Claustrophobia – pathological fear of the closed spaces. Can arise in any closed rooms: elevators, the closed rooms, shower cabins, fitting rooms, a compartment of the train etc. It is shown by fear, increase of breath and heartbeat, dizziness, nausea, muscular weakness, strengthening of sweating and the expressed requirement to immediately leave the room, despite of circumstances. Results from processing of former traumatic experience and formation of accurate association between sense of danger and limited space. It is diagnosed on the basis of complaints of the patient and the clinical record. Treatment – psychotherapy, sometimes against the background of medicinal therapy.
Claustrophobia – insuperable fear of stay in the closed space. Along with fear of open spaces (agoraphobia), heights (arophobia), depths (batofobiy) and darkness (niktofobiy) enters into group of spatial phobias. Is among widespread phobias. According to the western researchers, heavy claustrophobia suffers from 3 to 7% of the population, however only a small part of patients sees doctors. Claustrophobia usually begins at young age, to a thicket comes to light at women. Expressiveness of claustrophobia can strongly differ – from slight alarm at hit to the enclosed space to utter impossibility to use elevators, to be in the small closed rooms, etc. Treatment of claustrophobia is performed by experts in the field of clinical psychology and psychotherapy.
Claustrophobia develops as a result of interaction of several factors. The fear of death caused by earlier necessary, and nowadays lost the relevance ways of response of an organism to changes of the external environment is the cornerstone of frustration. Our ancestors lived in much more dangerous world, once ability to quickly leave open space or to escape from a trap to avoid a meeting with the enemy or a predator, was an indispensable condition of survival. Today we are trapped absolutely by other dangers, however the human body did not manage to be reconstructed yet therefore reacts as reacted during the millennia, connecting the alarm and fear caused absolutely by other circumstances with the closed or open space.
Psychologists consider that a part in development of claustrophobia is played by the volume of personal space (the certain invisible "buffer zone" existing at each person at penetration into which there is an expressed discomfort). The more personal space – the is higher probability of developing of claustrophobia. However experts assign the main role in formation of pathological fear to the injuring situations taking place at children's age.
The psychological trauma can arise if the child was punished, standing in the corner or closing in the small room (a bathroom, a toilet, a temnushka); if the kid during the game or a cruel entertainment of peers was locked in a case, the cellar or a closet; if the child was lost and long was in the crowded place without parents and so forth. The most significant are the acts of aggression or violence happening in the closed space: beatings and threats of parents or other children, sexual harassments. The fear is fixed in similar circumstances and then even many years later emerges in any similar situations.
Experts also note that claustrophobia quite often comes to light at several generations of one family. It is caused as similar features of character and the mental organization of close relatives, and a peculiar induction – the parents feeling fear of the closed space, the behavior and emotional reactions involuntarily transfer to children the message "here dangerously". The child is not able to estimate critically behavior of the parent, he just accepts this message and does it by a part of the life.
Attacks of claustrophobia develop in the closed spaces: elevators, closets, cellars, fitting rooms, shower cabins, narrow corridors, compartment of the train, interiors of cars, devices MRT etc. At the same time klaustrofoba, as a rule, most heavier transfer stay in close rooms with small windows or absolutely without them. The alarm also quite often arises if the patient having claustrophobia is forced to remain long time in any place and cannot imperceptibly leave it. Are among similar situations standing in long turns, stay in a chair at the hairdresser or at the stomatologist.
At hit to frightening places sick claustrophobia feels strong concern and fear of restriction of freedom of action (a trap, it is impossible to escape). Many patients are afraid that indoors there will not be enough oxygen for breath. A characteristic symptom is the feeling of loss of control over own behavior. It seems to the patient with claustrophobia that the world blurs and loses clearness, and he is not self-controlled any more, can faint, die, do himself harm, in some inadmissible way to show the weakness and helplessness.
Actually, violations of perception of and surrounding reality are caused by change of activity central and the autonomic nervous system. The brain of the patient with claustrophobia regards a situation as it potentially dangerous, posing threat for life, and sends signals to the autonomic nervous system, transferring an organism to a particular treatment – the mode "fight or get away" which got to us from our far ancestors. Adrenal glands throw out a high dose of adrenaline. Breath and heartbeat become frequent to provide rough physical activity.
Blood casts from a stomach and intestines (the main thing at present – survival, but not digestion of food) and arrives to muscles. Glands located in all departments of a digestive tract including – salivary, begin to allocate less secret. The brain "eliminates" unnecessary information and concentrates on danger signals. But danger signals from the outside world are absent, everything that feels sick claustrophobia – changes of work of the body. He concentrates on these changes, distinctly feels how heart fights as it presses a breast from the strengthened work of respiratory muscles as dins in the ears and the head from excess of oxygen as dries in a mouth because of reduction of secretion of salivary glands as the stomach clenches is turned and muscles of intense hands and legs shake.
