Claustrophobia: Are You A Victim?

It is dark and you are trapped. You are kneeling in very close quarters; you discover that you cannot stand up.  You extend your hands and blindly feel for the ground.  You lower yourself to your hands and knees and you begin to crawl forward toward a bit of light, hoping you are moving in the direction that'll get you out.  What are your reactions?  You are certainly and justifiably frightened.  You probably start breathing heavily and your pulse starts to race.  You may start sweating and trembling.  These are all normal reactions to being placed in a dangerous situation.   However, if you experience these symptoms or feel like you are having a heart attack just by sitting in a car, you probably have claustrophobia.  The word claustrophobia originates from the Latin word “claustrum” which means a shut in place and the Greek word “phobos” which means fear. Research has shown that approximately 6% of people suffer the disorder worldwide.  However, the majority of claustrophobics are not receiving treatment for it.

Claustrophobia is considered an anxiety disorder that typically begins in childhood. Claustrophobics have an irrational fear of having no escape or being closed-in. The National Institute of Mental Health estimates that over 19 million adults have a form of a specific phobia, including claustrophobia. Diagnostic criteria for claustrophobia include a persistent and excessive fear of a specific situation, anxiety provocation upon exposure to the situation, and avoidance of the specific situation. The Anxiety Support Center further clarifies the diagnosis that claustrophobia is the fear of restriction or suffocation because of a perceived lack of escape from a particular place or situation; it isn’t simply the fear of being in an enclosed space. It frequently results in panic attack.  People with claustrophobia will go to great lengths to avoid small spaces and situations that would trigger anxiety and panic responses.  Examples of small spaces that could trigger a claustrophobic's anxiety include elevators/lifts, basements/cellars, small or locked rooms (jail cells), airplanes, cars, trains, subways, caves, tunnels, constrictive medical procedures/tests (MRIs) and crowded areas.  Some people may even experience claustrophobia when wearing tight-necked clothing.

Symptoms of Claustrophobia

Individuals who suffer with claustrophobia experience immediate anxiety-related symptoms when exposed to their feared situation.  Claustrophobics usually know that their fears are out of proportion with the actual threat; however, their reactions are automatic and uncontrollable. The symptoms of claustrophobia are actually identical to those that occur in the fight-or-flight response to genuine danger. The associated anxiety can range from mild feelings of apprehension to dread, horror, terror, or panic. The closer a claustrophobic is to the situation, the greater their reaction will be.   

When in a small confined space, someone with claustrophobia may start to show the following symptoms: sweating, accelerated heart rate, increased blood pressure, hyperventilation, light headedness, fear of actual harm or illness, and panic attacks.   Many claustrophobics remove clothing during attacks, believing it will relieve the symptoms.  Most claustrophobics do everything in their power to avoid getting into constrictive situations.  They will take the stairs instead of an elevator or escalator, go to the store in the middle of the night to avoid check-out lines, and drive only in non-peak traffic times.  As soon as they enter a room they may urgently check out where the exits are and position themselves near them. At a crowded party they will position themselves near the door.

Causes of Claustrophobia

Claustrophobia is usually the result of an experience in an individual’s childhood.  Examples include being shut into a pitch-black room and not being able to find the door/the light-switch, falling into a deep pool without knowing how to swim, getting separated from parents in a large crowd, being left alone in a vehicle, and crawling into a hole and not being able to find a way out.  These types of situations can cause trauma at the time of the experience which can affect the child’s ability to deal with any subsequent situation rationally.   If a child observes a parent or peer’s behavior to restricted areas they may develop the same fear.  Additionally, there is also a theory that claustrophobia is a prepared phobia resulting from genetic predisposal to be afraid of things that are truly dangerous. 

