Claustrophobia is a fear or anxiety of confined spaces. It is triggered by many situations or stimuli, including elevators, especially when crowded to capacity, windowless rooms, and hotel rooms with closed doors and sealed windows. Even bedrooms with a lock on the outside, small cars, and tight-necked clothing can induce a response in those with claustrophobia. It is typically classified as an anxiety disorder, which often results in panic attacks. The onset of claustrophobia has been attributed to many factors, including a reduction in the size of the amygdala, classical conditioning, or a genetic predisposition to fear small spaces.

One study indicates that anywhere from five to ten percent of the world population is affected by severe claustrophobia, but only a small percentage of these people receive some kind of treatment for the disorder.

The term claustrophobia comes from Latin claustrum "a shut in place" and Greek ', phóbos, "fear".

Signs and symptoms

Claustrophobia is classified, as an anxiety disorder. Symptoms generally develop during childhood or adolescence. is one of the smallest structures in the brain, but also one of the most powerful. The amygdala is needed for the conditioning of fear, or the creation of a fight-or-flight response. A fight-or-flight response is created when a stimulus is associated with a grievous situation. Cheng believes that a phobia's roots are in this fight-or-flight response.

In generating a fight-or-flight response, the amygdala acts in the following way: The amygdala's anterior nuclei associated with fear each other. Nuclei send out impulses to other nuclei, which influence respiratory rate, physical arousal, the release of adrenaline, blood pressure, heart rate, behavioral fear response, and defensive responses, which may include freezing up. These reactions constitute an 'autonomic failure' in a panic attack.

thumb|alt=Neuron upclose|Brain [[synapse]]

A study done by Fumi Hayano found that the right amygdala was smaller in patients who suffered from panic disorders. The reduction of size occurred in a structure known as the corticomedial nuclear group which the CE nucleus belongs to. This causes interference, which in turn causes abnormal reactions to aversive stimuli in those with panic disorders. In claustrophobic people, this translates as panicking or overreacting to a situation in which the person finds themselves physically confined.

Classical conditioning

Claustrophobia results as the mind comes to connect confinement with danger. It often comes as a consequence of a traumatic childhood experience, although the onset can come at any point in an individual's life. Such an experience can occur multiple times, or only once, to make a permanent impression on the mind. The majority of claustrophobic participants in an experiment done by Lars-Göran Öst reported that their phobia had been "acquired as a result of a conditioning experience." In most cases, claustrophobia seems to be the result of past experiences.

Conditioning experiences

thumb|A war worker cleaning the inside of a naval cannon. Being enclosed in tight spaces can precipitate the development of claustrophobia.

A few examples of common experiences that could result in the onset of claustrophobia in children (or adults) are as follows:

  • A child (or, less commonly, an adult) is shut into a pitch-black room and cannot find the door or the light-switch.
  • A child gets shut into a box.
  • A child is locked in a closet.
  • A child sticks their head between the bars of a fence and then cannot get back out.
  • A child crawls into a hole and gets stuck, or cannot find their way back.
  • A child is left in their parent's car, truck, or van.

The term 'past experiences', according to one author, can extend to the moment of birth. In John A. Speyrer's "Claustrophobia and the Fear of Death and Dying", the reader is brought to the conclusion that claustrophobia's high frequency is due to birth trauma, about which he says is "one of the most horrendous experiences we can have during our lifetime", and it is in this helpless moment that the infant develops claustrophobia.

thumb|alt=GE Signa MRI|In an MRI, the patient is inserted into the tube.

