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On Agoraphobia and Depression

Dear Sir: I was pleased to see Dr. Bowen and Mr. Kohout relate "agoraphobia" to affective disorders in their article recently published in this Journal (I). Although from a different vantage point, I came to similar conclusions on the basis of a survey of a random sample of 100 depressed outpatients (5). An irrational fear of "going out" and( or mixing with outsiders at their own homes was present in 61 of those patients during the depressive episode for which they attended a semi-rural clinic; five others admitted to having experienced this same fear some time in the past. I have argued recently (6) the. appropriateness of the very term denoting 'the symptom, labeled also occasionally as "social" or "people phobia", with Dr. Hallam (3). Phenomenologically speaking, it is not a genuine phobia but "pseudophobia". As to the triggering factor, it is not so much exposure to crowds (some probands would dread encounter with one specific person, for example), to strangers (occasionally it is very familiar faces, close friends, or even relatives), or even to the outside world (many experience it while receiving, or are about to receive, people in their own homes). These "specific insecurity fears" have to do with a variance or change introduced into the proband's familiar, everyday social environment. For these reasons I have coined the term "hetero(pseudo-)phobia" instead, which is linguistically correct, I have been told by my Greek colleagues. Diagnostically speaking, those who had heteropseudophobia (HPP) fell predominantly into the neurotic depression category (37(61) rather than reactive depression (10(61) or else bipolar or unipolar affective illness (3(61). The only two depressions accompanying schizophrenia in the sample were "HPP+", as were two cases (out of a total of 8 cases for the total sample, i.e., 8%) with some organic background. The balance of symptom-positive patients were assigned to the involutional melancholia category.