Mental Health First Aid

Understanding hydrophobia: how Rabies causes fear of water

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Pratyusha Pal

May 08, 2025

Read time : 09 mins

Table of contents

Hydrophobia, meaning “fear of water,” is most commonly associated with rabies, a viral disease that attacks the central nervous system. It arises from involuntary throat spasms that make swallowing liquids extremely painful. In severe cases, even the sight, sound, or thought of water can provoke intense anxiety and distress.

Hand holding a glass of water, symbolising fear of drinking due to hydrophobia

Hydrophobia vs aquaphobia: what’s the difference?

Aquaphobia is an intense, irrational fear of water that stems from psychological factors like trauma or anxiety. In contrast, hydrophobia is a symptom of end-stage rabies infection. It involves painful throat spasms that make swallowing liquids extremely difficult. As the condition progresses, even seeing or thinking about water can trigger distress, leading to an intense fear of drinking. To get a better understanding, refer to the table below:

Identifying the symptoms of hydrophobia

Hydrophobia is a significant symptom of rabies that appears in the later stages of infection. It causes severe reactions in the body. Below are the key symptoms associated with hydrophobia and rabies:

  • Fever
  • Muscle pain
  • Agitation
  • Irritability
  • Nausea and vomiting
  • Excessive drooling: As the rabies virus spreads through saliva, it triggers increased saliva production, leading to difficulty swallowing and constant drooling.
  • Throat spasms
  • An intense fear of swallowing water, even though the person may feel extremely thirsty.
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How rabies leads to hydrophobia

Rabies is a viral infection that typically spreads through the bite or scratch of an infected animal. Once inside the body, the virus travels through the nervous system and multiplies. In the final stages of the illness, it causes painful throat spasms that make swallowing difficult. This leads to a fear of drinking liquids, even when the person is extremely thirsty, resulting in a condition known as hydrophobia.

Common animal sources of rabies

Rabies is most commonly transmitted by warm-blooded animals that carry the virus in their saliva. While wild animals are a frequent source, domestic pets can also pose a risk if they are not vaccinated. The animals most often associated with rabies include:

  • Bats
  • Foxes
  • Dogs
  • Raccoons
  • Cats
  • Monkeys

Common animal carriers of rabies, including bats, dogs, foxes, and raccoons.

Diagnosing hydrophobia

If you’ve been bitten or scratched by a potentially rabid animal, it’s crucial to seek medical attention immediately, even if no symptoms have appeared. Early diagnosis and timely post-exposure treatment can prevent the virus from progressing. Healthcare professionals may perform several tests to detect rabies, including saliva analysis, skin biopsies, and cerebrospinal fluid testing. Several diagnostic methods are available to confirm rabies infection, particularly in suspected hydrophobia cases. The table below outlines the key tests and what each one involves.

Tests

Description

Direct fluorescent antibody test

Detects the antigen of the virus in brain tissue

A skin biopsy

Examines a sample of skin tissue for signs of the virus

A blood test

Checks for the presence of rabies antibodies in the blood 

A lumbar puncture

Tests cerebrospinal fluid for the presence of rabies antibodies

How is hydrophobia treated?

There’s no cure once rabies symptoms appear, so acting fast is crucial. Post-Exposure Prophylaxis (PEP) can stop the virus before it takes hold. Here’s what you need to do:

  • Clean the wound immediately: Rinse the area with soap and running water for at least 15 minutes. Apply an antiseptic like povidone-iodine at the entry point to kill the virus.
  • Get rabies immunoglobulin (RIG): If you haven’t had a rabies vaccine before, it gives you instant protection while your body builds immunity.
  • Start the rabies vaccine course: You’ll need four injections on days 0, 3, 7, and 14. If your immune system is weakened, you’ll need a fifth dose on day 28. If you’ve been vaccinated before, just two booster shots (days 0 and 3) are enough, and you can skip the RIG

Frequently Asked Questions

Are hydrophobia and aquaphobia the same?

No, they are different. Hydrophobia is a symptom of rabies infection, while aquaphobia is an irrational fear of water.

Does rabies make you afraid of water?

In the advanced stages of rabies, painful throat spasms can make it extremely difficult to swallow water or any liquid, which may result in a fear of drinking.

Can I get infected by any wild animal?

Rabies can only be transmitted by infected warm-blooded animals such as dogs, bats, and monkeys.

Is hydrophobia curable?

Hydrophobia is not curable once it reaches its advanced stage.

How can hydrophobia be prevented?

It can be prevented by receiving a rabies vaccination and an immunoglobulin injection immediately after exposure to an infected animal.

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