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Agoraphobia in adults: Incidence and longitudinal relationship with panic

  • O. Joseph Bienvenu (a1), Chiadi U. Onyike (a1), Murray B. Stein (a2), Li-Shiun Chen (a3), Jack Samuels (a1), Gerald Nestadt (a1) and William W. Eaton (a4)...

Abstract

Background

Theories regarding how spontaneous panic and agoraphobia relate are based mostly on cross-sectional and/or clinic data.

Aims

To determine how spontaneous panic and agoraphobia relate longitudinally, and to estimate the incidence rate of and other possible risk factors for first-onset agoraphobia, using a general population cohort.

Method

A sample of 1920 adults in east Baltimore were assessed in 1981 -1982 and the mid-1990s with the Diagnostic Interview Schedule (DIS). Psychiatristdiagnoses were made in a subset of the sample at follow-up (n=816).

Results

Forty-one new cases of DIS/DSM–III–R agoraphobia were identified (about 2 per 1000 person-years at risk). As expected, baseline DIS/DSM-III panic disorder predicted first incidence of agoraphobia (OR=12, 95% CI 3.2-45), as did younger age, female gender and other phobias. Importantly, baseline agoraphobia without spontaneous panic attacks also predicted first incidence of panic disorder (OR=3.9, 95% CI 1.8-8.4). Longitudinal relationships between panic disorder and psychiatrist-confirmed agoraphobia were strong (panic before agoraphobia OR=20, 95% CI 2.3–180; agoraphobia before panic OR=16, 95% CI 3.2–78).

Conclusions

The implied one-way causal relationship between spontaneous panic attacks and agoraphobia in DSM–IV appears incorrect.

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Copyright

Corresponding author

Dr O. J. Bienvenu, 600 North Wolfe Street, Meyer 101, Baltimore, MD 21287, USA. Tel: +1 410 614 9063; fax: +1 410 614 5913; e-mail: jbienven@jhmi.edu

Footnotes

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Declaration of interest

None.

