Agoraphobia is a distinct disorder

A epidemiological study conducted by Hans-Ulrich Wittchen and colleagues at the University of Dresden has found that agoraphobia is a distinct disorder independent of panic disorder.

The aim of this study was to prospectively examine the 10-year natural course of panic attacks, panic disorder and agoraphobia in the first three decades of life, their stability and their reciprocal transitions.

The syndromes were assessed in a 10-year prospective-longitudinal community study of 3,021 subjects aged 14-24 years at the beginning of the study.

At the end of the study, incidence patterns for panic attacks (9.4%), panic disorder (with and without agoraphobia: 3.4%) and agoraphobia (5.3%) revealed differences in age of onset, incidence risk and gender differentiation.

Temporally primary panic attacks and panic disorder revealed only a moderately increased risk for subsequent onset of agoraphobia, and primary agoraphobia had an even lower risk for subsequent panic attacks and panic disorder.

In prospective analyses, all baseline groups (panic attacks, panic disorder, agoraphobia) had low remission rates (0-23%). Baseline panic disorder with agoraphobia or agoraphobia with panic attacks were more likely to have follow-up agoraphobia, panic attacks and other anxiety disorders and more frequent complications (impairment, disability, help-seeking, comorbidity) as compared to panic disorder without agoraphobia and agoraphobia without panic attacks.

Differences in incidence patterns, syndrome progression and outcome, and syndrome stability over time indicate that agoraphobia exists as a clinically significant phobic condition independent of panic disorder. The majority of agoraphobic subjects in this community sample never experienced panic attacks, calling into question the current pathogenic assumptions underlying the classification of agoraphobia as merely a consequence of panic. The findings point to the necessity of rethinking diagnostic concepts and DSM diagnostic hierarchies.

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Wittchen HU, Nocon A, Beesdo K, et al. Agoraphobia and Panic. Psychother Psychosom 2008;77:147-157   [Abstract]