Gehl presents three cases to show that these two symptoms often appear alternately in the same patient. He concludes that they are closely related phenomenologically, dynamically, structurally, and genetically. The cycle appears to consist of maintenance of object cathexis by projection of the conflict onto the claustrum, increasing spread of claustrophobia leading to panic, acting out that becomes a desperate attempt to deny the loss and maintain the object, increasing guilt, withdrawal of object cathexis, depression, and gradual re-formation of claustrophobia. Pregenital fixation is present in these cases.