Claustrophobia

What is Claustrophobia?

Claustrophobia is an anxiety disorder or situational phobia. It may come as a consequence of a traumatic past experiences or as a result of a present stressful or anxious situation.

A suffer has an irrational fear of being closed in with no escape.  The mind comes to associate confinement with danger. An enduring fear of defined situations develops e.g. a crowded elevator, a storage room with no windows, an aeroplane, a dark tunnel or cave, or any crowded location  People with Claustrophobia will try to avoid situations relating to their phobia as a panic attack may ensue thus affecting normal, daily functioning.   

The acute anxiety created by being in an enclosed environment can create feelings of suffocation, hyperventilation, sweating, shaking, dry mouth, rapid heartbeats, nausea, and tightness in the chest, an urge to use the toilet, and an increase in blood pressure. The sufferer may become confused and disorientated and fears death by being trapped or buried alive.

Case Taking - Marketing Manager with Claustrophobia

John a 40-year-old father of two called to see me at my clinic. My first impression of John was that he was pleasant, well mannered and energetic. His clothing, hair etc were immaculate. He was an accomplished marketing manager and had worked for a well known company for the past 18 years. Recently he was suffering with claustrophobia

Homeopath: Well John what brings you to my clinic?

John: Lately my work load has doubled and it means spending long hours in the confinement of my office working alone or meeting with prospective clients.

Homeopath: Go on

John: Well a month ago while meeting with clients, my heart started to race and my stomach began to churn. It felt as though the walls of the office were closing in on me. I felt I was losing control of the situation and had to get out of the office. I made the excuse of having to use the bathroom.

Homeopath: Not pleasant, go on

John: Since then my self-confidence has diminished, I get terrible surges of panic and want to run from my office building. I can get the same feeling when in crowded shops, public spaces, venues etc. I get anxious. I need to escape the situation / place I find myself in. If I don’t get out, get away I think I will suffocate or something.

Homeopath: Is this your first time to experience these symptoms?

John:  About 20 years ago I was sitting a college exam. There were perhaps a hundred more students sitting the exam too. I glanced around and thought everyone else was writing I couldn’t. I got a mental block or something, became lightheaded, started to perspire, my heart was racing, and the walls of the examination hall seemed to be closing in on me. I felt stupid and out of control. I had to leave the examination hall. Thankfully I was able to re-sit the exam at a later stage.

Homeopath:  Anything else?

John: Well it is having a terrible affect on my daily life. I dread going into the office, meeting clients in crowded restaurants or coffee shops. I get short with my two boys and I am not interested in or enjoy sex now. I know my wife sees a change in me, she doesn’t like it. I snap at her too when she suggests ways for me to wind down.

Homeopath: I can imagine, continue

John: A younger more academic manager has been taken on by the firm and I know I am competing with him. Silly perhaps but I need to be on top of my game, successful, achieve things. I always excelled in business, in everything. Yet now I feel overwhelmed and fearful least I screw up.

Homeopath: How are you feeling now?

John: Just thinking about it makes me tense; I feel my neck and back tightening. Its effecting my breathing (observation- breathing became shallow), my stomach feels tight and sick. I feel I am out of control.

Homeopath: Take a minute. Are you ok to continue?

John: Yes, Yes

Homeopath:  Can you tell me more about yourself

John: I am competitive and ambitious. My wife complains that I focus more on my work than I do on my family. As I said earlier I can become irritable and then angry. It has on occasion turned into outright rage when someone doesn’t work as they should. If they are too slow at producing what I am looking for I get infuriated. The other morning I broke the dishwasher door because it wouldn’t close for me.

Homeopath:  Anything else?

John: I find a few drinks always helps with work pressure; I frequently stop off for a drink on the way home from work. Smoking helps me get things clear in my head, helps me think. Coffee helps me stay awake and continue with my work late into the evening. Sex helps me sleep and relax.

 Homeopath: And how is your sleep?

John: I go to bead about 11.00 pm. My mind races thinking about work and the days events. I become anxious and can’t sleep. I dream of being in work and everybody laughing at me for messing up.  I wake in a panic, usually around 4am, but can back to sleep. When I wake again I feel worse, have a dull headache. I can have a sour taste in my mouth too.

Homeopath: Any physical complaints?

John: I suffer with a peptic ulcer and constipation. Lately I have developed a tender sensation around her (indicates liver area). I get headaches,  I get heartburn quite often too

Homeopath: Modalities? 

John: My headaches are worse in the mornings or from any kind of mental work like having to solve a problem. I love spicy food but always feel ill after eating it. The same applies if I drink a lot of alcohol, tea or coffee. I love getting out of my suit, shirt and tie and putting on my sweat suit. I don’t like being restricted. I always feel better after a nap or in the evenings after work. 

Homeopath; How does the weather affect you?

John: I prefer damp wet weather to dry weather.

Physical Generals

Homeopath: Thirst? 

John: Normal, but I drink beer or soft drinks like Coke during the day rather than water.

Homeopath: How do heat /cold affect you?

John: I don't like heat but I like to be warm. I am a chilly person so hate the cold.

