Jim, 65 and married, had been living a peaceful life in retirement for a couple of years when his life-long fear hit him like a ton of bricks. Ever since he was a teenager, he had endured a profound fear of closed spaces. Whenever he found himself in enclosed, small spaces, he would experience extreme anxiety, sweaty palms, racing heart, difficulty breathing, dizziness, handshakes, and an overall feeling of unreality. Jim also had a fear of being unfamiliar, social situations and always felt people were staring at him.
For decades, he was able to work around his fears and had a successful career as an accountant. His wife of forty years, with whom he had fathered three children, implored Jim to seek professional help when he announced to his family that he was not going to attend his only son’s wedding which was to take place in Paris. Jim really wanted to go but he was paralyzed by the fear of being on a plane. He had been hoping for months that he would gather enough courage somehow and ‘talk himself’ into flying to Paris. But, it did not happen. He stayed home in a Cleveland suburb while his wife, two daughters and other family members flew to Paris to celebrate his son’s wedding.
Jim was now experiencing a sad sense of loss. He was becoming withdrawn and irritable. Upon returning from France, his wife and two daughters became quite concerned about Jim’s emotional state. Now he was frequently tearful as well.
At his first visit with me, Jim was so thoroughly dejected that he was willing to try any psychotropic medications. After a full psychiatric evaluation, it was determined that Jim suffered from claustrophobia and social anxiety disorder. He was treated with an SSRI (Selective Seratonin Re-uptake Inhibitors) and Cognitive Behavioral Therapy. In 3-4 months, Jim’s sulky feelings lifted and he became more sociable. At about 6 months into the treatment he was, for the very first time in his life, able to give a speech in front of a crowd of several hundred people. And more importantly, this was in front of the entire congregation at his church where he served as a board member. He described that he did not feel panicky or nervous at all. He exclaimed ‘if I had to do this last year, I would have about died on stage!!’
However, the moment of truth was yet to come. A year after starting the treatment, Jim felt he had enough emotional strength to ‘overcome his demons’. By now, his son and his son’s wife were living a happily married life in London- and they just had their first child. Jim saw an opportunity to redeem himself. He asked me if I believed he would be alright if he flew to London. I was happy to give him a lot of encouragement and supported the idea. Jim was able to fly over the Atlantic for the first in his life to meet his son’s family.
Today Jim continues to do well. He remains very active socially, with his family and with his church. Now, he enjoys travelling very much.
Does Jim’s story ring a bell for you or a family member/friend?
Claustrophobia is one of the most common phobias, affecting 5%-7% of the general population. If you experience severe symptoms of anxiety while in or anticipating to be in closed spaces such as roller coaster, elevators, planes, cars, MRI chambers, etc., you most likely have claustrophobia.
What causes claustrophobia?
Like other phobias, claustrophobia also seems to be a result of some abnormalities in neurotransmitter systems of the brain.
Certain traumatic childhood experience such as physical/sexual abuse or neglect, being a nervous child, etc., seem to be risk factors of development of claustrophobia in adulthood.
When to seek professional help?
Since phobias are very common psychiatric disorders disorders and occur in varying severities, many people are able to cope with them effectively without any treatment. However, if claustrophobia begins to adversely impact your personal, family, social and occupational lives or if it starts to make you feel depressed/ irritable, it is time to seek professional help.
Know that you can be helped
The following are the various forms of effective treatment for claustrophobia:
Medications: Most effective ones include SSRIS (Zoloft, Paxil, Prozac, Lexapro, etc.) and beta-blockers (e.g.: Inderal)
Cognitive Behavioral Therapy (CBT): As with other psychiatric conditions treated with CBT, it focuses on helping understanding of irrational nature of beliefs which cause anxiety, and learning better ways to cope with it.
Behavior modification Therapies: There are different techniques which are useful:
Systematic Desensitization: Person is exposed to gradually increasing severity of the stimulus/ situation that causes anxiety with the hope that person will get ‘used to’ the situation.
Flooding: Person is at once exposed in its entirety to the stimulus/situation which causes anxiety. The hope is that once the person ‘survives’ the situation, he/ she will reorganize the irrationality of the fear.
Counter-conditioning: Visualization (of anxiety provoking situation) and relaxation techniques are utilized first, followed by actual gradual exposure to the trigger situation.
Immensive Virtual Reality Therapy: A new form of behavior therapy whereby an individual to exposed to feared situation in virtual reality using computers.
Breathing exercises: Are particularly helpful in aborting impending panic attacks.
Hypnosis: Somewhat effective in some people.
The purpose of this article is for educational purposes only. It is not intended to diagnose or treat any medical or psychiatric issue. Dr. Rakesh Ranjan is a practicing psychiatrist and a researcher. He is a recipient of several research awards and has authored several peer-reviewed journal articles and book chapter on psychiatric illnesses and their treatments. He is a national speaker for several organizations and serves on the medical advisory board for NAMI for Greater Cleveland. If you or a loved one is experiencing any symptoms that would lead you to believe that there could be a mental imbalance, please email your questions to Dr. Ranjan at firstname.lastname@example.org. Each Wednesday, Dr. Ranjan will address some of these questions in this column. All contact info will be kept confidential.