Agoraphobia: the interface between anxiety and personality disorder

Although agoraphobia includes distinct symptoms of avoidant and dependent personality disorder, it is currently classified as a form of "anxiety disorder." Such categorization seems to imply that uncontrolled panic attacks sometimes generate subsequent avoidant and dependent traits, leading afflicted persons to virtually seclude themselves in the home. The authors propose an alternate view, suggesting that in many cases the etiology of the disorder can be attributed to a predisposing antecedent character structure. The initial panic attacks are triggered by a stressor, but patients can then use these symptoms to further intensify and justify avoidant and dependent behavior. This paper features the autobiographical account of an agoraphobic woman who seldom comes to the clinic for therapy, and never on her own. The "fear of fear" characteristic of agoraphobia is readily traced in her history to a family background in which she was conditioned to feel that she could not manage without the direct support of her father.