Claustrophobia

introduction

As claustrophobia is popularly called the Fear of closed spaces (claustrophobia) designated. However, this definition is not exhaustive. Also for the so-called Agoraphobia is used as a synonym claustrophobia. The patient has Fear of situations in which he is exposed to embarrassing symptoms or circumstances that make him helpless. The psychiatric background for both anxiety disorders has been well studied and documented. However there is significant differences between claustrophobia and agoraphobia. The latter is often associated with panic disorder, which increases the level of suffering for the patient.

root cause

The root cause To define a feeling like claustrophobia has in the past been called difficult exposed. Various aspects play a role in the development of fear in general and in particular. To this end, different theories have been developed as to the underlying causes of an anxiety or panic disorder. However, one should assume that not just a model but that the interaction is likely to trigger the disease.

In the explanatory model of learning theory it is assumed that learns the claustrophobia over time has been. Negative events are associated with certain objects or locations - for example with an elevator or a public square. Either have the experience directly with that anxiety-inducing stimulus (Stimulus) to do (e.g. got stuck in the elevator) or the experience is via so-called Conditioning with the stimulus unintentionally linked. The latter usually happens randomly: a negative experience happens in a certain place (e.g. public square) and the feelings are then associated with the location. When looking again, the associated feelings. The Greek philosopher Epictetus described this fact as follows: "It is not the things in themselves that worry a person, but his view of things."

If anxiety disorders are examined according to their psychodynamic background, one can particularly well establish a connection between the underlying anxiety disorders Character of the patient and des Fearful experience produce. If the patient cannot show any limits in real life and is overwhelmed by interpersonal relationships, this can cause a fundamental fear of being cramped. The patient develops claustrophobia - a fear of confined spaces.

It is also believed that the Biochemical processes taking place in the brain as well as the genetic predispositions To influence the development of anxiety and panic disorders in some patients.Because every person is a different DNA possesses, there are also (sometimes minimal) differences in the brain. The areas in which the biochemical processes for the development of emotions take place are not excluded and therefore also individually more or less susceptible to corresponding disorders. However, the field of neurobiological and neurochemical aspects is extremely complex and little explored.

Anxiety in general, but also anxiety disorders such as claustrophobia, can Side effects of another underlying disease be. Various psychiatric illnesses like Psychosis, Delusional or personality disorders play a role here, but also different ones physical illness. Especially complications with heart and lung cause fear of death in affected patients. Heart attacks, Cardiac arrhythmias, shortness of breath or a allergic shock are just a few examples of fear-inducing somatic (physical) diseases. As a side effect when consuming drugs, anxiety and panic disorders can lead to so-called "Horror Trips" to lead. The main danger here is from substances that Hallucinations trigger (LSD, hallucinogenic mushrooms) or an activating, euphoric character to have (Amphetamines, cocaine, Ecstasy).

Symptoms

claustrophobia:
The claustrophobia describes that Fear of tight or closed spaces. It is a so-called specific phobiawhere anxiety is confined to an object or situation. The tight spaces, such as elevators, solve one more or less oppressive, tense emotional state on the patient. If the person concerned gets into the situation, physical symptoms such as difficult breathing or shortness of breath triggered even though there is no triggering cause for it. As a rule, the patient knows that his fears are unfounded, but cannot simply turn them off and therefore often goes through psychological torments. This can lead to avoidance behavior through which the patient tries to bypass fear-inducing circumstances. The level of suffering is increased by restrictions in the social or professional life as the patient feels powerless. When confronted with that uncomfortable situation, it can lead to a Panic attack come.

Agoraphobia:
In agoraphobia, anxiety is concentrated on public places, Crowds (e.g. in the bus, the subway or in halls) and in situations where the patient is on his own, for example in independent travel or far from home distant, unknown places. The fear is in Fear that problematic situations will arisefrom which the patient cannot escape or from which he is not given immediate help. Possible worries arise in part from previous experiences that have triggered a kind of trauma in the person concerned. Dizziness, Faint, of the Loss of continence (Urinary and bowel control) as well as Heart discomfort with associated pain can play a role in this context.

