What is Claustrophobia?

Approximately 10 million people in the UK have a type of phobia. Phobias can affect people of all ages and demographics and can be debilitating to the individual.

Claustrophobia is one of the most well-known and commonly occurring phobias, with approximately 6.7 million people in the UK experiencing claustrophobia at some point in their lifetime.

Today, we will look at claustrophobia in more detail, including common triggers and symptoms and possible treatments.

What is claustrophobia?

Claustrophobia is a type of anxiety disorder that causes an irrational and intense fear of confined or crowded spaces. The symptoms of claustrophobia may manifest in many different types of confined spaces, or it could be specific confined spaces that trigger your claustrophobia.

It can be rational to be afraid of confined spaces if there is a genuine threat or danger, for example, if you become trapped. However, a person experiencing claustrophobia will feel extreme fear or anxiety, even when there is no real threat or danger.

Claustrophobia is a type of phobia. To be characterised as a phobia, it must be an overwhelming and debilitating fear with an exaggerated or unrealistic sense of danger. Phobias are usually severe and can have a significant impact on a person’s day-to-day life.

While many people avoid objects, places or situations that make them uncomfortable or fearful, people experiencing a phobia may find that they avoid (or fear) their triggers so drastically that it negatively affects their day-to-day life and their overall wellbeing. The symptoms of a phobia are severe and intense, and usually irrational.

Symptoms of claustrophobia can range from mild to severe. In some people, claustrophobia interferes with their ability to carry out daily activities, negatively affects their professional, personal and social lives and impacts their mental health. Claustrophobia can be particularly harmful if it interferes with a person’s ability to function in their everyday life.

People who experience claustrophobia may feel anxious just thinking about a confined space. They may purposely avoid places and situations where they may encounter a closed or crowded space. However, avoiding confined spaces may reinforce the phobia and worsen the symptoms in the future.

The fears often related to claustrophobia can include fears of being unable to breathe, running out of oxygen or suffocating, and the fear of being buried alive or being trapped and unable to escape.

A person with claustrophobia may:

• Avoid any situation where they may be in a confined or crowded space.
• Obsessively check exits or remain near the exit at all times.
• Only travel or socialise during off-peak times when it is less busy.
• Use the stairs instead of the lift.
• Leave certain places or situations at the soonest possible time.

Because every person’s definition of an enclosed space is different, different situations can be triggering to different people.

How common is claustrophobia?

Claustrophobia is one of the most common types of phobia. Approximately 10% of the population in the UK is affected by claustrophobia at some point in their life. This equates to a huge 6.7 million people.

Claustrophobia is significantly more common in women, compared to men, with twice as many women compared to men being diagnosed with claustrophobia and other phobias and anxiety disorders every year.

Although people at any age can develop claustrophobia, the condition most commonly manifests in childhood and the teenage years.

Who is at risk of claustrophobia?

Although anyone can develop claustrophobia, there are certain risk factors that can increase the likelihood of you developing the condition.

This could include:

• Having a close family member with claustrophobia.
• Having another mental health condition, such as an anxiety disorder.
• If you were exposed to claustrophobia during childhood.
• Your age – claustrophobia is significantly more likely to occur before the age of 25.
• If you are naturally a more nervous or anxious person.
• If you have experienced a traumatic experience relating to a confined or crowded space.
• If you have a mutation in the GPM6A gene.
• If you have a smaller amygdala or an improperly functioning amygdala.

However, just because you have several risk factors for claustrophobia, this does not mean you will develop the condition. Many people who are considered to be at high risk never develop claustrophobia. On the contrary, people with no risk factors may begin experiencing symptoms of the condition.

How to deal with claustrophobia

You may think that the easiest way to deal with claustrophobia or manage your condition is to avoid situations or places that may trigger your symptoms. However, this may not be an effective long-term solution as it can worsen your condition and make your symptoms more severe in the future.

No matter how hard you try to avoid confined or crowded spaces, you may encounter an unavoidable situation in the future that triggers your claustrophobia.

Instead, learning coping strategies can help you to manage and alleviate your symptoms in the future.

Some ways you can deal with symptoms of claustrophobia while they are occurring include:

• Breathing slowly and deeply. Practising breathing exercises and techniques in advance can be helpful.
• Using visualisation techniques to focus on a memory or place that makes you calm or a positive outcome.
• Reminding yourself that the fear is irrational and that you are safe.
• Reminding yourself that the feeling will pass.
• Focusing on something external that will keep you calm, e.g. a clock ticking or the behaviour of another person.
• Not trying to resist the attack as this can make it worse.
• Staying in the same place until symptoms subside.

