Agoraphobia: a review of the diagnostic classificatory position and criteria

Abstract

The status of agoraphobia (AG) as an independent diagnostic category is reviewed and preliminary options and recommendations for the fifth edition of The Diagnostic and Statistical Manual (DSM-V) are presented. The review concentrates on epidemiology, psychopathology, neurobiology, vulnerability and risk factors, clinical course and outcome, and correlates and consequences of AG since 1990. Differences and similarities across conventions and criteria of DSM and ICD-10 are considered. Three core questions are addressed. First, what is the evidence for AG as a diagnosis independent of panic disorder? Second, should AG be conceptualized as a subordinate form of panic disorder (PD) as currently stipulated in DSM-IV-TR? Third, is there evidence for modifying or changing the current diagnostic criteria? We come to the conclusion that AG should be conceptualized as an independent disorder with more specific criteria rather than a subordinate, residual form of PD as currently stipulated in DSM-IV-TR. Among other issues, this conclusion was based on psychometric evaluations of the construct, epidemiological investigations which show that AG can exist independently of panic disorder, and the impact of agoraphobic avoidance upon clinical course and outcome. However, evidence from basic and clinic validation studies remains incomplete and partly contradictory. The apparent advantages of a more straightforward, simpler classification without implicit hierarchies and insufficiently supported differential diagnostic considerations, plus the option for improved further research, led to favoring the separate diagnostic criteria for AG as a diagnosis independent of panic disorder.

Anxiety disorders in young people: a population-based study

“…It should be noted that the prevalence found in our study refers to agoraphobia without a history of PD. 23 We found similar prevalences of PD to those reported in the literature. Kessler et al found that 2.7% of participants had PD in the U.S. National Comorbidity Survey Replication; in our study, we found a prevalence of 2.5%.…”

Depression Does Not Affect the Treatment Outcome of CBT for Panic and Agoraphobia: Results from a Multicenter Randomized Trial

“…As expected from epidemiological surveys, a substantial proportion of our patients with primary PD/AG [66,67] suffered from a comorbid depressive disorder (MDE and/or dysthymia; 43%). This rate was somewhat higher than those found in several other treatment studies of PD/AG (13% [40], 23% [37], 21% [43], 18% [30]) or PD with or without AG (19% [23], 12% [27], 30% [44]), but similar to the one reported by Starcevic et al (48%) [57].…”

Long-term stability of cognitive behavioral therapy effects for panic disorder with agoraphobia: A two-year follow-up study

“…This is important because evidence has cumulated that panic attacks, panic disorder, and agoraphobia are often independent Wittchen et al 2008;Wittchen, Gloster, Beesdo-Baum, Fava, & Craske, 2010), that agoraphobic avoidance is as important if not more so for long-term outcome (Fava et al, 1995), and recent emphasize on how one reacts to the attacks as opposed to the occurrence of the attacks themselves (Eifert & Forsyth, 2005).…”