The named expected symptoms represent only an excerpt of the overall possibilities. The patient develops claustrophobia as part of this Avoidance behavior. In doing so, he tries to avoid such unpleasant situations, which, however, often puts him in critical situations, such as social isolation. Dreadful environments may become only in company or not more visited. If there is a confrontation, it can become one Panic attack that may be accompanied by physical symptoms. Panic disorder is an isolated psychiatric disorder, but it often occurs in connection with anxiety disorders, especially in combination with agoraphobia.

Diagnosis

At the beginning of the diagnosis, it should be examined whether the patient's fear normal or as abnormal is to be designated. The symptoms that occur, any underlying pre-existing illnesses and the degree of social limitation that results from the avoidance behavior play a role here. In the case of previous illnesses, both psychiatric ailments, as well as physical illnesses be included. For example, occurs in the context of cardiovascular disease Angina pectoris a symptom, which those affected describe as a feeling of constriction in the upper body. If the symptoms occur in small rooms, this can be wrongly associated with claustrophobia. If there is no such mental or physical illness, one appears primary anxiety disorder to pass.

The means of first choice for the diagnosis and assessment of anxiety disorders are psychological testing procedures. These are usually called Questionnaires and must either be carried out by the patient himself (Self-assessment) or by the examiner (External assessment) fill out. For example, when diagnosing a questionable agoraphobia, it could be an existing one Investigate avoidance behavior. Even the direct question about stress-inducing or frightening situations can give an indication of a developed anxiety disorder in the case of unusual answers (healthy people do not classify these situations as negative).

therapy

The therapeutic measures are based on the form of claustrophobia and the individual experience of fearful situations. The aim of therapy should be that To minimize suffering for the patient and to discard established avoidance behavior. Both a Treatment without medication, as well as a pharmacological (drug) therapy strategy can be used. The Combination of both measures is often the most promising option.

Medical therapy

For drug treatment of anxiety disorders of all kinds you can use both Antidepressants and Benzodiazepines can be used. The former are actually used to treat depressions used, but have an anxiolytic and calming effect just like benzodiazepines. In contrast to benzodiazepines, antidepressants have to be used first 2 to 3 weeks be taken until a therapeutically effective drug level is im blood arises.

The treatment acute situations is benzodiazepines like Lorazepam (Tavor®) reserved, as the remedy works quickly. There is, however, the Risk of addiction, which means that long-term therapy with appropriate drugs is not possible. Therapy with so-called selective serotonin reuptake inhibitors (SSRI) like Citalopram has proven particularly successful in agoraphobia. In individual cases Beta blockers, which are usually used in the treatment of various heart conditions. The point here is to decouple the physical symptoms from the mental symptoms - the psychological experience remains, but it no longer occurs Racing heart or tremors.

Non-drug therapy

Most patients feel safer in the presence of the doctor. In order for this feeling to be reinforced, a relationship based on trust must be established between the patient and the doctor. The most important thing is to convey to the person concerned that their fears and related problems are being taken seriously. In the context of behavior therapy, the success of which is based on a good doctor-patient relationship, attempts can be made in various ways to alleviate or even reduce fears.

Cognitive behavioral therapy
The cognitive behavior therapy tries one in the patient understanding about the emergence of fears. In doing so, the person concerned learns how the feeling of fear is triggered and is sustained by his own behavior. With the information learned, the patient can better understand the processes during an anxiety or panic attack and thus weaken them. Due to the educational concept of this form of therapy are frequent Group therapies offered. These are also part of sociotherapeutic strategies and are intended to reduce the social withdrawal of most patients.

Systematic awareness raising
Another possibility is systematic desensitization. The patient should less sensitive to anxiety-inducing stimuli become. The attending doctor manages this confrontation with appropriate stimuli. First, the patient must in thought Put yourself in fearful situations. Later he will with real situations confronted until it comes to a so-called overstimulation. The affected person is brought “out of the cold” into a fear-inducing situation. Without the possibility of fleeing, it should be recognized that the fear of remaining in the corresponding situation subsides on its own. In addition to the confrontation method Relaxation exercises to be learned. For example, it is determined Muscle groups rhythmically tense and thus causes a mental relaxation.

