How common is claustrophobia

Claustrophobia (fear of space)

ICD-10-GM-2020 F40.01

What is a phobia?

“Phobos” is Greek for fear. Often used as a suffix in medicine, “phobia” describes a persistent exaggerated response to certain stimuli or expectations in the form of an anxiety disorder. As a result, the situation associated with the phobia is avoided with extraordinary effort. Although phobias are mental illnesses, there can also be physical symptoms, such as fainting spells.
Phobias rarely come alone. Around three quarters of all those with phobias suffer from more than one anxiety disorder. Claustrophobia is a specific (isolated) phobia, i.e. an inappropriate fear of a certain thing. Very many people suffer from at least one specific phobia, such as arachnophobia, the fear of spiders.

What does medicine understand by claustrophobia?

Claustrophobia is a specific anxiety disorder that is defined as a fear of being locked in (or feeling locked in), of long stays in narrow, enclosed spaces or in large crowds. The colloquial expression “claustrophobia” is used more medically for agoraphobia. Agoraphobia is a common comorbidity of claustrophobia and is often used as an umbrella term.

What are the symptoms of claustrophobia?

Like all phobias, claustrophobia manifests itself in an inappropriately strong feeling of fear when confronted with the fearful stimulus - in this case, narrow, enclosed spaces. If you are affected by claustrophobia, you will probably notice an emerging fear, possibly even panic about not getting out of a room or that you might run out of air - both forms occur.
Although those affected often know that nothing bad can happen to them, they usually fail to control the fear. In extreme cases, the claustrophobia manifests itself in a panic attack, in which the body is put into an alarm state: You may then feel that your heart starts racing, you get sweats and shortness of breath and possibly hyperventilate.
This extreme fear reaction often comes unexpectedly - apparently out of the blue - and is not only stressful for those affected per se, but is also perceived as a health hazard. Because the symptoms are often mutually reinforcing and aggravate the psychological and physical suffering. The panic attacks can be so severe that they terrify the person.
There are also minor symptoms that do not have to be associated with a particular fear. These are a high pulse, difficulty breathing, sweating or stomach problems.

How are claustrophobia and panic disorder related?

Panic disorder is also an anxiety disorder. The anxiety disorders claustrophobia and panic disorder often occur together. The latter are anxiety attacks for no apparent reason. In panic disorder, this leads to panic attacks. But there are also weakened, sometimes isolated symptoms that are similar to the physical reaction of claustrophobia such as hyperventilation, feelings of suffocation, sweats and a racing heart.
If the reason for the panic attack is the fear of being tight or locked in, then both mental illnesses are related. However, the claustrophobia does not have to lead to a panic disorder and the panic disorder can also have other or no known causes.

What is the difference between claustrophobia and agoraphobia?

The two anxiety disorders share many symptoms and often come together. Claustrophobia is often seen as a sub-form of agoraphobia. Agoraphobia describes the fear of certain places or panic attacks in certain places. This can be crowds in wide, open spaces or even narrow, closed spaces. The two phobias have in common the fear of losing control and avoiding the corresponding places, but also avoiding the fears themselves.

What is the course of a claustrophobia?

Claustrophobia begins most harmlessly. For example, as the person affected, you begin to avoid certain unpleasant situations, perhaps unconsciously at first. This self-protection often aggravates the illness: By fear of certain situations and places you restrict yourself further and out of concern that you only have to think about certain situations, everyday life becomes more and more limited and your own radius of action becomes smaller. This can result in self-reinforcing isolation.
However, the clinical picture does not always have to worsen. Quite a few people with claustrophobia avoid the fearful situation, which means that they do not feel restricted in their everyday life and therefore do not need any therapy.

What are the causes of claustrophobia?

The root cause research is not sure what could be causing the claustrophobia. One possible cause is genetic predisposition. However, there are different speculated reasons and many risk factors. Traumatic experiences in the past of a person affected can be a possible trigger.
For example, if you were locked up at school as a punishment or by classmates or pushed into tight corners, this can be the trigger for the anxiety disorder that emerges later. But traumas such as separations or losses can also be considered. This could be, for example, an elevator accident or the death of a loved one. It is still unclear why such events cause mental disorders in some people and not in others.
If the event is in the recent past, a traumatic cause cannot be so clearly separated from a psychological cause. Psychological causes also come into consideration: Mental overstrain increases the risk of developing the anxiety disorder. For example, one can feel visually restricted by pressure to perform or in human relationships, which is then expressed subconsciously in this real fear of tight situations.
After all, there does not always have to be a trigger, in some cases the claustrophobia develops insidiously without a specific experience or psychological state being able to be identified as the cause. Finding the cause and treating it is particularly difficult here.

Who is most likely to be affected by claustrophobia?

According to scientific studies, claustrophobia is very widespread: up to a tenth of all people suffer from a more or less severe form of it. Overall, women are affected twice as often as men.

When should I see a doctor if I have claustrophobia?

