It is considered a specific phobia according to the Diagnostic and Statistical Manual 5 (DSM-5).

Triggers may include being inside an elevator, a small room without any windows, or even being on an airplane.

Some people have reported that wearing tight-necked clothing can provoke feelings of claustrophobia.

What is claustrophobia?

The word claustrophobia comes from the Latin word claustrum which means “a closed-in place,” and the Greek word, phobos meaning “fear.”

People with claustrophobia will go to great lengths to avoid small spaces and situations that trigger their panic and anxiety.

They may avoid places like the subway and prefer to take the stairs rather than an elevator, even if many floors are involved.

Up to 5 percent of Americans may experience claustrophobia.

Symptoms may be severe, but many people do not seek treatment.

Diagnosis

A psychologist or psychiatrist will ask the patient about their symptoms.

A diagnosis of claustrophobia may emerge during a consultation about another anxiety-related issue.

The psychologist will:

• ask for a description of the symptoms and what triggers them
• try to establish how severe the symptoms are
• rule out other types of anxiety disorder

To establish some details, the doctor may use:

• a claustrophobia questionnaire to help identify the cause of anxiety
• a claustrophobia scale to help establish the levels of anxiety

For a specific phobia to be diagnosed, certain criteria need to be met.

These are:

• a persistent unreasonable or excessive fear caused by the presence or anticipation of a specific situation
• anxiety response when exposed to the stimulus, possibly a panic attack in adults, or, in children, a tantrum, clinging, crying or freezing
• a recognition by adult patients that their fear is out of proportion to the perceived threat or danger
• employing measures to avoid the feared object or situation, or a tendency to face the experiences but with distress or anxiety
• the person’s reaction, anticipation or avoidance interferes with everyday life and relationships or causes significant distress
• the phobia has persisted for some time, usually 6 months or longer
• symptoms cannot be attributed to another mental condition, such as obsessive-compulsive disorder (OCD) or post-traumatic stress disorder (PTSD)

Symptoms

Claustrophobia is an anxiety disorder. Symptoms usually appear during childhood or adolescence.

Being in or thinking about being in a confined space can trigger fears of not being able to breathe properly, running out of oxygen, and distress at being restricted.

When anxiety levels reach a certain level, the person may start to experience:

• sweating and chills
• accelerated heart rate and high blood pressure
• dizziness, fainting, and lightheadedness
• dry mouth
• hyperventilation, or “over breathing”
• hot flashes
• shaking or trembling and a sense of “butterflies” in the stomach
• nausea
• headache
• numbness
• a choking sensation
• tightness in the chest, chest pain, and difficulty breathing
• an urge to use the bathroom
• confusion or disorientation
• fear of harm or illness

It is not necessarily the small spaces that trigger the anxiety, but the fear of what can happen to the person if confined to that area.

This is why the person fears running out of oxygen.

Examples of small spaces that could trigger anxiety are:

• elevators or changing rooms in stores
• tunnels, basements, or cellars
• trains and subway trains
• revolving doors
• airplanes
• public toilets
• cars, especially those with central locking
• crowded areas
• automatic car-washes
• some medical facilities, such as MRI scanners
• small rooms, locked rooms, or rooms with windows that do not open

Reactions include:

• checking the exits and staying near them when entering a room
• feeling anxious when all the doors are closed
• staying near the door in a crowded party or gathering
• avoiding driving or traveling as a passenger when traffic is likely to be congested
• using the stairs instead of the elevator, even if this is difficult and uncomfortable

Claustrophobia involves a fear of being restricted or confined to one area, so, having to wait in line at a checkout may also cause it in some people.

Treatment

Following a diagnosis, the psychologist may recommend one or more of the following treatment options.

Cognitive behavioral therapy (CBT): The aim is to retrain the patient’s mind so that they no longer feel threatened by the places they fear.

It may involve slowly exposing the patient to small spaces and helping them deal with their fear and anxiety.

Having to face the situation that causes the fear may deter people from seeking treatment.

Observing others: Seeing others interact with the source of fear may reassure the patient.

Drug therapy: Antidepressants and relaxants can help manage symptoms, but will not solve the underlying problem.

Relaxation and visualization exercises: Taking deep breaths, meditating and doing muscle-relaxing exercises can help deal with negative thoughts and anxiety.

Alternative or complementary medicine: Some supplements and natural products, for example, lavender oil or a “rescue remedy,” may help patients manage panic and anxiety.

Treatment often lasts around 10 weeks, with sessions twice a week. With appropriate treatment, it is possible to overcome claustrophobia.

Tips for coping

Strategies that can help people cope with claustrophobia include:

• staying put if an attack happens. If driving, this may include pulling over to the side of the road and waiting till symptoms have passed.
• reminding yourself that the frightening thoughts and feelings will pass
• trying to focus on something that is not threatening, for example, the time passing or other people
• breathing slowly and deeply, counting to three on each breath
• challenging the fear by reminding yourself that it is not real
• visualizing positive outcomes and images

Longer-term strategies may include joining a yoga class, working out an exercise program, or booking an aromatherapy massage, to help cope with stress.

Information video

In this video, Stella Lourency, Assistant Professor of Psychology at Emory University, explains that people with higher levels of claustrophobic fear tend to underestimate distances.

Causes

Past or childhood experience is often the trigger that causes a person to associate small spaces with a sense of panic or imminent danger.

Experiences that can have this effect may include:

• being trapped or kept in a confined place, by accident or on purpose
• being abused or bullied as a child
• getting separated from parents or friends when in a crowded area
• having a parent with claustrophobia

The trauma experienced at that time will affect the person’s ability to cope with a similar situation rationally in future. This is known as classic conditioning.

The person’s mind is believed to link the small space or confined area with the feeling of being in danger. The body then reacts accordingly, or in a way that seems logical.

Classic conditioning can also be inherited from parents or peers. If a parent, for example, has a fear of being close in, the child may observe their behavior and develop the same fears.

Possible genetic or physical factors

Other theories that may explain claustrophobia include:

Having a smaller amygdala: This is the part of the brain that controls how the body processes fear.

Genetic factors: A dormant evolutionary survival mechanism causes reactions that are no longer needed in today’s world.

Mouse studies have indicated that a single gene may cause some individuals to have a greater degree of “resident-intruder stress.”

One group of researchers has suggested that people who experience claustrophobia perceive things as being nearer than they are, and that this triggers a defense mechanism.