A comparison of DSM ‐5 and DSM ‐IV agoraphobia in the World Mental Health Surveys

Abstract

Background The Diagnostic and Statistical Manual of Mental Disorders, version 5 (DSM‐5) definition of agoraphobia (AG) as an independent diagnostic entity makes it timely to re‐examine the epidemiology of AG. Study objective was to present representative data on the characteristics of individuals who meet DSM‐IV criteria for AG (AG without a history of panic disorder [PD] and PD with AG) but not DSM‐5 criteria, DSM‐5 but not DSM‐IV criteria, or both sets of criteria. Methods Population‐based surveys from the World Mental Health Survey Initiative including adult respondents (n = 136,357) from 27 countries across the world. The Composite International Diagnostic Interview was used to assess AG and other disorders. Results Lifetime and 12‐month prevalence estimates of DSM‐5 AG (1.5% and 1.0%) were comparable to DSM‐IV (1.4% and 0.9%). Of respondents meeting criteria in either system, 57.1% met criteria in both, while 24.2% met criteria for DSM‐5 only and 18.8% for DSM‐IV only. Severe role impairment due to AG was reported by a lower proportion of respondents who met criteria only for DSM‐IV AG (30.4%) than those with both DSM‐5 and DSM‐IV AG (44.0%; χ 2 1 = 4.7; P = 0.031). The proportion of cases with any comorbidity was lower among respondents who met criteria only for DSM‐IV AG (78.7%) than those who met both sets (92.9%; χ 2 1= 14.5; P < 0.001). Conclusions This first large survey shows that, compared to the DSM‐IV, the DSM‐5 identifies a substantial group of new cases with AG, while the prevalence rate remains stable at 1.5%. Severity and comorbidity are higher in individuals meeting DSM‐5 AG criteria compared with individuals meeting DSM‐IV AG criteria only.

The Burden of Agoraphobia in Worsening Quality of Life in a Community Survey in Italy

“…The lifetime prevalence of agoraphobia found by our study is in the range of the estimates found by studies that used DSM-IV criteria for diagnosis or that have recalculated rates with DSM-5. The World Health Survey (WHS) found lifetime prevalence of agoraphobia of 1.4% according to DSM-IV criteria and 1.5% according with those of DSM-5 [ 4 ]. The National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) had found in the US a lifetime prevalence of 1.3% (as a sum of panic disorder with agoraphobia and agoraphobia without panic disorder) [ 18 ].…”

“…It should be noted, however, that the only study that used trained clinical interviewers (in Sesto Fiorentino, Italy), even with structured interviews and using DSM-IV as a criterion, lifetime prevalence figures were much lower than in the others DSM-IV surveys (0.4% versus, on average, 2.0%) and much closer to ours [ 29 ]. In the WHS database, the comparison between the diagnoses of agoraphobia without panic disorder carried out applying DSM-IV and DSM-5 criteria indicated that these two systems tend to identify different conditions under the same diagnosis [ 4 ]. Conversely, the diagnoses that are done according to the criteria of the ICD-10 are closer to the ones that are based on the criteria of the DSM-5 [ 4 ].…”

“…In the WHS database, the comparison between the diagnoses of agoraphobia without panic disorder carried out applying DSM-IV and DSM-5 criteria indicated that these two systems tend to identify different conditions under the same diagnosis [ 4 ]. Conversely, the diagnoses that are done according to the criteria of the ICD-10 are closer to the ones that are based on the criteria of the DSM-5 [ 4 ]. It should be borne in mind that the WHS study, lay interviewers applied a highly structured interview while in the present study clinicians used semi-structured interviews.…”

“…A history of childhood fears or night terrors is a frequent antecedent of agoraphobia in youths and adults [ 3 ]. The estimated lifetime prevalence is around 1.3% and the incidence rate is 0.9% with no difference between men and women [ 4 ]. There is no established treatment for agoraphobia.…”

“…Agoraphobia is currently separated from panic disorder [ 4 , 7 ]. The new category has made it possible to better define a nonnegligible share of people with agoraphobia without the panic disorder in the general population and to start defining agoraphobia as a disorder per se with a great impact on the wellbeing of the individual regardless of the presence of the concomitance or not of panic disorder [ 4 ].…”