There are also some long-term strategies you can put into place to help you reduce the likelihood of claustrophobia symptoms occurring.

Some examples include:

• Practising yoga, meditation or mindfulness.
• Reducing stress in your everyday life.
• Exercising regularly and eating a healthy more balanced diet.
• Talking to someone you trust or someone who has also experienced claustrophobia.
• Joining a support group.
• Ensuring you get enough sleep.

What triggers claustrophobia?

Symptoms of claustrophobia can be triggered by different places, situations and objects in different people. Some people are only triggered by the stimulus that caused the first occurrence of claustrophobia; for example, if your first experienced claustrophobia on a train, you may feel unable to get on a train in the future. Other people are triggered by all confined or crowded spaces.

Different people define confined spaces in different ways because of the unique way people characterise their personal space. People have different definitions of their ‘near space’ which is the area of space surrounding their body that they consider their personal space.

If someone encroaches on their near space, they may feel uncomfortable or threatened. The larger a person’s ‘near space’ is, the more likely they are to experience claustrophobia. For example, if your ‘near space’ is 6ft, you are more likely to define something further away as being too close, which can result in anxiety and make you more susceptible to claustrophobia.

Although triggers can differ for different people, the most common triggers are:

• Lifts.
• Tunnels.
• Public transport, such as trains and aeroplanes.
• Public toilets.
• Crowded spaces.
• MRI or CT machines.
• Small rooms and/or rooms with no windows.
• Changing rooms in a shop.
• Revolving doors.
• Cars.
• Basements, cellars, lofts or attics.
• Car washes.
• A traffic jam.
• Caves.
• Rooms with windows that cannot open.

What are the symptoms of claustrophobia?

The symptoms of claustrophobia are usually similar to the symptoms of anxiety. The symptoms can be both physiological and psychological.

Physiological Symptoms

• Rapid heartbeat.
• Fast breathing, shortness of breath or hyperventilating.
• Nausea.
• Dizziness.
• Sweating.
• Shaking or trembling.
• Chills.
• Chest tightness or chest pains.
• Feeling dizzy, faint or lightheaded.
• Feeling confused or disorientated.
• High blood pressure.
• A dry mouth.
• A headache.
• Numbness or pins and needles.
• A sensation of choking.
• An immediate urge to use the bathroom.
• Freezing (feeling unable to move).

Psychological Symptoms

• Feelings of intense fear or panic.
• Feelings of overwhelming anxiety.
• Feeling trapped.
• Feeling a lack of control or fear of losing control.
• Feeling an intense need to escape or leave a situation.
• A sense of impending doom.
• A fear of dying.

Symptoms can differ from person to person. Symptoms can also differ in severity, and you may find that certain situations result in more severe symptoms than others.

What causes claustrophobia?

The causes of claustrophobia are still unclear. The condition can develop at any age, although it most frequently occurs in childhood or during the teenage years. The majority of people with claustrophobia develop the condition before 20 years of age.

Claustrophobia is thought to be related to a dysfunction of the amygdala, which is the part of the brain that processes fear. Neurochemicals can overstimulate your amygdala or you may have an imbalance of neurotransmitters in your brain, resulting in your body overreacting to the perceived fear.

There are many different causes of claustrophobia including:

A traumatic event

A traumatic event can cause a person to develop claustrophobia, for example:

• Being locked in a small space by accident.
• Experiencing turbulence or another scary event when on an aeroplane.
• Being on a train that becomes stuck in a tunnel.
• Being stuck in a tight or crowded space for an extended period.
• Getting stuck in a broken-down lift.
• Being crushed in a crowd or involved in a crowd surge.

Negative or distressing childhood experiences

Negative childhood experiences can have a detrimental effect on your future mental health. Experiencing a distressing childhood event can result in the individual developing claustrophobia, either during childhood or years after the event.

Examples of negative childhood experiences include:

• Being punished as a child by being locked in a cupboard or another small space.
• Being abused as a child.
• Being bullied as a child.
• Experiencing a traumatic event during childhood.
• Being separated or becoming lost in a crowded area.
• Accidentally being stuck in a confined place during childhood.

A traumatic experience relating to a confined or crowded space can affect your ability to cope with a similar situation or place in the future. You may associate the situation or place with the panic, fear or anxiety you felt during the initial event, causing your body to react as though it was dealing with a real threat or danger.

