Fearing laughter

Laughter is typically a positive behaviour – something to share within groups and between close friends. It's considered a social cue that furthers a relationship or conversation, linked to empathy and emotional authenticity. Laughter can even be used to manage negative experiences, such as regulating difficult conversations between married couples, increasing short term pain tolerance, and helping the functioning of the body's immune system (Scott, Lavan, Chen, & McGettigan, 2014).

But there are times when laughter leads to negative emotions. 'Gelotophobia' (from the Greek 'Gelos', meaning laughter) is the fear of laughter and being laughed at. First discovered through the clinical observations of German psychotherapist Michael Titze in 1996, gelotophobia was described as the 'Pathological fear of appearing to social partners as a ridiculous object' (Titze, 1996).

Many of us have been the target of humour, whether good natured or with the intent to embarrass. We actively try to avoid these situations – through not deviating from the social norm and deterring attention, but these behaviours themselves do not constitute gelotophobia (Ruch & Proyer, 2008a).

In Titze's original papers, those with the condition are said to be distinguishable due to certain observable criteria. These include social withdrawal, sensitivity to offence, paranoia, and a genuine fear of even good-natured laughter or smiling, to the extent that it can become debilitating. The consequences of living with gelotophobia can include low self-esteem and psychosomatic disturbances (such as irregular sleep), culminating in a 'lack of joy' in life. Gelotophobia is thought to share comorbidities with several other clinical conditions, including Autism Spectrum Disorder (ASD), Social Anxiety Disorder and Borderline Personality Disorder (Grennan, Mannion, & Leader, 2018; Havranek et al., 2017; Brück, Derstroff, & Wildgruber, 2018).

The study of gelotophobia has developed since Titze's observations. Thanks to the work of Ruch and Proyer, among others, we now think in terms of 'realistic' and 'pure' forms of gelotophobia instead of 'pathological' gelotophobia. Those with realistic gelotophobia are ridiculed often, for various reasons, and their fear is therefore justified. Those with pure gelotophobia are rarely the object of targeted humour, but experience fear nonetheless (Ruch, 2009).

These non-clinical classifications are determined by the diagnostic questionnaire GELOPH<15> and the more recent PhoPhiKat-45, which also examines traits for the joy of being laughed at (gelotophilia) and the joy of laughing at others (katagelasticism). Scores in these questionnaires range from 'No' to 'Extreme' fear of laughter with a cut-off for gelotophobia 'diagnosis' (Ruch & Proyer, 2008b; 2009).

Since gelotophobia is a relatively new concept that does not appear as a disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM), it is possible that gelotophobes have instead received other diagnoses such as 'specific' phobias or general social anxiety disorder. There is currently no comprehensive treatment specifically for the fear of laughter. However, some clinics offer hypnotherapy treatment, the success of which is dubious. 

Early experiences 

In 2004, Ruch published a model of gelotophobia based on Titze's observations in the 1990s. Within the model, causes are split into three sections: shame-bound development in infancy, repeated experience of ridicule from peers in childhood, and intense ridicule in adulthood. An inability to connect with others in early life, followed by ridicule in later social settings with targeted laughter, can lead to a fear of all laughter due to a limited capacity to understand laughter overall. 

Those who score highly for gelotophobic traits tend to have parents who score similarly (Proyer, Estoppey, & Ruch, 2012). It's speculated that fear of laughter may be passed from parent to child, with children learning from observed expression of attitudes towards laughter, resulting in shame-bound anxiety. Gelotophobes also recall having been subject to greater levels of punishment from their parents compared to those without gelotophobia, and less warm parenting styles (Platt, 2008; Ruch, Altfreder, & Proyer, 2009). With less warm parenting, which may include early joint laughter, recognition of laughter as a social cue could be reduced, and ambiguous laughter may be interpreted as ridicule. 

On the other hand, there is also a relationship between gelotophobia scores and the frequency of distress associated with childhood teasing (Edwards, Martin, & Dozois, 2010). Individuals may be teased for personality factors such as being shy, or psychosomatic reflexes like nervous shaking or stuttering, so teasing may exacerbate behaviours which could develop and lead to gelotophobia. For example, someone who stutters may be subject to bullying, increasing the stuttering and leading to a fear of laughter. But directional causality is yet to be determined: are gelotophobic behaviours present in infancy and increase because of ridicule, or do they develop as a consequence? Establishing the direction of causality could help untangle whether gelotophobia is a simple 'emotional reaction' to laughter or a genuine pathological condition that should be added to the DSM. 

Into adulthood

While earlier studies mainly focused on adults, more recent papers have looked at adolescence as a key period of development in the condition. Adolescence is a time of heightened self-awareness, and there is evidence that gelotophobia may be more present in teenage years than any other time of life. Gelotophobia prevalence seems to decrease after this, but there are some extreme forms that persist into adulthood (Kohlmann et al., 2018).