Magnetic resonance imaging (MRI) can trigger claustrophobia. An MRI scan entails lying still for some time in a narrow tube. In a study involving claustrophobia and MRI, it was reported that 13% of patients experienced a panic attack during the procedure. The procedure has been linked not only to the triggering of 'preexisting' claustrophobia, but also to the onset of the condition in some people. Panic attacks experienced during the procedure can stop the person from adjusting to the situation, thereby perpetuating the fear.

thumb|alt=Miners in small spaces|The conditions inside a mine

S.J. Rachman tells of an extreme example, citing the experience of 21 miners. These miners were trapped underground for 14 days, during which six of the miners died of suffocation. After their rescue, ten of the miners were studied for ten years. All but one were greatly affected by the experience, and six developed phobias to "confining or limiting situations". The only miner who did not develop any noticeable symptoms was the one who acted as leader.

Another factor that could cause the onset of claustrophobia is "information received. This would be analogous to observing someone getting stuck in a tight space, suffocated, or any of the other examples that were listed above.

Prepared phobia

There is research that suggests that claustrophobia is not entirely a classically conditioned or learned phobia. It is not necessarily an inborn fear, but it is very likely what is called a prepared phobia. As Erin Gersley says in "Phobias: Causes and Treatments", humans are genetically predisposed to become afraid of things that are dangerous to them. Claustrophobia may fall under this category because of its "wide distribution… early onset and seeming easy acquisition, and its non-cognitive features". The acquisition of claustrophobia may be part of a vestigial evolutionary survival mechanism, Hostile environments in the past would have made this kind of pre-programmed fear necessary, and so the human mind developed the capacity for "efficient fear conditioning to certain classes of dangerous stimuli". This brings about a prepared phobia, which is not quite innate, but is widely and easily learned. As Rachman explains in the article: "The main features of prepared phobias are that they are very easily acquired, selective, stable, biologically significant, and probably [non-cognitive]." 'Selective' and 'biologically significant' mean that they only relate to things that directly threaten the health, safety, or survival of an individual. 'Non-cognitive' suggests that these fears are acquired unconsciously. Both factors point to the theory that claustrophobia is a prepared phobia that is already pre-programmed into the mind of a human being.

Diagnosis

Claustrophobia is the fear of being closed into a small space. It is typically classified as an anxiety disorder and often results in a rather severe panic attack. It is also sometimes confused with cleithrophobia (an irrational fear of being trapped).

Diagnosis of claustrophobia usually transpires from a consultation about other anxiety-related conditions. Certain criteria have to be met to be diagnosed with specific phobias. These criteria include:

  • an interminable obstructive or excessive fear caused by the existence or anticipation of a specific situation
  • anxiety response when stimulus is exhibited; can result in panic attacks in adults or, for children, an outburst, clinging, crying, etc.
  • acknowledgment by adult patients that their fear stems from the anticipated threat or danger
  • engaging in procedures to evade dreaded object or situation, or proneness to face the situation but with discomfort or anxiety
  • the person's evasion of the object or situation impedes with everyday life and relationships
  • the phobia is continuous, usually for 6 months or longer
  • symptoms cannot be ascribed to other underlying mental conditions, such as obsessive-compulsive disorder (OCD) or post-traumatic stress disorder (PTSD)

Scale

This method was developed in 1979 by interpreting the files of patients diagnosed with claustrophobia and by reading various scientific articles about the diagnosis of the disorder. Once an initial scale was developed, it was tested and sharpened by several experts in the field. Today, it consists of 20 questions that determine anxiety levels and desire to avoid certain situations. Several studies have proved this scale to be effective in claustrophobia diagnosis.

Questionnaire

This method was developed by Rachman and Taylor, two experts in the field, in 1993. This method is effective in distinguishing symptoms stemming from fear of suffocation. In 2001, it was modified from 36 to 24 items by another group of field experts. This study has also been proven very effective by various studies. It is also thought to be particularly effective in combating disorders where the patient doesn't actually fear a situation but, rather, fears what could result from being in such a situation.

In vivo exposure

This method forces patients to face their fears by complete exposure to whatever fear they are experiencing. In fact, estimates say that anywhere from 4–20% of patients refuse to go through with the scan for precisely this reason. One study estimates that this percentage could be as high as 37% of all MRI recipients.