While the disease is quite widespread in the population, it is not absolutely necessary for most people to seek treatment, as claustrophobia only occurs in very special situations and has no impact on the person's daily life.
However, claustrophobia can also reach a level that requires treatment. This is achieved as soon as the claustrophobia massively intervenes in everyday life, behavior and life - for example, the regular keeping of appointments, disrupts social life or work. Basically, the earlier the disorder is treated, the better it can be brought under control and the fewer comorbidities and psychological stresses develop.

How does the doctor diagnose claustrophobia?

Symptoms and their duration are decisive for the diagnosis. First the anxiety disorder itself is diagnosed and the specific anxiety disorder is diagnosed based on the exact symptoms and in which situations they occur. The difference between anxiety and the anxiety disorder is that the anxiety disorder affects life and the person concerned has to adapt their life to it.
The first point of contact in the case of irrational fears can be your family doctor, who first tries to rule out physical causes. For example, he can record your blood values, examine your thyroid with an ultrasound or create an EKG. The MRI scan of your brain is also part of the repertoire in order to cover possible physical causes for the anxiety states, but it is particularly difficult for patients with claustrophobia. If there is no physical cause that explains your symptoms, the doctor will probably refer you to a therapist.
The therapist can use a claustrophobia questionnaire to get a better idea of ​​your disorder. This questionnaire lists various questions about symptoms of the disorder. In addition, the therapist can also check whether there are comorbidities, i.e. other mental illnesses such as depression.

How can claustrophobia be treated?

Exposure therapy along with behavior therapy is the most effective way to treat claustrophobia. Psychotherapy can usually bring this form of anxiety disorder very well under control, and sometimes even cure it completely. There are various therapies that can help you, the sufferer, to deal with claustrophobia:
Behavioral therapy can bring a feeling of normalcy into life. This is achieved by your therapist researching and working with you on the cognitive causes of the disorder. This means that it is important to find out which thought patterns perpetuate the fears and how one can consciously detach oneself from them through training.
Confrontation training: In this therapy, the person affected not only learns to live with fear, but also to face it. You will be asked to consciously put yourself in an emotionally stressful situation. The goal is to be able to experience these situations as normal and safe again by gradually approaching the fearful stimulus. So you learn that staying in a closed or narrow space is not dangerous. This approach is also referred to as the “learning theory”.
Psychological treatment: If there are unfounded causes such as stress or traumatic experiences, these can be dealt with therapeutically in a wide variety of ways. One can also speak of the “psychoanalytic” approach if one assumes that inner conflicts are expressed in claustrophobia.
Applied relaxation is a technique in which the patient should learn to suddenly relax in fear-inducing situations. The effect is achieved by the fact that relaxation and fear are mutually exclusive. This method is based on Jacobson's progressive muscle tone.
If you are very afraid, your therapist can also prescribe medication for you. Selective serotonin reuptake inhibitors (SSRIs) are most commonly used. Benzodiazepines are available to the doctor for acute intervention because they have a calming effect. However, these may only be taken for a short time, as they can be addictive. Doctors often prescribe antidepressants for long-term therapy.

What can I do if I have claustrophobia?

If the loss of control can be prevented, it can help to consciously deal with the fear. It is important to avoid the vicious circle of avoidance strategies and loss of control.
In the case of fear of death and panic attacks or bad physical symptoms, one should face the fear with a therapist and look for a treatment option.
It is also crucial for the long-term success of the therapy that you regularly expose yourself to the once fearful situations, even after the therapy has ended, and thus give yourself the chance to experience them as "normal". Of course, feelings of fear can flare up again and again, the more often you face them, the less they have an impact.
In self-help groups you will meet people with the same or similar anxiety disorders. This form of therapy often helps those affected in a supportive way, as they can exchange ideas with like-minded people and support one another.

Does the health insurance company cover the costs for the treatment of agoraphobia?

As a rule, the health insurance company covers the costs of diagnosing and treating claustrophobia. Depending on the treatment and the specialist who performs the treatment, costs may arise that are not covered by your health insurance. For the individual services and provisions, you should obtain information from your insurance company and speak to the treating doctors, psychologists or therapists.

About the author: Dr. med. Maximilian Strenkert

Specialist in internal medicine

Dr. med Maximilian Strenkert studied medicine in Munich, Erlangen and Verona. During his specialist training as an internist at the Munich-Bogenhausen and Herrsching hospitals, he dealt with all areas of modern medicine and learned a variety of diagnostic and curative methods. He worked as an emergency doctor in Herrsching for many years. His specialties are diseases of the cardiovascular system, metabolic diseases such as diabetes mellitus (diabetes), diseases of the gastrointestinal tract, ultrasound (abdominal organs, thyroid, heart, blood vessels). He has been to Lebanon and Costa Rica several times for humanitarian purposes and does voluntary work for disabled people as a doctor.

In cooperation with the Carl-Korth-Institut Erlangen for occupational medicine, one of the leading inter-company occupational medical service providers in Germany, he has been working as a company doctor for many years. He is a member of the Association of German Internists (BDI) and the German Society for Internal Medicine, the German Society for Tropical Medicine and Global Health (DTG) and the Association of German Company and Company Doctors (VDBW).