Claustrophobia is a fear of small spaces or confinement. It is a type of specific phobia, or an excessive fear of a specific object or situation. It is fairly prevalent with about 4% of the population experiencing significant symptoms of claustrophobia. Common triggers for claustrophobia are small rooms, elevators, crowded places, and MRI scanners.
Effective treatment is available for claustrophobia. There is no diagnostic laboratory test for phobias. The diagnostic criteria of the American Psychiatric Association for specific phobias are:
- Excessive or irrational fear of a specific object or situation
- Exposure to the feared object or situation leads to immediate anxiety or panic attack
- The individual is aware the fear is excessive and irrational
- The object or situation is tolerated with distress or avoided
- Avoidance or distress related to the feared object interferes with the person’s daily life.
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Claustrophobia can be confused with other psychiatric disorders. Some differential diagnoses for claustrophobia are paranoia, schizophrenia and obsessive-compulsive disorder. Other potential diagnoses are anxiety disorders, panic disorder, personality disorders, social phobia, obsessive compulsive disorder, hypochondriasis, and post-traumatic stress disorder.
Claustrophobia can also sometimes be confused with cleithrophobia, the fear of being trapped.
Panic disorder with agoraphobia is a common alternative diagnosis. A diagnosis of specific phobia is chosen over panic disorder when there are no spontaneous panic attacks and no fear of panic attack. Panic disorder with agoraphobia is diagnosed if the onset of panic attacks is unexpected and the individual subsequently avoids multiple situations that may trigger the attacks. Another difference is that people with specific phobia do not have enduring anxiety. The number and type of panic attacks, the number of context avoided, and the focus of the fear are all significant in making a diagnosis, as well.
The Claustrophobia Scale
The claustrophobia scale is one tool used to diagnose claustrophobia. It has one subscale of 20 items for measuring anxiety and another 18-item scale for assessing avoidance. In a study of 87 claustrophobic patients and 200 normal controls, the claustrophobia scale had high internal consistency, high test-retest reliability, and concurrent and discriminant validity. The scale was also sensitive to change after cognitive behavioral treatment.
The Claustrophobia Questionnaire
The claustrophobia questionnaire (CLQ) is another diagnosis instrument. An early version of the CLQ was designed to evaluate two separate, but related fears: the fear of suffocation and the fear of restriction. A shortened version of the CLQ has been developed that retains accurate measures of claustrophobia and its component fears.
Other psychological measures that may be used in assessing claustrophobia include the Behavioral Avoidance Task, the Anxiety Disorders Interview Schedule for DSM-IV (ADIS-IV), and the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-IV). These evaluations often include heart rate monitors. Self-report questionnaires may include measures of subjective units of distress (SUDS) and the Fear Survey Schedule (FSS-III).
Specific phobias typically begin in childhood or early adolescence. They can occur in combination with other disorders of mood and anxiety, and with substance abuse. In that case, the diagnosis associated with greater levels of distress is designated as the primary diagnosis.