Another case study investigated the effectiveness of virtual reality subjection in the case of a patient who was diagnosed with two particular phobias (claustrophobia and storms). Participant met DSM-IV criteria for two specific phobias, situational type (claustrophobia) and natural environment type (storms). She suffered from fear of closed spaces, such as buses, elevators, crowds, and planes, which began after a crowd trampled her in a shopping mall 12 years prior. In response to this event, she developed the specific phobia, natural environment type (storms) because the cause of the stampede was the racket of a big storm. Participant was assigned to two individual VR environments to distinguish the levels of difficulty in a "claustrophobic" environment, with one setting being a house and the other being an elevator. There was a total of eight sessions that were carried out over the span of 30 days, with each session lasting between 35 and 45 minutes. The results from this treatment proved to be successful in reducing the fear of enclosed spaces and additionally improved over the course of 3 months.

Separating the fear of restriction and fear of suffocation

Many experts who have studied claustrophobia claim that it consists of two separable components: fear of suffocation and fear of restriction. In an effort to fully prove this assertion, a study was conducted by three experts in order to clearly prove a difference. The study was conducted by issuing a questionnaire to 78 patients who received MRIs.

The data was compiled into a "fear scale" of sorts with separate subscales for suffocation and confinement. Theoretically, these subscales would be different if the contributing factors are indeed separate. The study was successful in proving that the symptoms are separate. Therefore, according to this study, in order to effectively combat claustrophobia, it is necessary to attack both of these underlying causes.

However, because this study only applied to people who were able to finish their MRI, those who were unable to complete the MRI were not included in the study. It is likely that many of these people dropped out because of a severe case of claustrophobia. Therefore, the absence of those who suffer the most from claustrophobia could have skewed these statistics.

Probability ratings in claustrophobic patients and non-claustrophobics

This study was conducted on 98 people, 49 diagnosed claustrophobics and 49 "community controls" to find out if claustrophobics' minds are distorted by "anxiety-arousing" events (i.e., claustrophobic events) to the point that they believe those events are more likely to happen. Each person was given three events—a claustrophobic event, a generally negative event, and a generally positive event—and asked to rate how likely it was that this event would happen to them. As expected, the diagnosed claustrophobics gave the claustrophobic events a significantly higher likelihood of occurring than did the control group. There was no noticeable difference in either the positive or negative events. However, this study is also potentially flawed because the claustrophobic people had already been diagnosed. Diagnosis of the disorder could likely bias one's belief that claustrophobic events are more likely to occur to them.

See also

  • Agoraphobia
  • Anxiety disorder
  • List of phobias
  • Panic attack
  • Premature burial

References

Bibliography

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  • Fritscher, Lisa. "Claustrophobia: Fear of Enclosed Spaces ". About.com. New York Times Company. 21 September 2009. Web. 9 September 2010.
  • Gersley, Erin. "Phobias: Causes and Treatments ". AllPsych Journal. AllPsych Online. 17 November 2001. Web. 18 September 2010.
  • Hayano, Fumi PhD., et al. "Smaller Amygdala Is Associated With Anxiety in Patients With Panic Disorder". Psychiatry and Clinical Neurosciences. Vol. 63, Issue 3. Japanese Society of Psychiatry and Neurology 14 May 2009.
  • Öst, Lars-Göran. "The Claustrophobia Scale: A Psychometric Evaluation". Behaviour Research and Therapy 45.5 (2007): 1053–64.
  • Rachman, S.J. "Claustrophobia", in Phobias: A Handbook of Theory, Research, and Treatment. John Wiley and Sons, Ltd. Baffins Lane, Chichester, West Sussex, England. 1997.
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  • Thorpe, Susan, Salkovis, Paul M., & Dittner, Antonia. "Claustrophobia in MRI: the Role of Cognitions". Magnetic Resonance Imaging. Vol. 26, Issue 8. 3 June 2008.
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