Footnotes

References

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American Psychiatric Association (1980) Diagnostic and Statistical Manual of Mental Disorders (3rd edn) (DSM-III). Washington, DC: APA.
American Psychiatric Association (1987) Diagnostic and Statistical Manual of Mental Disorders (3rd edn, revised) (DSM–III–R). Washington, DC: APA.
American Psychiatric Association (1994) Diagnostic and Statistical Manual of Mental Disorders (4th edn) (DSM–IV). Washington, DC: APA.
American Psychiatrie Association (2000) Diagnostic and Statistical Manual of Mental Disorders (4th edn, text revision) (DSM–IV–TR). Washington, DC: APA.
Andrews, G. & Slade, T. (2002) Agoraphobia without a history of panic disorder may be part of the panic disorder syndrome. Journal of Nervous and Mental Disease, 190, 624630.
Argyle, N. & Roth, M. (1989) The phenomenological study of 90 patients with panic disorder. Psychiatric Developments, 3, 187209.
Arrindell, W. A., Eisemann, M., Richter, J., et al (2003) Phobic anxiety in 11 nations. Part I: Dimensional constancy of the five-factor model. Behaviour Research and Therapy, 41, 461479.
Badawi, M. A., Eaton, W. W., Myllyluoma, J., et al (1999) Psycho pathology and attrition in the Baltimore ECA 15-year follow-up 1981–1996. Social Psychiatry and Psychiatric Epidemiology, 34, 9198.
Boyd, J. H., Robins, L. N., Holzer, C. E., et al (1985) Making diagnoses from DIS data. In Epidemiologic Field Methods in Psychiatry: The NIMH Epidemiologic Catchment Area Program (eds Eaton, WW & Kessler, L. G.), pp. 209231. Orlando, FL: Academic Press.
Cox, B. J., McWilliams, L. A., Clara, I. P., et al (2003) The structure of feared situations in a nationally representative sample. Journal of Anxiety Disorders, 17, 89101.
Craske, M. G. (1996) Is agoraphobic avoidance secondary to panic attacks? In DSM-IV Sourcebook (eds Widiger, T. A., Frances, A. J., Pincus, H. A., et al), pp. 448459. Washington, DC: American Psychiatric Association.
Eaton, W. W. & Keyl, P. (1990) Risk factors for the onset of Diagnostic Interview Schedule/DSM–III agoraphobia in a prospective, population-based study. Archives of General Psychiatry, 47, 819824.
Eaton, W. W., Anthony, J. C., Gallo, J., et al (1997) Natural history of Diagnostic Interview Schedule/DSM–IV major depression: the Baltimore Epidemiologic Catchment Area follow-up. Archives of General Psychiatry, 54, 993999.
Eaton, W. W., Anthony, J. C., Romanoski, A., et al (1998) Onset and recovery from panic disorder in the Baltimore Epidemiologic Catchment Area follow-up. British Journal of Psychiatry, 173, 501507.
Faravelli, C., Abrardi, L., Bartolozzi, D., et al (2004) The Sesto Fiorentino study: point and one-year prevalences of psychiatric disorders in an Italian community sample using clinical interviewers. Psychotherapy and Psychosomatics, 73, 226234.
Fava, G. A. & Mangelli, L. (1999) Subclinical symptoms of panic disorder: new insights into pathophysiology and treatment. Psychotherapy and Psychosomatics, 68, 281289.
Fava, G. A., Kellner, R. & Zielezny, M. A. (1988) Prodromal symptoms in panic disorder with agoraphobia. American Journal of Psychiatry, 145, 15641567.
Hayward, C., Killen, J. D. & Taylor, C. B. (2003) The relationship between agoraphobia symptoms and panic disorder in a non-clinical sample of adolescents. Psychological Medicine, 33, 733738.
Hettema, J. M., Prescott, C. A., Myers, J. M., et al (2005) The structure of genetic and environmental risk factors for anxiety disorders in men and women. Archives of General Psychiatry, 62, 182189.
Horwath, E., Lish, J. D., Johnson, J., et al (1993) Agoraphobia without panic: clinical reappraisal of an epidemiologic finding. American Journal of Psychiatry, 150, 14961501.
Kessler, L. G., Folsom, R., Royall, R., et al (1985) Parameter and variance estimation. In Epidemiologic Field Methods in Psychiatry: The NIMH Epidemiologic Catchment Area Program ((eds Eaton, WW & Kessler, L. G.), pp. 327349. Orlando, FL: Academic Press.
Kessler, R. C., McGonagle, K. A., Zhao, S., et al (1994) Lifetime and 12-month prevalence of DSM–III–R psychiatric disorders in the United States: results from the National Comorbidity Survey. Archives of General Psychiatry, 51, 819.
Klein, D. F. (1980) Anxiety reconceptualized. Comprehensive Psychiatry, 21, 411427.
Krueger, R. F. (1999) The structure of common mental disorders. Archives of General Psychiatry, 56, 921926.
Lelliott, P., Marks, I., McNamee, G., et al (1989) Onset of panic disorder with agoraphobia: toward an integrated model. Archives of General Psychiatry, 46, 10001004.
Marks, I. M. (1987a) The agoraphobic syndrome (panic disorder with agoraphobia). In Fears, Phobias, and Rituals: Panic, Anxiety, and Their Disorders, pp. 323361. New York: Oxford University Press.
Marks, I. M. (1987b) Phobic and obsessive-compulsive phenomena: classification, prevalence, and relationship to other problems. In Fears, Phobias, and Rituals: Panic, Anxiety, and Their Disorders, pp. 290296. New York: Oxford University Press.
Regier, D., Myers, J., Kramer, M., et al (1984) The NIMH Epidemiologic Catchment Area program: historical context, major objectives, and study population characteristics. Archives of General Psychiatry, 41, 934941.
Robins, L. N., Helzer, J. E., Croughan, J., et al (1981) National Institute of Mental Health Diagnostic Interview Schedule: its history, characteristics and validity. Archives of General Psychiatry, 38, 381389.
Rubio-Stipec, M., Freeman, D. H., Robins, L., et al (1992) Response error and the estimation of lifetime prevalence and incidence of alcoholism: experience in a community survey. International Journal of Methods in Psychiatric Research, 2 217224.
Samuels, J., Eaton, W. W., Bienvenu, O. J., et al (2002) Prevalence and correlates of personality disorders in a community sample. British Journal of Psychiatry, 180, 536542.
Tyrer, P. (1985) Neurosis divisible? Lancet, i, 685688.
Weissman, M. M., Leaf, P. J., Blazer, D. G., et al (1986) The relationship between panic disorder and agoraphobia: an epidemiologic perspective. Psychopharmacology Bulletin, 22, 787791.
Wing, J. K., Babor, T., Brugha, T., et al (1990) SCAN: Schedules for Clinical Assessment in Neuropsychiatry. Archives of General Psychiatry, 47, 589593.
Wittchen, H.-U., Reed, V. & Kessler, R. C. (1998) The relationship of agoraphobia and panic disorder in a community sample of adolescents and young adults. Archives of General Psychiatry, 55, 10171024.
World Health Organization (1993) The ICD-10 Classification of Mental and Behavioural Disorders: Diagnostic Criteria for Research. Geneva: WHO.

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Agoraphobia in adults: Incidence and longitudinal relationship with panic

  • O. Joseph Bienvenu (a1), Chiadi U. Onyike (a1), Murray B. Stein (a2), Li-Shiun Chen (a3), Jack Samuels (a1), Gerald Nestadt (a1) and William W. Eaton (a4)...
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