Parental bonding, pathological development, and fear of losing control among agoraphobics and normals

With its often crippling fears, Agoraphobia has been identified for more than a century, and has become the most commonly treated phobic disorder. An yet, despite extensive research and theoretical attention, it remains largely a tragic, if fascinating, enigma. Traditional theories have proven inadequate to account for it, or to unravel its complex etiology. The most useful models have taken a developmental perspective, integrated diverse theoretical positions, and sought empirical verification. Bowlby has suggested that adult-onset agoraphobia may begin during childhood, in pathological parent-child attachments that undermine development and engender pervasive insecurity and separation anxiety. Rigorously testing a developmental model poses daunting methodological constraints. Still, there is considerable clinical lore and provocative, if limited, empirical support suggesting that attachment theory may be a promising framework for an integrated understanding of agoraphobia. The present investigation was designed to explore this perspective by examining the relationship between parental bonding and subsequent psychopathology, including chronic fears of losing control. Study 1 involved 88 Agoraphobics and 88 matched Normals. Bonding, assessed as care and overprotection for each parent, was compared to dependent measures tapping fears of losing control, impaired trust, phobic avoidance, dysphoric mood, histories of major depression and childhood separation anxiety, and selected aspects of developmental and family history. Study 2 involved 31 Agoraphobics and 36 Normals in an experimental test of relaxation-induced anxiety (RIA), as one of several measures of fear of losing control. Approval motives and socioeconomic status were controlled statistically in both studies. Agoraphobics perceived their parents as more uncaring and overprotective than Normals, were more likely to have been physically abused, experienced more fear of losing control, and were more untrusting of their intimate partners. For both Normals and Agoraphobics, unfavorable parental bonding was linked with pervasive fears of losing control, impaired trust/rapport, and more phobic avoidance and dysphoria. As predictors of pathology, parental overprotection was as important as lack of care, and fathering played as central a role as mothering. These findings lend modest, though not unequivocal, support to Bowlby's view that agoraphobia is linked with pathogenic parent-child attachments. Anomalous findings are considered, including implications for a diathesis model. Treatment and research suggestions are discussed.