Agoraphobia and space phobia.

Is near basal blood pressure a more accurate predictor of cardiorenal manifestations of hypertension than casual blood pressure ? pressure monitoring in the diagnosis and management of difficult hyper-tensive problems. It is over 100 years since Westphal1 gave the name agoraphobia to a group of symptoms experienced by patients walking in streets or open spaces. These consist in dizziness, anxiety, palpitations, and trembling, and Westphal singled out anxiety as the central symptom. In this he differed from his contemporary Benedikt, who a year earlier had described similar cases and concluded that dizziness was the core problem.2 Benedikt went on to suggest that this dizziness was caused by a disorder of the ocular muscles, a suggestion that Westphal rejected. Since these original reports the concept of agoraphobia has been retained. Westphal's important paper was based on detailed observations of only three patients; rather surprisingly all were men, for two-thirds of most subsequent series of patients with agoraphobia have been women.3 Nevertheless, Westphal's men had much the same fears that agoraphobic patients tell their doctors about today: they felt anxious not only in the street but also in crowded places indoors; and, like our patients today, they were less anxious when a trusted companion was present. Nowadays our agoraphobics tell us about anxiety in crowded shops and buses, rather than the churches and theatres that Westphal described, but these variations reflect social changes rather than any fundamental difference in the disorder. Modern accounts of agoraphobia also emphasise that anxiety is not just an automatic response to circumstances: the patient's thoughts are also important both at the time he enters these places and when he anticipates doing so. Though this aspect of the disorder was not emphasised by Westphal, the phenomenon is not new, for it was referred to by Cordes4 in a paper written in the same year. Despite this reassuring sameness of the clinical picture over the years some authors doubt whether agoraphobia is a primary syndrome. Thus Snaith5 has written that it is "a misleading diagnostic label for a group of conditions which are not homogeneous and have in common only a certain type of feared situation," and others have expressed similar doubts.6 7 They point out that fears of going out into open spaces and crowds are common in anxiety states and depressive disorders and go on to suggest that whenever these phobic symptoms occur they are merely an …