Skip to main content Accessibility help

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

  • Giovanni B. Cassano, Alessandro Rotondo, Jack D. Maser, M. Katherine Shear, Ellen Frank, Mauro Mauri and Liliana Dell'Osso...


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.



Hide All
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.
2.Spitzer, R, Endicott, J, Robins, E. Research diagnostic criteria. Arch Gen Psychiatry. 1978;35:773782.
3.American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th edition (DSM-IV). Washington, DC: American Psychiatric Association; 1994.
4.World Health Organization. International Statistical Classification of Diseases and Related Health Problems. Geneva: World Health Organization; 1992.
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.
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.
7.Hollander, E. Obsessive-compulsive spectrum disorders: an overview. Psychiatr Ann. 1993;23:355358.
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.
9.Klein, DF. Anxiety reconceptualized. In: Klein, DF, Rabkin, JG, eds. Anxiety: New Research and Changing Concepts. New York, NY: Raven Press; 1981:235265.
10.Kushner, MG, Beitman, BD. Panic attacks without fear: an overview. Behav Res Ther. 1990;28:469479.
11.Jones, BA. Panic attacks with panic masked by alexithymia. Psychosomatics. 1984;25:858859.
12.Rosenbaum, JF. Limited-symptoms panic attacks. Psychosomatics. 1987;28:407412.
13.Norton, GR, Cairns, SL, Wozney, KA, Malan, J. Panic attacks and psychopathology in nonclinical panickers. J Anxiety Disord. 1988;2:319331.
14.Fyer, AJ, Mannuzza, S, Martin, LY, et al.Reliability of anxiety assessment. II: symptom agreement. Arch Gen Psychiatry. 1989;46:11021110.
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.
16.Craske, MG, Barlow, DH, Nocturnal panic. J Nerv Ment Dis. 1989;177:160167.
17.Orenstein, H. Briquet's syndrome in association with depression and panic: a reconceptualization of Briquet's syndrome. Am J Psychiatry. 1989;146:334338.
18.Liskov, B, Othmer, E, Penick, EC, Souza, CD, Gabrielli, W. Is Briquet's syndrome a heterogeneous disorder? Am J Psychiatry. 1986;143:626629.
19.Roth, WT, Margraf, J, Ehlers, A, et al.Stress test reactivity in panic disorder. Arch Gen Psychiatry. 1992;49:301310.
20.McCann, UD, Ricaurte, GA. MDMA (ecstasy) and panic disorder: induction by a single dose. Biol Psychiatry. 1992;32:950953.
21.Nutt, DJ, Lawson, C. Panic attacks: a neurochemical overview of model and mechanisms. Br J Psychiatry. 1992;160:165178.
22.Sheehan, DV. Current concepts in psychiatry: panic attacks and phobias. N Engl J Med. 1982;307:156158.
23.Breier, A, Charney, DS, Heninger, GR. Agoraphobia with panic attacks: development, diagnostic stability, and course of illness. Arch Gen Psychiatry. 1986;43:10291036.
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.
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.
26.Klein, DF. False suffocation alarms, spontaneous panics, and related conditions: an integrative hypothesis. Arch Gen Psychiatry. 1993;50:306317.
27.Argyle, N, Roth, M. The definition of panic attacks, part I. Psychiatr Dev. 1989;7:175186.
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.
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.
30.Liebowitz, MR, Gorman, JM, Fyer, AJ, Klein, DF. Social phobia: review of a neglected anxiety disorder. Arch Gen Psychiatry. 1985;42:729736.
31.Barsky, AJ, Barnett, MC, Cleary, PD. Hypochondriasis and panic disorder: boundary and overlap. Arch Gen Psychiatry. 1994;51:918925.
32.Schmidt, AJM. Bottlenecks in the diagnosis of hypochondriasis. Compr Psychiatry. 1994;35:306315.
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.
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.
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.

Related content

Powered by UNSILO

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

  • Giovanni B. Cassano, Alessandro Rotondo, Jack D. Maser, M. Katherine Shear, Ellen Frank, Mauro Mauri and Liliana Dell'Osso...


Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed.