Claustrophobia
Claustrophobia is the intense and uncontrollable fear or panic of being in closed or limited spaces (DSM-V, 2013), it is a specific phobia within disorders of anxiety.
Being a fear of closed spaces, those who suffer from it tend to avoid elevators, tunnels, airplanes, small rooms, the use of medical diagnostic techniques such as computerized axial tomography or magnetic resonance imaging, etc.. And it is that the claustrophobic person is not afraid of the closed space itself, but of the possible negative consequences of being in that place, such as being locked up forever or suffocation because they believe that there is not enough air in that place.
Most small, enclosed spaces pose a risk of being locked in, such as in an elevator, and limiting movement, so people with claustrophobia can feel very vulnerable when movement is restricted in this way.
When a claustrophobic person anticipates entering or enters an enclosed space, they experience an intense anxiety reaction such as shortness of breath, rapid heartbeat, or dizziness. Due to these symptoms, enclosed spaces are normally avoided. For example, taking the stairs of twelve floors before using the elevator, refusing to have a CT scan, it is not considered to use the train or the subway or public transport in general since these, by definition, would be included in agoraphobia. As in other specific phobias, the anxiety response decreases considerably when the person leaves the closed place.
Etymology
This term was coined by the Italian clinical psychiatry professor Andrea Verga and introduced and popularized in France by the neurologist Benjamin Ball in his work De la claustrofobia (Société Médico-psychologique, 1879), and is made up of the Latin claustrum '[closed] place' and the Greek suffix -φόβος -phóbos 'phobia, fear'; In Spanish it comes through the French claustrophobie, and this from the Italian claustrofobia.
A person who is claustrophobic is either "claustrophobic, -ba" or "claustrophobic, -ca", although the latter is much more widely used.
Epidemiology
A study indicates that between 5% and 7% of the world's population suffers from severe claustrophobia, but only a small percentage of them receive treatment for the disorder. Likewise, it is estimated that between 8% and 6% of the general population suffers from claustrophobia, generally caused by having lived an unpleasant experience in a closed space (such as being locked in an elevator). However, the fear of closed spaces can also be acquired indirectly, by receiving information about unpleasant experiences in closed spaces or seeing someone go through an experience of this type, it should be noted that those people who suffer from this mental disorder should avoid spaces closed, since once this disorder begins it is difficult to control the person, since they begin to despair. There are different degrees of claustrophobia, in the sense that not all people suffer from it the same, and that some do not get as upset.
Causes
Cerebral tonsil
The cerebral amygdala is one of the smallest structures in the human brain, but by far one of the most powerful. The amygdala conditions fear or reason for the fight or flight response. Some studies showed that the brain structure responsible for the response to fear, the so-called cerebral amygdala, was smaller in patients with phobia, causing exaggerated reactions to fearful situations.
Classical Conditioning
Claustrophobia develops when confined spaces are psychologically synonymous with imminent danger. It is the consequence of a traumatic experience lived during childhood, although the symptoms can appear at any time in an individual's life. Such an experience can occur once or several times to mark the spirit. Most claustrophobes, participants in a study conducted by Swedish clinical psychologist Lars-Göran Öst, reported that their phobia had "developed during conditioning." In most cases, claustrophobia seems to be the result of a past experience.
The term "past experience," according to one author, can be extended to the moment of birth. In John A. Speyrer's Claustrophobia and the Fear of Death and Dying, the reader concludes that the high frequency of claustrophobia is due to birth trauma, which he says is “ one of the most horrendous experiences that we can have during our life and all our lives”, and it is in this moment of helplessness that the baby develops claustrophobia.
Conditioning experiences
Some examples of common experiences that could trigger claustrophobia in children (or adults) include:
- A child (or, less often, an adult) is locked in a dark room and cannot find the door or the light switch.
- A child is locked in a box.
- A child is locked in a closet.
- A child falls into a deep pool and can't swim.
- A child is separated from his parents in a large crowd and lost.
- A boy sticks his head between the bars of a fence and then he can't go out again.
- A child gets in a hole and gets stuck or can't find the way back.
- A child is left in the car, truck or truck of his parents.
- A child is in a crowded area without windows (a classroom, basement, etc.) and has stools with other people, or put it there as a means of punishment.
Prepared Phobia
There is research to suggest that claustrophobia is not entirely an acquired or classically conditioned phobia. It is not necessarily an innate fear, but rather what is called a "prepared phobia." According to Erin Gersley in her book Phobias: Causes and Treatments, humans are genetically predisposed to fear. Claustrophobia could fall into this category, among other things, because of its "wide distribution...early onset and apparent easy acquisition, and its noncognitive features." The acquisition of claustrophobia may be part of a vestigial evolutionary survival mechanism, a latent fear of entrapment or suffocation that was once important to humanity's survival and could easily be awakened at any time. Hostile environments in the past would have necessitated this type of preprogrammed fear, so the human mind developed the ability for "efficient fear conditioning to certain classes of dangerous stimuli".
