Hostname: page-component-8448b6f56d-c4f8m Total loading time: 0 Render date: 2024-04-20T04:13:48.677Z Has data issue: false hasContentIssue false

The Panic-Agoraphobic Spectrum: Rationale, Assessment, and Clinical Usefulness

Published online by Cambridge University Press:  07 November 2014


This paper describes a model of psychopathology termed the panic-agoraphobic spectrum. The model has been constructed by identifying different psychopathologic and clinical domains that incorporate and extend the diagnosis of panic disorder as described in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV).

Categorical classifications do not take into account the subthreshold, atypical, and often enduring symptoms that accompany the core manifestations of full-blown mental disorders. These often-neglected spectrums of symptoms, however, may be as distressing and debilitating as the full-blown disorders and can have unrecognized importance in selection of and response to treatment. At the Department of Psychiatry, Neurobiology, Pharmacology, and Biotechnology, Institute of Psychiatry of the University of Pisa, Italy, a spectrum approach to mental disorders (eg, bipolar, obsessive-compulsive, eating, and panic disorders) has been used extensively and has proven effective in clinical practice.

The need for systematic identification and assessment of a broad array of symptoms and behavioral features has led, as a first step, to the conceptualization of the panic-agoraphobic spectrum model. In collaboration with researchers from the University of Pittsburgh, PA, and elsewhere, the University of Pisa scientists have further refined the panic-agoraphobic spectrum model and have developed a structured interview for this spectrum called the Structured Clinical Interview for Panic-Agoraphobic Spectrum. The rationale, clinical usefulness, and heuristic significance of the panic-agoraphobic spectrum model are discussed below.

Feature Articles
Copyright © Cambridge University Press 1998

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)



