Hydrophobia and aquaphobia: the fear of water

Water is a crucial part of life. Given how we all need water to survive, being afraid of water can be highly detrimental to your health, quality of life, and well-being.

Hydrophobia is caused by physical symptoms related to rabies infection, whereas aquaphobia is typically due to traumatic experiences involving water. Although it may seem like they cause the same primary symptom, a fear of water, a medical professional can quickly tell the two apart.   

Although hydrophobia has "phobia" in its name, its fear of water is due to physical symptoms associated with the rabies virus. Aquaphobia, on the other hand, is psychological and not physiological like hydrophobia. 

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The definition of hydrophobia is an extreme fear of water that results from rabies, a viral disease passed from animals to humans through bites or scratches. A rabies-based fear of water is characterized by physical symptoms that cause difficulty swallowing. People experience muscle spasms when they taste, see, or hear water (Koury, 2021). 

Fearing water isn't always caused by rabies, however. Some people develop a fear of water after experiencing a traumatic event related to water. This type of water-based fear is called aquaphobia. 

Aquaphobia is a type of anxiety disorder known as specific phobia. Phobias are one of the most common mental disorders. There are five types of specific phobias: animal, natural environment, blood-injection-injury, situational, and other. Aquaphobia may develop in childhood or later in life (American Psychiatric Association, 2013).  

Hydrophobia is the result of late-stage rabies that spreads from the initial wound through the central nervous system. Human beings typically contract rabies through scratches or bites from rabid animals. Almost all rabies cases, 99%, come from rabid dogs (World Health Organization, 2018). However, cases of human rabies in the United States are extremely rare, with only one to three cases reported per year (CDC, 2020).

There are two types of rabies: furious rabies and paralytic rabies. Furious rabies causes encephalitis, inflammation in the brain, which destroys the nerve cells in the brainstem that control breathing. This nerve cell breakdown leads to so-called pharyngeal spasms, constrictions in the tube that connects your nose and throat to your esophagus, induced by attempts to drink water. These spasms make it hard to swallow (Wertheim, 2009). 

A psychological fear of water, aquaphobia, is often the result of a traumatic incident involving water and is not a symptom of rabies. You may fear water after choking on water, nearly drowning, or witnessing someone choke or drown (Mehta, 2021). 

Estimates suggest specific phobias affect 7.4% of people, with women more commonly affected. Almost 10% of women will experience a specific phobia within their lifetime (Wardenaar, 2017). Phobias also tend to run in families, although the specific fear is not always the same (Fyer, 1990). For example, your mother might be afraid of spiders, while you fear water. 

When caused by rabies, hydrophobia causes intense thirst that can not be satisfied due to spasms triggered by the sight, taste, or sound of water. Hydrophobia may present with other symptoms of rabies, such as going in and out of consciousness, hyperactivity, agitation, difficulty breathing, and a fear of fresh air known as aerophobia (Tongavelona, 2018; Koury, 2021).

Aquaphobia causes an irrational and persistent fear of water. It may start as avoiding situations related to what triggered the fear (e.g., refusing to drink water or not wanting to be near water) and then grow to encompass any experience involving water. People with aquaphobia may fear drinking liquids or eating watery foods, avoid showering or other personal hygiene tasks like shaving, or skip any water-based interactions like washing the dishes. 

They may also experience anxiety-based symptoms such as shortness of breath, an accelerated heart rate, sweating, and dizziness when looking at water, hearing aquatic sounds, or discussing matters involving liquids (Mehta, 2021). 

Unfortunately, rabies is nearly always fatal by the time it reaches the hydrophobia stage. Death typically occurs within six days of the first symptoms of furious rabies, the type of rabies that comes with hydrophobia (Tongavelona, 2018). 

Most rabies fatalities occur in those who were unable to access treatment or who started treatment late. Rabies has an incubation period of one to three months; however, rabies treatment should ideally begin on the day of infection. Rabies treated early has a much better prognosis. Prompt treatment following severe exposure is effective in preventing rabies (World Health Organization, 2018). 

Treatment consists of the rabies vaccine and rabies immunoglobulin, both of which help your body produce antibodies to fight the virus. The typical course of treatment recommended by the World Health Organization requires four to five vaccinations within the first 28 days of infection (World Health Organization, 2018). 

Fortunately, rabies-related human deaths in the United States are very rare. In the early 1900s, around 100 people died from rabies annually; but since 1960, there are only one or two rabies deaths per year, thanks to successful pet vaccination and availability of post-exposure prophylaxis (PEP) for rabies (CDC, 2020). 

Aquaphobia is not fatal and can resolve with psychotherapy, medication, or a combination of the two. The most effective phobia treatment is cognitive-behavioral therapy with exposure (Wolitzky-Taylor, 2008; Thng, 2020). 

Working with a therapist, you'll confront your triggers through graded exposure therapy. These exposures start small, and you work your way up to scenarios that cause increasing amounts of panic. Treatment generally includes five to eight 90-minute sessions or one 2–3-hour session. The benefits of exposure therapy last for at least one year, and you can maintain them through self-exposure (Koch, 2004). 

Your healthcare provider might also prescribe medication when you suffer from specific phobias. Benzodiazepines, a fast-acting sedative medication, may be used to help you in situations where your trigger is present. However, benzodiazepines are typically not advised for phobias experienced daily due to their sedative nature and risk of addiction, dependence, and withdrawal. These medications can also affect your daily functioning, making it hard to work or engage in tasks such as driving (Rickels,1999). In some cases, antipsychotics or antidepressants may be used (Mehta, 2021).

If you are afraid of water, you most likely have aquaphobia and not hydrophobia. Rabies is rare, whereas specific phobias are one of the most common and most treatable mental health conditions (Wolitzky-Taylor, 2008). Facing your fears can be scary, but you don't have to live your life afraid of water. 

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Current version

August 17, 2021

Written by

Jordan Davidson

Fact checked by

Felix Gussone, MD

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About the medical reviewer

Felix Gussone, MD, Ro

Felix Gussone is a physician, health journalist and a Manager, Medical Content & Education at Ro.