Homeopath Foods you like / dislike? 

John: I love any kind of hot spicy food, fresh white bread with loads of butter, barbecued spare ribs, steaks, tea, coffee, wine, beer. I have a sweet tooth so like sweets, chocolate, cakes, biscuits.

Homeopath:  In general whats going on for you?

John:  I feel tense and overworked. Don’t sleep well and think too much about my work. I can be impatient, irritable and angry. When it gets too much for me I feel suffocated, restricted, and have to escape.

Homeopathic Analysis

Up at 6 am, John jumps out of bed and is ready to go. He is extremely demanding of himself and his accomplishments. John is feeling out of control and fearful of messing up. He frequently competes with a younger manager and in doing so loses his confidence. He is consumed by thoughts of not being good enough at his job. John had his first panic attack at 18 years when he was sitting exams with other students. He became lightheaded, drenched in perspiration, his heart raced, and he had to get out of the room. This incident instilled in John a fear of looking stupid, out of control. The situation is repeating itself frequently in recent times especially when stressed and anxious. He wants to find an answer to the problem rather than resorting to antidepressants.

This case is pretty straight forward. I gave John Nux Vomica the classic homeopathic medicine for an overstressed, overworked, irritable, hard-driving, Type A character

 Repertorization

Mind, Anger, ailments after anger, vexation, etc.
Mind, Impatience,
Mind, Ambitious
Mind, Anxiety, night, midnight, after
Head, Pain, morning, bed, in 
Mouth, Taste, bitter 
Stomach, Desires alcoholic drinks
Rectum, Constipation, difficult stool
Sleep, Dreams, business, of

Differentiation - remedies considered based on the repertorization were : Puls, Rhus Tox, Nux Vom,

Rhus Tox  has constant anxiety “ as if something is going to happen”. Johns anxiety is not constant. Rhus Toxs anxiety is experienced more inside the house/ office and ameliorated by walking in open air. This they have in common but again the Rhus Tox anxiety is different to Johns.  Rhus tox feels helpless and forsaken John anxiety is around appearing stupid and loosing control. I believe Rhus Tox to be milder, more timid, and more nervous than John. Rhus Tox has a constant physical restlessness. John can and does sit for hours at his desk until anxiety strikes when he may need to flee the room. Rhus Tox tends not to respond to situations. John on the other had becomes angry. I am of the opinion that John is more expressive, more explosive than Rhus Tox.

Puls is mild timid and tearful. John has angry outbursts. Puls can be yielding and submissive. John does not fit this picture. By contrast John is determined, competitive and firm. Puls is sympathetic. John does not treat people in this way. He gets irritated by people who don’t live up to his high standards. They both share a fear of narrow places and crowds. Puls can be manipulative; John is more direct in getting what he wants. John would be more responsible for his actions than Puls who places responsibility on others. I am of the opinion that John is too hotheaded, too forceful and more confident than Puls.

Nux Vom,  has a strong urge to achieve, to win to have things his own way. John is also very competitive and ambitious., They are ardent in whatever they do.  Both are fastidious, fault finding and reproach others. Both Nux Vomica and John can become irritable and impatient. Both crave stimulants coffee, alcohol, cigarettes. They both wake at night (around 4am) thinking of business matters. Both suffer with constipation and dislike restrictive tight clothing.  Both John and Nux Vom are chilly. I am of the opinion that Nux Vomica is the most likely remedy / simimilum for John

First follow-up: John visited with me 4 weeks later. He reported being less irritable and stressed. His episodes of claustrophobia have lessened. His sleep has improved too. However, He still gets dull headaches, constipation, and his ulcer still bothers him.
Dosage prescribed Nux Vomica 200c

Second Follow-up (4 weeks later): John’s anger is much more controllable now; He can talk to his family without getting short with them. His wife sees a great improvement. He has reduced his alcohol consumption and is eating healthier. He had only one claustrophobic episode which passed quicker than usual.

Dosage prescribed. Nux Vomica 200c

Third Follow-up (4 weeks later): John reported having no irritability and did not have any angry episodes with family or work colleagues. His headaches have disappeared. He now makes a point of going for a walk at lunch time rather than working through it. His interest in sex has returned. He still gets constipated, and his ulcer still bothers him. He did have a claustrophobic episode but it passed very quickly and he did not need to flee the room.

Dosage prescribed. Nux Vomica 200c

Fourth Follow-up (5 weeks later): John no longer feels threatened by the new manager and has offered to help him with any problems he may have. His constipation has improved and he did not have any claustrophobic episodes. His peptic ulcer is less troublesome

Dosage prescribed. Nux Vomica 200c

I didn’t see John again for six months. He didn’t feel a need to come see me since he was doing so well. The notion of losing control or appearing stupid rarely occurred to him. He felt like his old self and didn’t get wound up about meetings anymore. The sensation of suffocating/ the walls closing in on him had disappeared. Sex life, family life had also improved. His physical symptoms of headache, constipation, broken sleep were gone. He had less bother with his ulcer. He continues to check in with me yearly and he continues to do well.