Testing the Paleolithic-human-warfare hypothesis of blood-injectiion phobia in the Balitmore ECA Follow-up Study-Towards a more etiologically-based conceptualization for DSM-V
Objective:
The
research
agenda
for
the
fifth
edition
of
the
Diagnostic
and
Statistical
Manual
of
Mental
Disorders
(DSM-V)
has
emphasized
the
need
for a
more
etiologically-based
classification
system,
especially
for
stress-induced
and
fear-circuitry
disorders.
Testable
hypotheses
based
on
threats
to
survival
during
particular
segments
of
the
human
era
of
evolutionary
adaptedness
(EEA)
may
be
useful
in
developing a
brain-evolution-based
classification
for
the
wide
spectrum
of
disorders
ranging
from
disorders
which
are
mostly
overconsolidationally
such
as
PTSD,
to
fear-circuitry
disorders
which
are
mostly
innate
such
as
specific
phobias.
The
recently
presented
Paleolithic-human-warfare
hypothesis
posits
that
blood–injection
phobia
can
be
traced
to a
“survival
(fitness)
enhancing”
trait,
which
evolved
in
some
females
of
reproductive-age
during
the
millennia
of
intergroup
warfare
in
the
Paleolithic
EEA.
The
study
presented
here
tests
the
key a
priori
prediction
of
this
hypothesis—that
current
blood–injection
phobia
will
have
higher
prevalence
in
reproductive-age
women
than
in
post-menopausal
women.
Method:
The
Diagnostic
Interview
Schedule
(version
III-R)
,
which
included a
section
on
blood
and
injection
phobia,
was
administered
to
1920
subjects
in
the
Baltimore
ECA
Follow-up
Study.
Results:
Data
on
BII
phobia
was
available
on
1724
subjects
(1078
women
and
646
males)
.
The
prevalence
of
current
blood–
injection
phobia
was
3.3%
in
women
aged
27–49
and
1.1%
in
women
over
age
50
(OR
3.05,
95%
CI
1.20–7.73)
.
[The
corresponding
figures
for
males
were
0.8%
and
0.7%
(OR
1.19,
95%
CI
0.20–7.14)]
.
Conclusions:
This
epidemiological
study
provides
one
source
of
support
for
the
Paleolithic-human-warfare
(Paleolithic-threat)
hypothesis
regarding
the
evolutionary
(distal)
etiology
of
bloodletting-related
phobia,
and
may
contribute
to a
more
brain-
evolution-based
re-conceptualization
and
classification
of
this
fear
circuitry-related
trait
for
the
DSM-V.
In
addition,
the
finding
reported
here
may
also
stimulate
new
research
directions
on
more
proximal
mechanisms
which
can
lead
to
the
development
of
evidence-based
psychopharmacological
preventive
interventions
for
this
common
and
sometimes
disabling
fear-circuitry
disorder