The brain ready it is negative to treat any unusual signals, considers changes in work of an organism as a sign of serious threat and transforms this alleged danger to the installation "with me something is serious not as it should be, I will die now". This thought increases alarm and fear of the patient with claustrophobia even more and stimulates adrenal glands to further emission of adrenaline. If the patient having claustrophobia does not manage to leave the enclosed space, in its organism there is a vegetative storm. The panic attack develops.
After a while sick claustrophobia begins with any way to avoid hit in frightening situations to prevent development of the next panic attack. The fear of the enclosed space is fixed. In the subsequent the panic attacks, as a rule, disappear, but not because claustrophobia passed but because the patient learned to plan the life in a special way, having excluded from it elevators, close corridors and other similar rooms. If the patient with claustrophobia has to visit the office located on the top floors of the multystoried building he learns in advance whether it is possible to use a ladder if the distant trip is necessary – chooses the transport causing less than unpleasant feelings.
In hard cases such behavior seriously limits life of the patient having claustrophobia. He can refuse well paid work because it is connected with stay in close rooms, to cease to travel etc. One more characteristic symptom of claustrophobia (as well as other phobias) is the fear of expectation. If sick claustrophobia knows that after a while it should appear in the closed space, he begins to be anxious in advance and tests all listed above vegetative symptoms, even without meeting a frightening situation in reality.
Diagnosis of claustrophobia
In most cases diagnosis of claustrophobia does not represent difficulties. The diagnosis is exposed on the basis of complaints of the patient and data obtained when holding special poll. In some cases the symptoms reminding claustrophobia can be caused by an endocrine, neurologic or somatic disease. At suspicion of organic pathology of patients direct to consultations to general practitioners: to therapists, endocrinologists, cardiologists, neurologists and other experts.
The differential diagnosis of claustrophobia is carried out with neurosis of fear and nonsense at schizophrenia. At fear neurosis the alarm is not connected with a certain situation, is empty and has an unstable plot. Duration of a disease makes no more than half a year. At claustrophobia the alarm arises in a certain psychoinjuring situations or waiting for such situations. The fear has an accurate plot which practically does not change eventually, but can become more widespread, include more situations, than earlier. The disease has continuous or recidivous character and lasts for many months or years. At nonsense the patient is firmly convinced in reality of the fears, the criticism is lowered or is absent. At claustrophobia of the patient accurately realizes that his fears have under themselves no real reasons.
Treatment of claustrophobia
Treatment of claustrophobia is usually performed in out-patient conditions and includes training in technicians of a relaxation, psychotherapy and medicinal therapy. The patient having claustrophobia is told about the reasons and mechanisms of development of vegetative reactions – it does not save from fear, but gives the chance to find confidence in safety of an attack for life and creates a basis for training in skills of self-control. The patient with claustrophobia is trained in simple methods of derivation, switching, control over breath and so forth. The most famous technicians helping to reduce the level of alarm and to prevent development of the panic attack at hit in a frightening situation are an elastic band on a wrist (at sharp click pain distracts from alarm and interrupts the beginning panic), tension of muscles with their subsequent relaxation and increase in duration of an exhalation.
The most effective psychotherapeutic method of treatment of claustrophobia is cognitive and behavioural therapy. The psychotherapist helps the patient to reveal the pathological schemes of thinking becoming the reason of development of alarm and fear and to create instead of these schemes others, more adaptive. Sick claustrophobia learns to block negative thoughts and to replace them positive. After study of a psychological basis of claustrophobia gradual immersion of the patient in frightening situations begins. Sick claustrophobia (in the beginning – with assistance of the doctor, and then independently) enters close rooms, gets into the elevator, etc. Cognitive and behavioural therapy is a short-term technique, duration of a course of treatment usually makes no more than 12 weeks.
In some cases the good effect is reached when using hypnosis and the technician of the NLP (work with the image of frightening situations on the screen which the patient represents in the imagination). In the presence of severe children's psychological injuries and the long internal conflicts long-term therapy (gestalt therapy, classical psychoanalysis, psychoanalytic psychotherapy and other similar techniques) which in itself does not save from a phobia can be required, but allows to solve the problems which are its cornerstone. At the expressed concern, the accompanying generalized disturbing frustration, a depression and a subdepression the psychotherapy is carried out against the background of medicamentous support. Use tranquilizers and antidepressants.
The forecast at claustrophobia
The forecast at claustrophobia depends on duration and disease severity, and also on readiness of the patient for active consecutive work on overcoming own fears. At exact observance of recommendations of the doctor and regular performance of independent tasks in most cases it is possible to achieve long remission, however in hard cases restoration can be incomplete. It is necessary to lead a healthy lifestyle, to observe a work-rest schedule, and at renewal of fears, strengthening of uneasiness or stay in stressful situations to ask for the help the psychologist or the psychotherapist.