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January 1980

Treatment of Endogenous Anxiety With Phobic, Hysterical, and Hypochondriacal Symptoms

Author Affiliations

From the Department of Psychosomatic Medicine Clinic, Massachusetts General Hospital, and Harvard Medical School, Boston (Dr Sheehan), the Biological Psychiatry Branch, National Institute of Mental Health, Bethesda, Md (Dr Ballenger), and Westwood Lodge Hospital, Westwood, Mass (Dr Jacobsen). Dr Ballenger is now with the Department of Behavioral Medicine and Psychiatry, University of Virginia School of Medicine, Charlottesville.

Arch Gen Psychiatry. 1980;37(1):51-59. doi:10.1001/archpsyc.1980.01780140053006

• Endogenous anxiety (anxiety hysteria, agoraphobia with panic attacks) is characterized by sudden, spontaneous panic attacks accompanied by multiple autonomic symptoms, overwhelming fear, a flight response, and polyphobic behavior. Psychotherapy, behavior therapy, and tranquilizers have been of limited success in treating this syndrome. Fifty-seven patients severely disabled by the syndrome for a mean period of 13 years completed the three-month study. Randomly assigned in a double-blind, placebo-controlled design to imipramine hydrochloride, phenelzine sulfate, or placebo, they were seen in supportive group therapy every two weeks. Patients in the phenelzine and imipramine cells showed significant improvement over patients in the placebo group and over baseline on all outcome measures. The persistent trend for phenelzine to be superior to imipramine achieved significance only on the Work and Social Disability Scale and the Symptom Severity and Phobic Avoidance Scale. The implications for classification and theory are discussed.