Natural history of phobic anxiety

The characteristics of those with phobic anxiety--anxiety with or without avoidance of specific fear-provoking situations--seen in family practice have not been previously described. However, patients with agoraphobia--extreme avoidance of fear-provoking situations--are frequently seen in the general health sector. In addition, panic attacks, which are spontaneous episodes of intense anxiety associated with at least four autonomic symptoms that build rapidly in intensity, are believed to be antecedent to phobic anxiety. This secondary analysis used 29 patients with panic attacks. During a structured interview, these patients completed a phobic anxiety questionnaire and the Health Locus of Control questionnaire. Of the 21 patients with phobic anxiety, 16 (76%) reported that they avoided at least one situation. Although patients frequently left home during the week (mean = 10.8 times), 11 (58%) felt that their fears controlled their lives. Patients' responses generally supported the model of fear causing anticipatory anxiety that in turn causes avoidance; however, panic attacks frequently began after phobic anxiety but before the fear was reported by patients to control their lives. Recognition and early intervention with those with phobic anxiety may minimize its severity and pervasiveness.