Some Etiological Factors in Phobic Neurosis

A group of 47 phobic patients (92 percent agoraphobic and 8 percent specific phobics) were matched with the same number of controls on age, socio-economic status and education. All subjects were assessed by two independent psychiatrists, on psychometric tests (IPAT, FSS) and on self-assessment of neurotic symptoms and social maladjustment. Among the control group 40 percent were found to have specific phobias and 5 percent agoraphobia; the severity of both being much below that of the patients. The rate of incidence of other neurotic illness (obsessions, alcoholism, depression, and so on) in the families of phobic patients was higher than in the control group. Mothers of phobic patients had a higher incidence of phobic neurosis and were more frequently described as overprotective than were control mothers. Childhood fears were more frequent among the phobic patients (slightly obsessive, worried persons) long before the onset of the phobic neurosis. On the IPAT anxiety scale and on the FSS, agoraphobic patients scored higher than the specific phobics, who scored higher than the controls. Specific phobias in both patient and control groups seemed to have begun in childhood and persisted until treatment. On the other hand, agoraphobia developed much later, and half the patients reported temporary remissions. Other neurotic symptoms (hysterical signs, obsessive symptoms, and so on) while clinically unimportant, were still significantly more frequent in the phobies than in the control group. The agoraphobic syndrome showed surprising uniformity from patient to patient. It was postulated that agoraphobia is due to reactivation of separation anxiety, while specific phobias develop as a conditioned fear response.