While in most cases the behavioral therapies already described achieve an improvement, a depth psychological treatment be necessary. This takes a lot of time - usually several years. It tries to uncover the inner conflict that is causing the anxiety disorder. A precise knowledge of the doctor or therapist about the patient's life and great trust between both parties are prerequisites for a goal-oriented depth psychological therapy.

Course and prognosis

If there is no treatment, anxiety disorders, especially agoraphobia, have a poor prognosis. The untreated course is characterized by Avoidance behavior and steady social withdrawal. The Anxiety becomes chronic and the patient always suffers stronger psychological agony. However, if a suitable therapy is found as early as possible, the chances of improvement are good. The majority of patients who go to therapy with motivation are rewarded with relief or even freedom from fear.

Claustrophobia in the MRI

On average, one in ten patients gets that one MRI examination should get claustrophobia. This refers to claustrophobia, the fear of cramped surroundings. A MRI-The device is large, but the space for the patient is very small: the tube of most devices only measures 60 to 70 centimeters. Some patients manage to overcome themselves and endure the quarter to half hour procedure without panicking. However, there are ways and means of making it possible for the opposite patient group to have the diagnostically extremely important magnetic resonance tomography performed.

First of all, if they are already aware that they have claustrophobia or panic attacks, they should do so notify the investigators. The team can therefore adjust to the situation and the Duration of exertion for the patient can be minimized. The Body areawhich should be examined determines the patient's position during tomography. For example, only the leg, the foot, the pool or the Lumbar spine are shown, there is a possibility that the head and upper body of the patient is positioned outside the tube. Most of those affected already find this an extraordinary relief. However, if the examination takes place on the upper body or even on the head, it is impossible to relieve the patient in this way.

The next option is, in consultation with the patient, to use anti-anxiety and sedative drugs. Primarily it is on Benzodiazepines resorted to.
This is usually done Lorazepam (Trade name: Tavor®) is used. It relieves the patient's tense mood and makes them easily sleepy. The drug takes a moment before it is fully effective, so it has to be taken about half an hour before the examination. With an existing Myasthenia gravis or a well-known Drug addiction allowed to no benzodiazepines administered. The drug remains in the for a relatively long time blood - half of the substance is only broken down after about 15 hours - and makes the patient not roadworthy. Others too Activities or work prone to accidents must be refrained from.
The majority of all is problematic due to the administration of medication MRI exams makeable. If this attempt to make the examination easier for the patient also fails, a short anesthetic can be initiated if the diagnosis is extremely urgent. With this procedure, which must also be discussed with the patient, he does not notice anything of this.

Panic disorder

A panic disorder is through that recurring panic attacks Are defined. These can arise in the context of other psychiatric disorders or illnesses, but can also manifest themselves as general panic disorder.

Panic attacks are due to one suddenly incipient, massive fear characterized. This can increase even further up to an individual climax. The most common Symptomsthat occur during a panic attack are the following, with decreasing probability: Racing heart, Hot flashes, oppressive feeling, Tremble, Drowsiness and sudden sweating. The signs appear frequently in combination on. Only about half of all panic attacks are accompanied by these symptoms: Shortness of breath, Fear of death (Fear of dying), stomach pain, Fainting (“Black before eyes will ") and Paresthesia how tingle.

Since the symptoms appear very dramatic from the outside, in many cases a Emergency doctor called. This is the right decision, albeit often unnecessary. As a layperson (and sometimes as an expert), you cannot initially tell the difference between a panic attack and actual physical complaints. The duration of a panic attack usually amounts to 10 minutes to half an hour. How long the condition actually lasts, however, can differ from patient to patient. After experiencing the horror of a panic attack for the first time, those affected usually have additional fear of having to experience another attack. This fear of fear is called Phobophobia. Here, too, there is a risk of social isolation in order to prevent confrontation with the fear-inducing stimulus at all costs. Panic disorder plays an important role in relation to heart disease. Both sick people and relatives of sick people (especially men) are afraid of cardiac incidents. In the case of a panic attack, the subjective signs (felt by the patient) set in, but from a medical point of view there are no cardiac symptoms.