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July 2012
No Villains In Space And Darkness
Dr Ponmurugan P
Claustrophobia, the fear of enclosed spaces can limit daily life in many ways. The affected person is likely to miss out on many things which s/he would otherwise enjoy. It becomes an emergency when a panic attack leads to severe distress. Treatment and management lies in the combination of medication and behavioural therapies.

Claustrophobia, or fear of enclosed spaces, is one of the most common phobias. It can involve intense fear or even panic as a result of being in a small and enclosed space. Worldwide, approximately 2-10 per cent of the people are said suffer from the disorder, but the majority of them do not seek/receive any treatment. Most claustrophics learn to live with their malady by not participating in certain activities or avoiding certain situations.

Manifestation Of Claustrophobia
Claustrophobia can develop from traumatic childhood experiences like being trapped in a confined space during a game, or from unpleasant experiences involving confined spaces in growing/adult years like being stuck in an elevator. Such experiences trigger a frightening panic attack, which gets programmed in the brain and establishes in the psyche of the individual an association between being in a tight space and anxiety. The result is claustrophobia.

Claustrophobia is not a panic disorder; it is a disorder that is triggered by some stimuli-situations. The phobia of the small space is actually the fear of running out of oxygen combined with the fear of restriction. When a claustrophic anticipates entering or actually enters a closed space, s/ he experiences intense anxiety. The affected individual actually recognizes that the fear is excessive or unreasonable and tends to avoid the phobic situation.
Situational-Stimuli For Claustrophobia
  • Being in a crowded elevator
  • Being stuck in a room without windows
  • Being confined in a closed space,like during an MRI scan or in an airplane during air travel or in an underground parking lot
  • Crowded parties
  • Rides that use shoulder restraints (like in a roller coaster ride)
  • Driving during peak traffic hours
  • Tight-necked clothing too can make some people claustrophic
When Is Claustrophobia An Emergency?
Claustrophobia becomes an emergency when an individual experiences, for the first time, severe distress from a panic attack and s/he cannot control oneself. The person breathes really fast and there is risk of a dip in blood CO2 (Carbon Dioxide) level. The latter presents as spasms involving the digits of the hands (fingers) and is medically referred to as tetany. These symptoms may be caused by other potentially dangerous health conditions too.

The Risks Of Receiving No Help
Claustrophobia can have crippling social and psychological effects, since claustrophics will often avoid situations in which they think they will have an anxiety attack. It leads to isolation and depression. Medically, claustrophobia can be dangerous because a claustrophic is likely to avoid tests like an MRI scan, even when it is necessary.

How Can You Help A Claustrophic?

  • Understand that the person needs medical help.
  • Ask him to take in slow, deep breaths and exhale slowly.
  • Maintain verbal, visual, and/or physical contact with the victim.
  • Try to remove the victim from the triggering source/situation.
  • In medical situations where a claustrophic has to undergo an MRI scan, measures like music therapy, the use of a fan inside the room, and blindfolding the person are likely to be of help.
  • Seek a doctor when you cannot help the patient sufficiently. The doctor is likely to prescribe anti-anxiety medications or antidepressants to help manage the symptoms.
Dr. Ponmurugan P Senior Registrar, Dept.of Emergency Medicine,Apollo Hospitals, Chennai.

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