in children use questionnaire rating scales.[64] There are many tests to study this including The Death Anxiety Scale for Children (DASC) developed by Schell and Seefeldt.[64] However the most common version of this test is the revised Fear Survey Schedule for Children (FSSC-R).[64] The FSSC-R describes specific fearful stimuli and children are asked to rate the degree to which the scenario/item makes them anxious or fearful.[64] The most recent version of the FSSC-R presents the scenarios in a pictorial form to children as young as 4. It is called the Koala Fear Questionnaire (KFQ).[64] The fear studies show that children's fears can be grouped into five categories. One of these categories is death and danger.[64] This response was found amongst children age 4 to 6 on the KFQ, and from age 7 to 10.[64] Death is the most commonly feared item and remains the most commonly feared item throughout adolescence.[64]
A study of 90 children, aged 4–8, done by Virginia Slaughter and Maya Griffiths showed that a more mature understanding of the biological concept of death was correlated to a decreased fear of death. This may suggest that it is helpful to teach children about death (in a biological sense), in order to alleviate the fear.[64]
Relationship to adult attachment[edit]
Death anxiety refers to the fear of death and the unknown that comes with it. Adult attachment, on the other hand, refers to the emotional bond between two individuals, often romantic partners, that provides a sense of security and comfort. Research has shown that there is a complex relationship between death anxiety and adult attachment.[65]
According to the attachment theory, people exhibit different attachment patterns. Several studies have found that individuals who are more anxious about death tend to have less secure attachment styles. Insecure attachment styles are characterized by a fear of abandonment and a lack of trust in others, which can make it difficult for individuals to form close, supportive relationships. These individuals may also have difficulty coping with the idea of death, as they may feel a lack of support and security in their relationships.[66][67]
On the other hand, individuals who have more secure attachment styles tend to have lower levels of death anxiety. This may be because they feel more supported and connected to others, which can provide a sense of comfort and security when dealing with the idea of death.[68]
There is evidence that suggests increasing one's social curiosity, which plays a role in interpersonal relations, can reduce and subdue death anxiety. In the context of particular study, social curiosity and its tendency to foster social connection and relatedness with others acts as a form of symbolic immortality. Symbolic immortality is a conceptual model that can help reduce the fear of death.[69]
Sex[edit]
The connection between death anxiety and one's sex appears to be strong.[63] Studies show that females tend to have more death anxiety than males. In 1984, Thorson and Powell did a study to investigate this connection, and they sampled men and women from 16 years of age to over 60. The Death Anxiety Scale, and other scales such as the Collett-Lester Fear of Death Scale, showed higher mean scores for women than for men.[70] Moreover, researchers believe that age and culture could be major influences in why women score higher on death anxiety scales than men.[71]
Through the evolutionary period, a basic method was created to deal with death anxiety and also as a means of dealing with loss.[70] Denial is used when memories or feelings are too painful to accept and are often rejected.[72][73] By maintaining that the event never happened, rather than accepting it, allows an individual more time to work through the inevitable pain.[73] When a loved one dies in a family, denial is often implemented as a means to come to grips with the reality that the person is gone.[73] Closer families often deal with death better than when coping individually.[73] As society and families drift apart so does the time spent bereaving those who have died, which in turn leads to negative emotion and negativity towards death.[73] Mothers hold greater concerns about death due to their caring role within the family.[14] It is this common role of women that leads to greater death anxiety as it emphasize the 'importance to live' for her offspring.[14] Although it is common knowledge that all living creatures die, many people do not accept their own mortality, preferring not to accept that death is inevitable, and that they will one day die.[14]
Age and sex[edit]
Using the Collett-Lester Fear of Death scale, studies can be performed to examine the age and sex effects on death anxiety. In 2007, two studies were compared to support these claims and they discovered the evidence that was needed. The studies claim that death anxiety peaks in men and women when in their 20s, but after this group, sex plays a role in the path that one takes. Either sex can experience a decline in death concerns with age, but the studies show an unexpected second spike in women during their early 50s. Regardless of sex, once the age of 60 is reached death anxiety levels seem to decrease and stabilize to a low level.[74]
From a study done on elderly men and women in a care facility they were able to see that many older people were not as worried about what happens to their soul beyond death, but more, what they will have to go through in order to get to that process. In relation to their personal health/deterioration, self esteem, etc. From this study, it was also seen that women seem to be more concerned with others they will be leaving behind and the loss of those around them, in many cases even more-so than themselves.[75]
Another study that was performed on specifically black and white men and women over the age of 65 found that race and sex tend to not have the most effects on death anxiety in elderly age. The age of the individuals ended up being a greater predictor of death anxiety than the other two variables previously mentioned. Age was the greatest predictor in how much death anxiety women had, but not in men. This study also found that this difference in death anxiety between sexes may be caused due to the different ways men and women communicate with other people specifically about death.[76]
Measuring[edit]
There are many ways to measure death anxiety and fear.[77] In 1972, Katenbaum and Aeinsberg devised three propositions for this measurement.[77] From this start, the ideologies about death anxiety have been able to be recorded and their attributes listed.[77] Methods such as imagery tasks to simple questionnaires and apperception tests such as the Stroop test enable psychologists to adequately determine if a person is under stress due to death anxiety or post-traumatic stress disorder.[77]
The Lester attitude death scale was developed in 1966 but not published until 1991 until its validity was established.[77] By measuring the general attitude towards death and also the inconsistencies with death attitudes, participants are scaled to their favorable value towards death.[77]
One systematic review of 21 self-report death anxiety measures found that many measures have problematic psychometric properties.[78]
Death anxiety and COVID-19[edit]
Millions[79] of people around the world have died from COVID-19 during the COVID-19 pandemic. The pandemic presents a psychological stressor for pre-existent death anxiety fears. COVID-19 death anxiety was found to influence people's judgement throughout their lives.[80] In an Australian study, those who fear that they are more prone to contracting and dying from COVID-19 have higher levels of death anxiety. The study finds a positive correlation with death anxiety and general psychological disturbances such as depression, anxiety, stress, and paranoia.[81] Participants were also found to have greater fears of death from COVID-19 (average 22%) than the Australian fatality case rate (2%).[82] Elderly individuals, who were already likely to experience death anxiety outside of a pandemic situation, now find their fear of death largely exacerbated.[83] The fear of dying from COVID-19 has also been one of the leading factors in psychological distress among many countries during the course of the pandemic. It has particularly affected women and those with a lower level of education.[84] During the COVID-19 pandemic, death anxiety has been a large contributor to declining mental wellbeing among those working in helping professions such as nursing and social work.[85]