Adult gelotophobes often describe themselves as insecure, frequently bullied, and unable to sustain long-term positive relationships with others. According to Ruch and Stahlmann (2020), those with gelotophobia have lower life and job satisfaction, and more workplace bullying and stress. The lower success in interpersonal relationships may be due to attachment styles between parent and child; without experiencing suitable 'warmth' and positive relations from parents, gelotophobes might be unable to replicate this with potential friends and partners (Brauer & Proyer, 2020). This can lead to withdrawal from social engagement, resulting in an 'introverted' personality (Ruch & Proyer, 2008a). It is not yet known if there is a typical age of onset, so memories and experiences of ridicule could be either causers or reinforcers of the condition. 

Treatment

Gelotophobes who have learnt coping strategies and built resilience may provide clues as to how to develop and structure treatment (Ruch & Stahlmann, 2020). Researchers have deduced three fundamental factors of gelotophobia that vary within individuals who have the condition. These are coping with derision (through control, withdrawal, internalising), disproportionate negative responses towards being laughed at, and paranoid sensitivity to anticipated ridicule (Platt, Ruch, Hofmann, & Proyer, 2012). Treatments for gelotophobia may need to vary according to which factors are most present in an individual, though specific programmes of treatment are yet to be developed and tested. 

General programmes of treatment co-opted from other social phobia treatments have been suggested for gelotophobes, but there is much debate about whether they are effective in reducing the fear of laughter. In 'shame-attack' or 'humour-drama' methods, the individual with the phobia is faced with 'shameful' or 'embarrassing' situations in a controlled environment (Titze, 2006). The idea is to familiarise the patient with situations that may draw laughter, or to use their own humour (e.g. talking in silly voices) to cope with the fear (Titze, 2009). These methods and their variants appear successful in some samples (Titze, 2009). However, other researchers claim they may not be universally applicable to all gelotophobes, depending on which factors are present, and the individual's relationship with humour, which can vary over time (Führ, Platt, & Proyer, 2015). 

Exploring differences

Across 39 countries, most respondents to a questionnaire believed everyone has a fear of being laughed at, and that the severity of this fear could lead to changes in behaviour, such as paranoia (Ruch, 2002). But cross-cultural differences indicate that culture seems to influence how laughter and humour are perceived, and how individuals react to laughter. For example, more people in Ethiopia class laughter as suspicious than in Scotland; while people from Egypt are more likely than those from Turkmenistan to avoid social situations due to laughter (Proyer et al., 2009). Britain appears to have the highest rates of gelotophobia, while Denmark has one of the lowest rates (Hofmann, Platt, Ruch, & Proyer, 2015). Lack of both awareness of gelotophobia and research into gelotophobia treatments in Britain may in part be due to the British cultural stereotype of the stiff upper lip.

There is a high rate of gelotophobia in those with Autism Spectrum Disorder (ASD). This may be due to more early negative social experiences compared to neurotypical counterparts (Leader, Grennan, Chen, & Mannion, 2018). These individuals may have experienced more bullying due to their neurodivergence. Gelotophobia measures in those with ASD are correlated with the frequency and severity of remembered bullying in early life, supporting previous accounts of gelotophobia as a product of early negative social interactions (Samson, Huber, & Ruch, 2011; Schroeder et al., 2014). 

In later life, autistic individuals tend not to describe humour as a strength or relate it to a signal of 'life satisfaction'. Moreover, negative social interpretations may exacerbate fear of situations containing ambiguous laughter in those with ASD compared to non-autistic gelotophobia sufferers. Improving the lives of those with both gelotophobia and ASD should therefore be a priority. Autistic individuals often enjoy short inoffensive puns, or 'dad jokes' (Cai, Chen, White, & Scott, 2019). Through these types of jokes, positive laughter can perhaps be explored in those with ASD, to reduce fear and help engagement with social laughter. 

Going forward

While there are no comprehensive empirically studied interventions for gelotophobia, there are some promising steps to take. An awareness of gelotophobia as a specific condition with distinct factors could help clinicians consider how to tailor treatment for those who have other diagnoses (Platt, Proyer, Hofmann, & Ventis, 2016). Anti-bullying efforts in schools could incorporate measures to reduce negative associations of laughter at an early age, potentially highlighting to children that those with ASD may be particularly affected by laughter. Early interventions might stop the fear of laughter developing and have a positive impact on later behaviour. 

Ultimately, interventions and treatments that alleviate stressors and facilitate positive attachment styles are needed to help gelotophobes lead a better life. Hopefully, in the future, laughter can be enjoyed by everyone.

-       Grace Sanders is a psychology undergraduate at the University of York

References 

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