There are some other possible causes of claustrophobia:

Childhood exposure to claustrophobia

If during childhood your parent or sibling experienced claustrophobia or severe anxiety relating to confined spaces, you are more likely to develop claustrophobia yourself. This is because you are more likely to perceive confined spaces as dangerous or scary.

Genetics

Studies have found that mutations in the GPM6A gene are linked to claustrophobia. Individuals who have this mutation may have a genetic risk of developing claustrophobia.

In some cases, there is no clear point of origin of why a person develops claustrophobia.

How is claustrophobia diagnosed?

If you think you have claustrophobia, you should visit your doctor, particularly if your condition:

• Hinders your ability to function in your everyday life.
• Negatively impacts your quality of life.
• Causes you to avoid certain situations or places.
• Negatively impacts your mental health or wellbeing.

An early diagnosis can be beneficial and can help you to manage your claustrophobia more effectively. Your doctor may perform a physical exam and may ask questions relating to any previous phobias or anxiety issues.

Your doctor may also look at your family history and medical history, including any medications or supplements you take. You may also be asked about any recent life stressors or traumatic events. You may then be referred to a psychologist who can assess your symptoms and conduct a psychological evaluation.

The doctor or psychologist will want to confirm that you are experiencing a phobia, rather than a fear. They will also need to confirm that your symptoms are not connected to another medical condition, mental health condition or any medication you are taking.

The psychologist will likely ask for information about your triggers, the type of symptoms you experience and the severity of your symptoms. You will likely also be asked how often you experience symptoms and whether the symptoms affect your daily life or your relationships.

You may also be given a claustrophobia questionnaire to help you establish your triggers.

In order to achieve a diagnosis of claustrophobia, the psychologist will look at the following criteria:

• Is the fear persistent, unreasonable and excessive?
• Is the fear caused by the presence or anticipation of a particular situation, place or object?
• Is there an anxiety response when exposed to the stimulus?
• Is the individual aware that their fear is out of proportion to the threat?
• Does the individual avoid the object or situation where possible?
• Does the individual experience anxiety, fear or distress when presented with the stimulus?
• Does their fear interfere with the individual’s everyday life?
• Has the phobia persisted for a minimum of six months?
• Can the symptoms be attributed to another mental health condition? (If so, a diagnosis of claustrophobia is unlikely).

How is claustrophobia treated?

Treatment for claustrophobia will depend on the frequency and the severity of your symptoms. Most commonly, the symptoms of claustrophobia are treated with psychotherapy. Psychotherapy can help you overcome the fear, manage your triggers and reduce or relieve your symptoms. You may be offered psychotherapy in conjunction with another type of treatment.

The most common treatments for claustrophobia are:

Cognitive Behaviour Therapy (CBT)

This is the most common treatment for claustrophobia. Cognitive Behaviour Therapy is a type of talk therapy that helps you to change flawed or negative ways of thinking and patterns of behaviour. CBT can also help you to develop coping strategies to allow you to face your triggers in the future.

During your CBT sessions, you will:

• Discuss your symptoms.
• Explore your fears in more detail.
• Learn how to recognise your negative thoughts and change the way you are thinking.
• Learn coping strategies.
• Learn calming strategies.

Exposure Therapy

Also known as desensitisation therapy or interoceptive exposure therapy, this is where you are gradually exposed to your trigger. It is a common treatment for phobias as it allows you to be exposed to your phobia in a safe, controlled environment. Gradual and repeated exposure allows you to confront your fear and become more comfortable in triggering situations. It can also help you to overcome the fear altogether.

There are different types of exposure therapy, and your psychologist will create a unique plan based on your triggers and the severity of your symptoms. Exposure therapy may involve looking at pictures or using virtual reality, recalling and describing your experiences or facing your triggers in real time.

Rational Emotive Behavioural Therapy (REBT)

This is a type of Cognitive Behaviour Therapy that helps you to identify irrational and negative thoughts and unhealthy attitudes, emotions and behaviours. REBT is an action-oriented approach that helps people challenge irrational beliefs and manage their thoughts, emotions and behaviours in a more realistic and healthy way.

Relaxation and Visualisation

You will be taught different relaxation and visualisation techniques to help you cope if you are ever in a triggering situation. Techniques may include mental imagery, guided imagery, deep breathing techniques, autogenic training and progressive muscle relaxation. These techniques can help you remain calm when faced with your triggers in the future.

Medication

If your symptoms are particularly severe, you may be prescribed medication, such as anti-anxiety medication and antidepressants. The medication may treat your physical symptoms, or your anxiety or panic. The medication would usually be prescribed in addition to psychotherapy, rather than as a stand-alone treatment.