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Real Doctors (Life Makers)  |  Clinical  |  Psychiatry , Pyschology and Behavioral Medicine  |  [psychiatry-research] Just don't stand so close to me « previous next »
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musheera
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[psychiatry-research] Just don't stand so close to me
« on: /November/ 18, 2005, 11:40:55 AM »

[psychiatry-research] Just don't stand so close to me
   
September 02, 2005

Just don't stand so close to me
by David Mattin

Some people have a psychological need to keep their distance at
all times, even from those who are closest to them. One doctor
has identified the condition as personal space phobia
IT WAS two months after she was the victim of a violent physical
assault that Laura first started to notice strange feelings
towards her children. While previously she had enjoyed cuddling
the four of them ? especially the youngest, a five- year-old boy
? now the thought of physical contact was unbearable.

?Whenever my son approached, I was immediately anxious and on
the defensive,? she recalls. ?It was as if I wanted to lash out
and run a mile from him. I couldn?t understand why.?

Laura, a single mother who was then 38, realised too that she
could no longer bear to be physically close to anyone, from
strangers to her parents. Though the injuries that had initially
kept her housebound were improving, she locked herself in her
home. Social invitations went unanswered, a return to work was
out of the question ? she eventually retired on ill-health
grounds ? and she ended her relationship with her partner.

One morning she found herself sobbing uncontrollably because the
postman had knocked on the door. ?The idea of getting close
enough to take the parcel from him was terrifying. My
personality had been transformed. On the rare occasions when I
had to leave the house I?d have panic attacks so severe that I
was being sick. I thought I was going mad.?

Through her GP, Laura ended up in the office of Dr Peter Kirby,
a clinical psychologist. It was a fortunate referral. Dr Kirby
told Laura that he had identified a condition that he called
personal space phobia (PSP): an intense, irrational fear of
physical closeness to, or contact with, others. The condition,
he said, occurred in severe cases of post-traumatic stress
disorder (PTSD) and she was a sufferer. Five years on, Dr Kirby,
who runs a private practice in Staffordshire, says that for some
Britons his discovery is more relevant now than ever.

?I would expect many of those who were witness to the London
bombings ? those trapped underground or badly injured ? to be
suffering from PSP. Fundamental to onset is a traumatic
experience in which the victim becomes convinced that death is
imminent. How often in the news reports have we heard people
say: ?I thought I was going to die?. ?

Psychologists have long known that each individual carries
around a ?personal space?, or a set of rules concerning physical
closeness to others, which varies depending on circumstances.
While working with sufferers of PTSD, Dr Kirby began to think
that the established description of that condition did not
account for some of the seemingly bizarre symptoms that a few of
his patients described: of being unable to bear physical
closeness, or the thought of it, even with family members. ?I?ve
had mothers who have left their children to live alone. One wife
insisted on living on a separate floor of the house from her
husband.?

In every case, Dr Kirby realised, victims had suffered a trauma
in which they believed that they were going to die. ?It?s as if
they had unconsciously said to themselves: ?I?m certain to die,
but if I somehow get out of this I?ll avoid harm by never
letting anyone in my space again?.?

Many PTSD patients will not develop the phobia, he says. But in
those who do, even the smallest loss of control over personal
space can trigger the instinctive ?fight or flight? response to
a perceived danger, causing the sufferer to become anxious or
aggressive. Walking down a busy street, standing in a queue,
even eating around a table: all become unbearable.
Antidepressive medication can dampen the symptoms but not remove
them entirely. Dr Kirby has identified about 40 cases of

PSP among the trauma victims he has seen, but believes there may
be thousands of undiagnosed cases in the UK.

When Laura heard about PSP it was, she says, ?like a light going
on?. During the vicious physical attack that she suffered, she
had thought death was a certainty. Now, just as Dr Kirby had
said, she was filling her life with strategies to avoid physical
closeness: ?In the evening I?d paint my nails over and over so
I?d have an excuse not to touch my children. The truth was, it
was hard enough just knowing that they were in the house. I felt
so unnatural, and tortured myself over failing as a mother.

?My oldest, a 16-year-old, could understand my condition but my
smallest boy couldn?t. There were times when I felt so guilty.
I?d worry that my youngest son would grow up unable to show
affection to anyone. I didn?t feel that I could talk about it,
not even to my parents. Feelings like that are taboo. How can
you tell someone: ?I can?t bear to touch my child?? I shed a lot
of tears; that was all I could do.?

Robert Sommer, a psychology professor at the University of
California, Davis, is one of the world?s leading experts on
personal space. He believes that current thinking on its origins
supports the idea that personal space and perceived danger are
closely linked: ?It seems likely that personal space served an
evolutionary function,? he says. ?People have always faced
physical threat from others: having a personal space helps to
keep you safe from your enemies.?

While he doesn?t lend support to Dr Kirby?s identification of
PSP, Professor Sommer says that an event such as the London
bombs will have consequences for the personal space of everyone
in the city. ?After this kind of event, people will become more
guarded about their space. They will distance themselves from
strangers, especially those they perceive to be a threat. So
you?ll get people on the Tube changing carriages to avoid being
near those with rucksacks, because of an instinctive need to
protect personal space.?

Dr Kirby continues to work towards greater recognition of the
condition, and says more research is needed. Through the
treatment for PSP ? cognitive behavioural therapy ? sufferers
are encouraged to confront their fears of closeness and
gradually to reintroduce themselves to a normal lifestyle. Five
years after her attack, Laura says that she has improved: ?I can
go out with friends, but they know I?ll have to sit with my back
to the wall and that I must be able to see the door. I can
cuddle my youngest.

?It?s taken great self-determination. But I still couldn?t
consider a relationship with a partner, and it?s frightening to
think I may never have that again. I just hope that, one day,
the situation changes.?

# For more information, write to: Dr Peter Kirby, Cornwall
House, Sandy Lane, Newcastle, Staffordshire, ST5 0LZ.

http://www.timesonline.co.uk/article/0,,8123-1759950,00.html

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