One hundred and sixty female patients with a DSM-III diagnosis of agoraphobia completed a measure of fears and general symptoms (FSS) and personality (HDHQ). Many patients had significant psychological symptoms in addition to their agoraphobia. FSS scores were factor analysed. First-order analysis revealed agoraphobia as a heterogeneous clinical entity occurring independently of a large General Symptoms factor which included panic attacks. Second-order analysis revealed a General Symptoms/Social Phobia factor and a well-defined but heterogeneous Agoraphobia factor comprising the lower-order factors Claustrophobia, Travel Fears and Agoraphobia (fear of crowded public places). Correlations of first- and second-order factors with HDHQ scores showed that the Travel Fears factor was not associated with abnormal personality traits, whereas the Claustrophobia and Agoraphobia factors were. This suggested that travel fears should respond well to behaviour therapy per se, whereas additional treatment aimed at modifying abnormal personality traits may sometimes be indicated for claustrophobia and fear of crowded places. The heterogeneous nature of agoraphobia and the large size of the independent General Symptoms factor underlined the desirability of a multi-modal approach to treatment and research.
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