Claustrophobia

What is claustrophobia?

Claustrophobia is a mental health condition belonging to a category called anxiety disorders. In the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5), claustrophobia is labeled as a specific phobia ^[1].

People who have specific phobias like claustrophobia experience extreme fear and anxiety when faced with the source of the phobia. In the case of claustrophobia, people become extremely anxious when thinking about what might happen to them while they are in an enclosed space. For example, they may worry about being trapped and unable to move, or they may be fearful of being unable to breathe in tight spaces [1[.

When a person lives with claustrophobia, they are likely to avoid enclosed spaces altogether, or they may place themselves in such spaces, when necessary, but experience significant anxiety. This anxiety can manifest in the form of sweaty palms, lightheadedness, increased heart rate, and difficulty breathing ^[1].

Symptoms of Claustrophobia

Claustrophobia symptoms align with the symptoms for diagnosing specific phobias, but they apply to fear of enclosed or confined spaces. Some symptoms of claustrophobia, based upon those associated with specific phobias, include the following ^[2]:

• Extreme and unreasonable fear when exposed to tight spaces, or when thinking or speaking about tight spaces
• Avoiding tight spaces as much as possible
• Immediate fear or anxiety when exposed to tight spaces
• Having a fear of running out of oxygen or being unable to breathe when confined
• Being afraid of being unable to move when in a tight space

Along with the specific symptoms related to claustrophobia, someone who is anxious as a result of exposure to confined spaces may experience ^[1]:

• Sweating and chills
• Elevated heart rate and blood pressure
• Dizziness or lightheadedness
• Dry mouth
• Hyperventilation
• Headache
• Feelings of nausea
• Numbness
• Feeling as if they are choking
• Tightness in the chest
• Difficulty breathing
• Confusion
• Strong need to urinate

Causes of Claustrophobia

There is not one specific cause of claustrophobia. Rather, experts believe that it is the result of a combination of risk factors. Some factors that increase the risk for claustrophobia include ^[1]:

• Brain function: An area of the brain called the frontal lobe is responsible for emotional regulation. Research with individuals who experience phobias has shown that the frontal lobe fails to regulate an overactive amygdala, which is responsible for the fear response.
• Genetics: Specific gene defects have been found to contribute to the development of anxiety disorders, including
• Through social learning: Claustrophobia may develop as a result of others modeling fear of confined spaces. For example, if a parent has claustrophobia, a child may develop the same fear ^[2].
• Negative experiences: Psychologists believe that some phobias may be acquired because of learned fears. For instance, if someone experiences a negative outcome from being in a confined space, they may begin to associate confined spaces with fear and anxiety ^[2]. One example might be a person who has claustrophobia because of the experience of being locked in a closet as a child.

Diagnosing Claustrophobia

A doctor or mental health clinician will diagnose claustrophobia using criteria in the DSM-5.

To determine if a diagnosis is warranted, the professional will complete a full assessment. They will ask about the nature of the person’s fear of confined spaces, including when the fear began, and how it affects their daily life.

A doctor or clinician may use a standardized scale to measure the level of anxiety and determine whether it is excessive, and that it is linked specifically to confined spaces and not a result of another stimulus ^[1].

Ultimately, a diagnosis of claustrophobia is made if a person has a fear of confined spaces and meets the following criteria ^[3]:

• Noticeable fear or anxiety in response to confined spaces
• The experience of fear or anxiety almost every time confined spaces are encountered
• Fear or anxiety that is out of proportion to the danger presented by the confined space
• Avoidance of confined spaces, or enduring great anxiety when exposed to them
• The experience of clinical levels of distress or difficulty with functioning in important areas of life, such as at work, school, or in relationships, because of the fear of confined spaces
• The fear of confined spaces lasts for at least 6 months.

Treatment for Claustrophobia

Claustrophobia is typically treated with therapy, but some people may also benefit from taking medication. Therapeutic methods and medications typically used in the treatment of claustrophobia are discussed below ^[1]:

Claustrophobia Therapies

One of the most common claustrophobia treatments is cognitive-behavioral therapy (CBT). This modality can be used to help people correct distorted thinking patterns. For instance, a fear of small spaces may arise from the distorted belief that a person will be permanently trapped.

Another helpful therapy method is interoceptive exposure therapy, in which people are exposed to the physiological sensations associated with anxiety in a safe setting, such as a counseling office. Finally, individuals with claustrophobia may benefit from using virtual reality devices, which can provide virtual exposure to enclosed spaces.

Claustrophobia Medication

Several classes of medications, which are often used to treat anxiety, can be effective for treating claustrophobia:

• Benzodiazepines: This class of anxiety medications is typically used to treat phobias in which the source of the phobia is rarely encountered. Drugs in this class include alprazolam, lorazepam, and diazepam. However, these medications can be addictive so doctors may be more cautious when prescribing them. ^[4]
• Selective serotonin reuptake inhibitors (SSRIs): SSRIs are commonly used to treat depression and anxiety, and they can be effective for treating claustrophobia. Some common drugs in this category include paroxetine and escitalopram.
• Other medications: Other medications, including hydrocortisone, have been used in the treatment of claustrophobia. Research suggests that hydrocortisone is beneficial when given in combination with CBT.

Self-Care for Claustrophobia

If you live with symptoms of claustrophobia, there are things you can do to care for yourself and manage your condition. Some helpful self care strategies include:

• Practice relaxation techniques. Learning and practicing relaxation techniques like deep breathing or progressive muscle relaxation can help you to cope with physical symptoms of anxiety when you’re faced with a trigger for claustrophobia ^[5].
• Make healthy lifestyle choices. Getting plenty of sleep, following a nutritious diet, and making time for exercise will improve your overall health and wellbeing and can reduce anxiety.
• Join a support group. Ask your doctor or mental health clinician for information about local support groups, where you can connect with others coping with similar challenges. If a support group is not available, talk with someone you trust.

Frequently Asked Questions about Claustrophobia

How common is claustrophobia?

Prevalence data show that about 7.7% of people experience claustrophobia at some point during their lives. There is a higher prevalence of specific phobias like claustrophobia in women ^[1].

How does claustrophobia impact daily life?

Claustrophobia can cause significant distress, and some people may have difficulty being successful in important areas, such as at work, because of their anxiety. Some people may avoid maintaining a social life, because they may worry about being confined to an elevator or a subway when interacting with friends in public ^[1].

While not a factor in daily life, it’s also important to note that claustrophobia may lead to extreme fear when undergoing an MRI. Individuals with claustrophobia may need to be sedated prior to such a procedure ^[1].

What’s the difference between claustrophobia and agoraphobia?

Claustrophobia and agoraphobia are both labeled as specific phobias. While there are some similarities between the two, they are distinct conditions. Claustrophobia involves a fear of small spaces, as a person may worry about being restricted or unable to breathe.

On the other hand, while agoraphobia does involve a fear of being unable to escape, people with this specific phobia tend to experience extreme fear in response to events like being away from home on their own, being unable to escape from a public space like a mall, or being in a long line ^[6].

Individuals with claustrophobia may be perfectly fine with leaving home alone, as long as they are not in a small space where they fear they will be restricted from moving or unable to breathe.