1.Angst, J. Recurrent brief psychiatric syndromes hypomania, depression, anxiety and neurasthenia. In: Judd, LL, Saletu, B, Filip, V, eds. Basic and Clinical Science of Mental and Addictive Disorders. Basel, Switzerland: Karger; 1997:3338.Google Scholar
2.Spitzer, R, Endicott, J, Robins, E. Research diagnostic criteria. Arch Gen Psychiatry. 1978;35:773782.Google Scholar
3.American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th edition (DSM-IV). Washington, DC: American Psychiatric Association; 1994.Google Scholar
4.World Health Organization. International Statistical Classification of Diseases and Related Health Problems. Geneva: World Health Organization; 1992.Google Scholar
5.Kety, SS, Rosenthal, D, Wender, D, Schulsinger, F, Jacobsen, B. The types and prevalence of mental illness in the biological and adoptive families of adopted schizophrenics. J Psychiatr Res. 1968;6:345362.CrossRefGoogle Scholar
6.Akiskal, HS. The bipolar spectrum: new concepts in classification and diagnosis. In: Grinspoon, L, ed. Psychiatry Update. Vol 2. Washington, DC: American Psychiatric Press; 1983:271292.Google Scholar
7.Hollander, E. Obsessive-compulsive spectrum disorders: an overview. Psychiatr Ann. 1993;23:355358.Google Scholar
8.Deltito, JA, Perugi, G, Maremmani, I, Mignani, V, Cassano, GB. The importance of separation anxiety in the differentiation of panic disorder from agoraphobia. Psychiatr Dev. 1986;4:227236.Google ScholarPubMed
9.Klein, DF. Anxiety reconceptualized. In: Klein, DF, Rabkin, JG, eds. Anxiety: New Research and Changing Concepts. New York, NY: Raven Press; 1981:235265.Google Scholar
10.Kushner, MG, Beitman, BD. Panic attacks without fear: an overview. Behav Res Ther. 1990;28:469479.Google Scholar
11.Jones, BA. Panic attacks with panic masked by alexithymia. Psychosomatics. 1984;25:858859.Google Scholar
12.Rosenbaum, JF. Limited-symptoms panic attacks. Psychosomatics. 1987;28:407412.Google Scholar
13.Norton, GR, Cairns, SL, Wozney, KA, Malan, J. Panic attacks and psychopathology in nonclinical panickers. J Anxiety Disord. 1988;2:319331.Google Scholar
14.Fyer, AJ, Mannuzza, S, Martin, LY, et al.Reliability of anxiety assessment. II: symptom agreement. Arch Gen Psychiatry. 1989;46:11021110.CrossRefGoogle ScholarPubMed
15.Linzer, M, Varia, I, Pontinen, M, Divine, GW, Grubb, BP, Estes, NA. Medically unexplained syncope: relationship to psychiatric illness. Am J Med. 1992;92:18S25S.Google Scholar
16.Craske, MG, Barlow, DH, Nocturnal panic. J Nerv Ment Dis. 1989;177:160167.Google Scholar
17.Orenstein, H. Briquet's syndrome in association with depression and panic: a reconceptualization of Briquet's syndrome. Am J Psychiatry. 1989;146:334338.Google Scholar
18.Liskov, B, Othmer, E, Penick, EC, Souza, CD, Gabrielli, W. Is Briquet's syndrome a heterogeneous disorder? Am J Psychiatry. 1986;143:626629.Google Scholar
19.Roth, WT, Margraf, J, Ehlers, A, et al.Stress test reactivity in panic disorder. Arch Gen Psychiatry. 1992;49:301310.Google Scholar
20.McCann, UD, Ricaurte, GA. MDMA (ecstasy) and panic disorder: induction by a single dose. Biol Psychiatry. 1992;32:950953.CrossRefGoogle ScholarPubMed
21.Nutt, DJ, Lawson, C. Panic attacks: a neurochemical overview of model and mechanisms. Br J Psychiatry. 1992;160:165178.Google Scholar
22.Sheehan, DV. Current concepts in psychiatry: panic attacks and phobias. N Engl J Med. 1982;307:156158.CrossRefGoogle ScholarPubMed
23.Breier, A, Charney, DS, Heninger, GR. Agoraphobia with panic attacks: development, diagnostic stability, and course of illness. Arch Gen Psychiatry. 1986;43:10291036.CrossRefGoogle ScholarPubMed
24.Lelliott, P, Marcks, I, McNamee, G, Tobena, A. Onset of panic disorder with agoraphobia: toward an integrated model. Arch Gen Psychiatry. 1989;46:10001004.Google Scholar
25.Roth, M. The panic-agoraphobic syndrome: a paradigm of the anxiety group of disorders and its implications for psychiatric practice and theory. Am J Psychiatry. 1996;153(suppl 7):111124.Google Scholar
26.Klein, DF. False suffocation alarms, spontaneous panics, and related conditions: an integrative hypothesis. Arch Gen Psychiatry. 1993;50:306317.Google Scholar
27.Argyle, N, Roth, M. The definition of panic attacks, part I. Psychiatr Dev. 1989;7:175186.Google Scholar
28.Argyle, N, Roth, M. The relationship of panic attacks to anxiety states and depression. In: Shagass, C, ed. Biological Psychiatry: Developments in Psychiatry. New York, NY: Elsevier; 1986:460465.Google Scholar
29.Perugi, G, Simonini, E, Savino, M, Mengali, F, Cassano, GB, Akiskal, HS. Primary and secondary social phobia: psychopathologic and familial differentiations. Compr Psychiatry. 1990;31:245252.CrossRefGoogle ScholarPubMed
30.Liebowitz, MR, Gorman, JM, Fyer, AJ, Klein, DF. Social phobia: review of a neglected anxiety disorder. Arch Gen Psychiatry. 1985;42:729736.Google Scholar
31.Barsky, AJ, Barnett, MC, Cleary, PD. Hypochondriasis and panic disorder: boundary and overlap. Arch Gen Psychiatry. 1994;51:918925.Google Scholar
32.Schmidt, AJM. Bottlenecks in the diagnosis of hypochondriasis. Compr Psychiatry. 1994;35:306315.Google Scholar
33.Barlow, DH. Current models of panic disorder and a view from emotion theory. In: Frances, AJ, Hales, RE, eds. American Psychiatric Press Review of Psychiatry. Vol 7. Washington DC: American Psychiatric Press; 1988:1028.Google Scholar
34.Salkovskis, PM. Phenomenology, assessment, and the cognitive model of panic. In: Rachman, S, Maser, JD, eds. Panic: Psychologic Perspectives. Hillsdale, NJ: Lawrence Erlbaum Associates; 1988:111136.Google Scholar
35.Cassano, GB, Michelini, S, Shear, MK, Coli, E, Maser, JD, Frank, E. The panic-agoraphobic spectrum: a descriptive approach to the assessment and treatment of subtle symptoms. Am J Psychiatry. 1997;154(suppl 6):2738.Google Scholar