The problem of which cues, internal or external, permit a person to label and identify his own emotional state has been with us since the days that James (1890) first tendered his doctrine that \"the bodily changes follow directly the perception of the exciting fact, and that our feeling of the same changes as they occur is the emotion\" (p. 449). Since we are aware of a variety of feeling and emotion states, it should follow from James' proposition that the various emotions will be accompanied by a variety of differentiable bodily states. Following James' pronouncement, a formidable number of studies were undertaken in search of the physiological differentiators of the emotions. The results, in these early days, were almost uniformly negative. All of the emotional states experi-

"Cognitive, social, and physiological determinants of emotional state": Erratum

Introduction to the Interpersonal Approach The Interpersonal Motive as an Explanatory Construct Attachment and the Stress of Separation Communion and Agency in Interpersonal Interactions The Self-Image and Interpersonal Processes The Dependent and Avoidant Personality Disorders The Obsessive-Compulsive and Paranoid Personality Disorders Syndromes and Axis I Disorders: Depressive and Panic Disorders Difficulty Regulating Impulses, Thoughts, and Behavior: Obsessive-Compulsive Disorders and Eating Disorders Diffuse Identity and Lack of Long-Term Direction: The Histrionic Personality Disorder and Other Related Disorders Split Identity and Instability: Borderline Personality Disorder and Related Conditions Schizophrenia and Related Disorders Summary and Conclusions

Interpersonal foundations of psychopathology.

• A review of the life-time occurrence of major depression, the temporal relationship of major depression to episodes of panic and agoraphobic disorders, and the severity of anxiety and depressive symptoms were determined In 60 patients with agoraphobia or panic disorder. Forty-one (68%) of the patients had a past or current episode of major depression, and 35 (85%) of these patients had endogenous-type major depression. Twenty patients (33%) had an episode of primary major depression, and an average of three years separated the end of primary major depression and the first panic attack. Secondary major depression occurred in 28 patients. Patients with a history of major depression had a more severe anxiety disorder. These data support the view that In a subgroup of patients, episodes of depression and panic anxiety disorder may be manifestations of a common underlying pathogenic process.

Major Depression in Patients With Agoraphobia and Panic Disorder

Anxious Depressions Clinical, Family History, and Naturalistic Outcome -- Comparisons with Panic and Major Depressive Disorders

• A structured psychiatric interview was used to examine the symptom history of 55 patients meeting DSM-III criteria for agoraphobia with panic attacks and five patients meeting DSM-III criteria for panic disorder. Anticipatory anxiety and generalized anxiety occurred in over 80% of the patients, and these anxiety states together with panic attacks and phobic avoidances had courses that were chronic and unremitting. Major depression occurred in 70% of the patients and had an episodic course that differentiated it from the anxiety states. Other frequently reported disorders were childhood separation disorder (18%), alcoholism (17%), and obsessive compulsive disorder (17%). An initial nonspontaneous first panic attack and separation anxiety was associated with earlier onset and longer duration of agoraphobia and panic disorder. An inaccurate cognitive appraisal of the initial panic attack frequently led to the rapid development of subsequent agoraphobia. Caffeine consumption exacerbated anxiety in 54% of the patients and triggered panic attacks in 17%. Fifty-one percent of female agoraphobics experienced premenstrual exacerbation of anxiety symptoms.

https://jamanetwork.com/journals/PSYCH/articlepdf/493912/archpsyc_43_11_003.pdf

Agoraphobia With Panic Attacks: Development, Diagnostic Stability, and Course of Illness

Detailed clinical records were kept on a series of 55 agoraphobic patients who presented to a general hospital psychiatric practice over a 3 year period. A review of the records revealed that 91% of these patients were diagnosed as suffering from a unipolar or bipolar primary affective disorder. The anxiety and phobic symptoms tended to mask the presence of the affective disorder. This observation is consistent with most of the published data on the agoraphobic syndrome. It could also explain the inconsistent effects of treatment of agoraphobia compared with simple phobias. The possible biological and psychological connections between primary affective disorders and the agoraphobic syndrome are discussed.

J. Kohout

Papers

The Relationship between Agoraphobia and Primary Affective Disorders