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The association of phobia with somatic symptoms is so frequent, and the ability of phobic patients to rationalize and conceal their phobia with the somatic symptoms so great, that many phobic, and especially agoraphobic, patients are often treated solely for their somatic symptoms by the medical practitioner while the phobia is not recognized and remains untreated. Such is also frequently the case with other neurotic disorders, particularly with certain types of depression, in which somatic symptoms prevail and mask the underlying neurosis (Sperling, 1959a).
I have analyzed a considerable number of patients with multiple phobias and with severe agoraphobia in whom the phobia had not been diagnosed and who came to me for analysis because of their somatic complaints, which had not responded to medical treatment. I have also observed that some psychoanalysts who treat phobic patients for their neurotic behavior tend to refer such patients for medical treatment of their somatic symptoms, especially when these symptoms develop during analysis or are of a very severe nature. In this way, the totality of this neurosis, which can express itself either neurotically or somatically or in a combination of both, is missed, and the somatic expressions of the phobia escape analytic investigation.
I have repeatedly seen patients who came for analysis because of phobia and character problems develop somatic symptoms during the analysis, usually at a time when the phobic mechanisms had been undermined by analysis but the
character structure of the patient had not yet been sufficiently modified. On the other hand, some patients who had somatic symptoms preceding or concomitant with their phobia were prone to act out during this phase of analysis after their somatic symptoms and phobia had subsided (Sperling, 1968).
Because such observations suggest that the psychoanalytic investigation of these phenomena could contribute to a fuller understanding of the genesis and dynamics of phobias