Stanley Rachman provides an argument for this theory in his article Phobias. He agrees with the statement that phobias generally refer to objects that pose a direct threat to human survival, and that many of these phobias are rapidly acquired due to "inherited biological preparation." This causes a prepared phobia, which is not entirely inborn, but is widely and easily learned. As Rachman explains in the article: "The main characteristics of primed phobias are that they are very easily acquired, selective, stable, biologically significant, and probably [non-cognitive]." "Targeted" 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 in the mind of a human being.
Symptoms
Claustrophobia is classified as a mental and behavioral disorder, specifically an anxiety disorder. Symptoms usually develop during childhood or adolescence. Claustrophobia is generally believed to have one key symptom: the fear of suffocation. In at least one, if not more, of the following areas: small rooms, MRI or CT scanners, cars, buses, airplanes, trains, tunnels, basements, elevators, and caves.
Being locked in or thinking about being locked in a confined space can trigger fears of not being able to breathe properly and running out of oxygen. It's not always the small space that triggers these emotions, but rather the fear of the possibilities of what could happen while confined to that area. When anxiety levels start to reach a certain level, the person may begin to experience:
- Sensation of lack of air
- Sweating
- Accelerated beats
- Lack of breath or hyperventilation
- Pain in the chest
- Tremors
- Dumbness or fainting
- Nausea
- Mare
- Sensation of having turkey, terror, panic
Other signs of claustrophobia include: Automatically and compulsively searching for exits when in a room or feeling fearful if doors are closed. Avoiding elevators, getting on subways or planes, or in a car when there is heavy traffic. In social situations where there are a lot of people, stay close to the exits
Experiencing any of these symptoms does not mean they are due to claustrophobia. These symptoms can be caused by other health conditions, some of them potentially dangerous.
Treatments
Psychoanalysis
Psychoanalysis is a long and expensive process, which focuses on finding out the root causes of the phobia, usually associated with a trauma or deeply unpleasant event that happened in childhood. The results of this type of therapy are under discussion, although its success has been proven on numerous occasions in phobic disorders that have not disappeared using other types of psychotherapy.
The most common type of treatment for claustrophobia involves mental health counseling aimed at overcoming fear and managing triggers. The different types of strategies include:
Cognitive Behavioral Therapy
Cognitive-behavioral therapy (CBT) is a strategy that involves learning to modify the thoughts and behaviors that are activated when the person faces a situation that causes fear and anxiety. Furthermore, it is a widely accepted form of treatment for most anxiety disorders. It is also believed to be particularly effective in combating disorders in which the patient is not actually afraid of a situation, but fears what might result from being in such a situation. The ultimate goal of therapy is to change distorted thoughts or misconceptions associated with what is feared; the theory is that modifying these thoughts will decrease anxiety and avoid certain situations. For example, cognitive behavioral therapy would try to convince a claustrophobic patient that elevators are not dangerous, but are in fact very helpful in getting them where they would like to go faster. A study conducted by Stanley Rachman shows that cognitive-behavioral therapy decreased fear and negative thoughts.
In vivo or gradual progressive exposure
In vivo exposure is a method that forces patients to face their fears by fully exposing them to whatever fear they are experiencing. This is usually done in a progressive manner starting with minor exposures and working up to severe exposures. For example, a claustrophobic patient would start by taking an elevator and continue with an MRI. Several studies have shown this to be an effective method for overcoming various phobias, including claustrophobia. Stanley Rachman also tested the effectiveness of this method in treating claustrophobia and found that it decreased fear and negative thoughts by an average of almost 75% in his patients. Of the methods he tested in this particular study, this was by far the most significant reduction.
Similarly, when in vivo exposure is not available or possible, virtual reality confrontation methods are also recommended.
Interoceptive exposure
Interoceptive exposure is a method that attempts to recreate internal physical sensations within a patient in a controlled environment and is a less intense version of in vivo exposure. This was the last treatment method tested by Stanley Rachman in his 1992 study. Reduced fear and negative thoughts by approximately 25%. These numbers did not quite match those for in vivo exposure or cognitive behavioral therapy, but still resulted in significant reductions.
Psychopharmacological treatment
This type of treatment is only used in the most serious cases together with psychological treatment.
Other types of treatments
Other forms of treatment that have also been shown to be reasonably effective include psychoeducation, counterconditioning, regressive hypnotherapy, and breath retraining. Medications that are often prescribed to help treat claustrophobia include antidepressants and beta-blockers, which help alleviate heartbeat symptoms often associated with anxiety attacks. Also relaxation and visualization techniques designed to calm fear when in a claustrophobic environment.
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