Aquaphobia: A Case Report on the Unique Presentation of a Specific Phobia

Introduction Aquaphobia is an irrational fear of water that is classified as a specific phobia. Specific phobias are a type of anxiety disorder that cause persistent and unrealistic fear triggered by an object, person, animal, activity, or situation. The National Institute of Mental Health states that approximately 19.2 million American adults suffer from some form of a specific phobia. They often present early in life but it is important to recognize that the geriatric population may develop phobias too, especially as they experience the negative effects of medical conditions. Previous studies report up to a 10% phobia prevalence rate in people 65 or older, with specific phobias accounting for 2.1% of this group. Adult phobias often last many years and will not subside unless treated appropriately. Those who suffer from specific phobias tend to avoid the trigger and, in certain situations, this can have a major detriment to quality of life. Here, we present the case of a 69-year-old male who developed aquaphobia while undergoing treatment for non-small cell lung cancer. Methods The patient was seen and treated by the psychiatry team through multiple telehealth evaluations over a four-month period. Results Case: JY is a 69-year-old male with the diagnosis of non-small cell lung cancer, 80 pack-year smoking history, COPD, chronic kidney disease, and no past psychiatric history. He was diagnosed in 2019 after a CT chest scan showed left upper lobe and right lower lobe lung nodules. He underwent a complex surgical procedure followed by chemotherapy and radiotherapy. In June 2020, he experienced coughing spells and distressing shortness of breath and underwent thoracentesis, which confirmed malignant pleural effusion. Shortly after thoracentesis, JY presented for initial psychiatry telehealth evaluation accompanied by his wife. Following this procedure, he had been experiencing persistent and irrational fear of water. He reported episodes of intense anxiety and shortness of breath associated with any activity that involved water, including looking at a glass of water, drinking water, shaving, washing dishes, or showering. The sight of water elicited an immediate anxious reaction where he started to gasp for air and felt that he was going to die. As a result, he began to avoid situations that required contact with water. He stopped showering and shaving and he avoided drinking water to the point of frequently experiencing thirst and dehydration. He recognized that his fear was irrational and believed his condition severely interfered with his life. He was diagnosed with aquaphobia based on history and DSM-5 Criteria. He was started on sertraline 25mg daily which was titrated up to 200mg daily. Quetiapine was added as an adjuvant with a dose of 12.5mg PO QAM, noon, and 50mg bedtime. The patient was referred to psychotherapy but was unable to attend sessions. However, during telehealth sessions the psychiatrist was able to provide psychoeducation about the patient's condition and guided breathing exercises; the patient found this to be helpful. After four months of treatment, the patient reported significant improvement in symptoms and was to resume activities that involved exposure to water. Conclusions Anxiety disorders in older adults reduce quality of life yet these disorders have received little attention in the literature. In this poster, we will discuss the unique presentation of aquaphobia in an elderly patient and the potential causes and treatment options. This case highlights that specific phobias can develop in the geriatric population particularly as they experience the long-term sequelae of medical conditions. In the case of JY, it is hypothesized that his feeling of choking while drinking water, in the setting of shortness of breath due to malignant pleural effusions, triggered an irrational fear of water. The development of this condition severely decreased the patient's quality of life and had negative effects on his overall health. Effective therapeutics to aquaphobia include a pharmacological approach as well as Cognitive Behavioral Therapy (CBT) or exposure therapy. These treatments allow patients to regain control of reactions to stress and stimulus in the presence of water. In the case of JY, a pharmacological approach was found to be successful. Phobias can severely affect quality of life in the elderly and it is therefore important to promptly recognize the diagnosis to quickly enact treatment modalities. Funding No funding was provided for this case report.