Treatment of Claustrophobia

• In Vivo Exposure:  This is the most common and effective way to treat claustrophobia. This method slowly and progressively exposes the sufferer to small spaces while helping him/her deal with the associated fear and anxiety.   For example, a claustrophobic individual would start by entering an elevator and work up to a MRI.
• Cognitive Behavioral Therapy (CBT):  The goal of cognitive therapy is to modify distorted thoughts/misconceptions associated with irrational fear to decrease anxiety and avoidance of restrictive situations.  For example, CBT would try to convince a claustrophobic that elevators are not dangerous but are useful in getting to a destination more efficiently. 
• Medications: This type of therapy can help manage the anxiety symptoms; however it does not deal with the disorder itself. Medications are prescribed to control panic and reduce anticipatory anxiety associated with claustrophobia. Antidepressants can be helpful when the feelings of fear are severe and debilitating. Three specific antidepressants; Paxil, Effexor, and Zoloft have been approved by the FDA to treat phobias.  Benzodiazepines; Valium, Xanax, Ativan, and Tranzene may be prescribed for severe anxiety. There is a strong potential for dependence on these medications, and should not be taken for longer than four months.  Additionally, beta-blockers (cardiovascular drugs) may be prescribed to reduce the physical symptoms of anxiety such as palpitations, elevated blood pressure, and increased heart rate. They work by blocking the flow of adrenaline that occurs during anxiety. While beta blockers don’t affect the emotional symptoms of anxiety, they can control physical symptoms such as shaking hands or voice, sweating, and rapid heartbeat.
• Relaxation Exercises: Deep breathing, meditating and doing muscle relaxing exercises are effective at dealing with negative thoughts and anxiety.
• Alternative/Natural Medicine: There are a few natural products and homeopathic medicines that some patients say help them manage panic and anxiety.
• Hypnosis:  Post hypnotic suggestions may also help claustrophobia.

Law Enforcement Tips

Congress enacted the ADA Amendments Act of 2008 to clarify its intent as to who is protected by the Americans with Disabilities Act of 1990. In enacting these amendments claustrophobia was listed as an ADA disability.  There have been several lawsuits related to this issue with varying results.  The bottom line for a LEO is to avoid heartache if possible.  If an officer can safely modify your confinement procedures when told that a suspect has claustrophobia and/or is having a panic attack he/she should do so.  Check on a claustrophobic detainee often; especially in your patrol car or a holding or jail cell.

How to Help Someone Having a Panic Attack

• Remember, a panic disorder may be caused by very real conditions, such as hypoglycemia, inner-ear infections, and even congenital heart defects.  If uncertain about a person’s medical stability call for paramedic back-up.  Ask the person to describe what they believe is causing them to have a panic attack. Individuals who experience panic attacks often feel as if they are having a heart attack or dying. It is important to determine as quickly as possible whether there is a real physical danger or medical emergency.
• Ascertain the individual if he/she is currently being treated by a medical professional for an anxiety disorder. He/she may be using prescription medications, combined with behavioral modification techniques to deal with panic attacks that may be helpful in the current situation.  
• Avoid discrediting the reasons why someone is having a panic attack. Do not use phrases like "there's nothing to worry about" or "it's all in your head", this will make the person feel more isolated, exacerbating the situation. Try to remain empathetic.
• Stay with someone who is having a panic attack by staying with him for the duration of the episode (usually about ten minutes).  Have the individual sit down and talk to him/her in a relaxed and calm manner.   
• If the individual is transported to a corrections facility notify the staff of their condition.  A trip to an emergency room is normally not necessary and may in fact make the situation worse.

What Can You Do If You Experience A Panic Attack?

• Don't be frightened; a panic attack cannot harm you.
• Flow with, rather than fight, the experience. The attack will pass sooner.
• Tell yourself, "I will not die," "I will not lose control," "I will not faint," "I am not going crazy," "I can breathe," "This will pass." Repeat.
• Breathe deeply in through your nose, hold it, and forcefully exhale through your mouth (like you are blowing out candles).
• Be cognizant of muscle tension. Relax your shoulders first, next progressively tense and hold, then relax each of your major muscle groups one by one, working downwards. Re-evaluate and notice where you are still tense; rework those areas.
• Write down everything you can remember about the attack after it passes. It will help you and your therapist understand the circumstances in which your attacks occur.
• Watch out for those frightening trigger thoughts. You have a better chance of winning the lottery than having a plane fall from the sky onto your patrol car.
• Call a hotline:  800-64-PANIC.

About The Author:

Pamela Kulbarsh, RN, BSW has been a psychiatric nurse for over 25 years. She has worked with law enforcement in crisis intervention for the past ten years. She has worked in patrol with officers and deputies as a member of San Diego's Psychiatric Emergency Response Team (PERT) and at the Pima County Detention Center in Tucson. Pam has been a frequent guest speaker related to psychiatric emergencies and has published articles in both law enforcement and nursing magazines.