Am J Psychiatry 1995; 152:1438-1443
Copyright © 1995 by American Psychiatric Association
DSM-IV and the disappearance of agoraphobia without a history of panic disorder: new data on a controversial diagnosis
RM Goisman, MG Warshaw, GS Steketee, EJ Fierman, MP Rogers, I Goldenberg, NJ Weinshenker, RG Vasile and MB Keller
Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
OBJECTIVE: This analysis describes subjects who met rigorous criteria for
DSM-III-R agoraphobia without a history of panic disorder and makes
inferences from these data regarding relationships among agoraphobia
without a history of panic disorder, panic disorder, and panic disorder
with agoraphobia. METHOD: Twenty-six subjects (seven men and 19 women) with
agoraphobia without a history of panic disorder were identified from among
711 subjects recruited for a multicenter, longitudinal anxiety disorder
study. Narrative transcripts prepared by raters from study evaluations were
coded for limited symptom attacks, situational panic, catastrophic
cognitions, and possible precipitants and stressors, course, and somatic
and psychosocial treatments received. RESULTS: Sixty-five percent of the
subjects reported experiences consistent with situational panic attacks,
and 57% had definite or probable limited symptom attacks; these attacks
usually preceded or appeared at the same time as avoidance behavior.
Eighty-one percent had catastrophic cognitions associated with agoraphobia.
Twenty-six percent reported a likely precipitating factor for symptom
onset, and 30% reported a definite or probable major life stressor within 6
months before symptom onset. Cognitive-behavioral treatments were
relatively infrequently used. Course was relatively unchanged across the
follow-up period. CONCLUSIONS: These data support a view of agoraphobia
without a history of panic disorder on a continuum with uncomplicated panic
disorder and with panic disorder and agoraphobia, rather than as a separate
diagnosis.
