Tetraphobia

You step into an elevator in Hong Kong or Seoul and the buttons go 1, 2, 3, 5. There’s no fourth floor, at least not by name. That missing button is tetraphobia at work.

Tetraphobia is the habit of avoiding the number 4. It’s most common in East Asia, where the word for “four” sounds almost the same as the word for “death.” Wikipedia: Tetraphobia

Most of the time, tetraphobia is a cultural superstition shared by many people, much like the Western unease about 13. It isn’t a diagnosis. For a small number of people, though, worry about the number can grow into real fear that shapes their choices. When that happens, a clinician would look at it the way they look at any strong, lasting fear of a particular thing. APA Dictionary of Psychology

Why is 4 unlucky?

It comes down to sound. In Mandarin, “four” is sì and “death” is sǐ. The two differ only in tone. Cantonese has a similar near-match. In Japanese, both words can be read as shi, and in Korean both can be sa. Wikipedia: Tetraphobia

Vietnamese is an interesting exception. The Sino-Vietnamese words for four and death use different tones, and everyday Vietnamese mostly uses native words for both, so the superstition is much weaker there. Wikipedia: Tetraphobia

Some combinations carry extra weight. In Cantonese, 14 can sound like “will certainly die” and 24 like “easy to die.” In Japanese, 49 can sound like a phrase meaning “to suffer and die.” Wikipedia: Tetraphobia So the concern often spreads beyond the single digit.

Where you might notice it

You can see tetraphobia in ordinary places once you know to look:

• buildings with no 4th, 14th, or 24th floor, or a fourth floor labeled “3A” or “F”
• hospitals and funeral halls in South Korea, where floor 4 or room 4 is almost always skipped
• apartment towers in Hong Kong that jump straight from the 39th floor to the 50th
• phone numbers, license plates, and house numbers chosen to avoid 4
• product names that skip it, such as phone models that go from 3 to 5

All of those examples come from documented cases. Wikipedia: Tetraphobia In the Hong Kong case, superstition may be more of a cover story. Higher floors usually sell for more there, so skipping the 40s makes the top apartments sound higher. Wikipedia: Tetraphobia

It travels with communities. In 2013, councillors in Richmond Hill, Ontario, a town north of Toronto, passed a bylaw keeping the single number 4 off new street addresses, after residents asked to avoid it. Numbers like 14 and 44 were still allowed. CBC News

Can fear of the number 4 actually hurt you?

This is the part that tends to go viral. In 2001, the BMJ published a study by David Phillips and colleagues. They looked at US death certificates from 1973 to 1998 and reported that deaths from chronic heart disease among Chinese and Japanese Americans peaked on the fourth day of each month. White Americans showed no such peak. The authors suggested the stress of an “unlucky” day might trigger fatal heart problems in vulnerable people, and named the pattern after The Hound of the Baskervilles, where a character dies of fright. BMJ via PubMed Central

That finding has not held up well.

• In 2002, economist Gary Smith reanalyzed California data in the same journal. When he compared day 4 with the days right before and after it, he found no persuasive peak. He also pointed out that the original study used only a subset of heart disease categories. BMJ via PubMed Central
• Smith also found relatively few suicides among Chinese and Japanese Americans on the fourth. If the day were stressful enough to cause heart deaths, you might expect other effects too. BMJ via PubMed Central
• A 2003 study looked at Hong Kong, where the superstition is strong and most people speak Cantonese. Cardiac deaths on the 4th, 14th, and 24th were no different from other days. The Medical Journal of Australia

McGill University’s Office for Science and Society reviewed the whole story and concluded there’s no good evidence that the superstition raises death rates on the fourth. McGill OSS It’s a fun fact you’ll still see shared, but the evidence behind it is weak.

Superstition, fear, or phobia?

For most people who skip the number 4, it’s a shared custom. They might pick a different apartment or phone number without much thought, the same way many Westerners shrug at a missing 13th floor. That isn’t a phobia. It’s a cultural habit, and it can carry real respect for family and tradition.

It may be more than a custom when:

• seeing or hearing the number brings on a rush of fear or panic
• you go to great lengths to avoid it, even when that costs you a good job, home, or opportunity
• you worry for days before a date with a 4 in it
• the fear has lasted for months and keeps getting in the way of daily life

Clinicians describe a specific phobia as fear that’s much stronger than the danger calls for and that leads to avoidance or a lot of distress. APA Dictionary of Psychology Our fear versus phobia guide goes through that line in more detail.

What can it feel like?

Here’s a made-up example. Imagine you’re offered a new apartment that you love. Then you see the unit number: 404. Your stomach drops. You picture the number every time you’d come home. You know it’s only a number, but the bad feeling won’t fade, and you turn the place down. Later, you notice you’ve started checking receipts, seat numbers, and calendar dates for 4s.

Some people describe:

• a sense of dread or bad luck when the number appears
• checking or counting to avoid it
• feeling they must “undo” it, such as by changing a seat or a time
• relief only once the number is out of sight

Checking and undoing can overlap with obsessive-compulsive patterns, which are different from a phobia. A professional can help sort out which fits.

Why might it happen?

Tetraphobia has a clear cultural root: the sound of the word. That’s different from most phobias, which often have no single starting point. Still, culture alone doesn’t explain why one person shrugs and another feels real fear.

Many phobias can be linked to a frightening event or a stressful time, and it’s possible to learn a fear from family or friends. NHS: Phobias Anxiety in close relatives is another known risk factor. NIMH For the number 4, that might mean growing up with relatives who took it very seriously, or linking the number to a loss in the family. Those are possibilities, not findings. Nobody has studied tetraphobia as a clinical fear.

What can help?

Respecting a cultural custom doesn’t need treating. If the fear itself is causing distress or costing you things you care about, talking therapies such as cognitive behavioral therapy (CBT) can help. NHS: Phobias treatment Exposure therapy, a CBT method, helps people slowly return to things they’ve been avoiding. NIMH

A good therapist will take your background seriously. You can keep a family tradition and still work on the fear, so a number stops making your decisions for you.

Things you might try on your own:

• notice what you expect to happen when you see a 4, and write it down
• slow your breathing when the feeling rises
• talk to family about where the belief came from and how they handle it

Don’t force yourself into situations that feel overwhelming. Gradual, chosen steps work better than throwing yourself in.

Helping someone who avoids the number 4

If someone you know avoids the number, the kind thing is usually to go along with it. Swapping a table number or a meeting date costs you very little. Don’t tease them or push the “it’s only a superstition” line. If their avoidance seems to be causing real distress, ask gently how it’s affecting them. Our guide on supporting someone with a phobia has more ideas.

When to talk to a professional

If fear of the number 4 has lasted for months and is affecting where you’re willing to live or work, a doctor or therapist can help. You don’t need to use the word “tetraphobia.” Describe what happens and what it’s costing you. Our appointment preparation tool can help you get your thoughts in order, and our find help page lists places to start.

If you’re curious about the Western cousin of this superstition, read our page on triskaidekaphobia, the fear of 13.