Agoraphobia Is A Disease
March 28, 2008
A landmark epidemiological study has been published in the third 2008 issue of
Psychotherapy and Psychosomatics by H.U. Wittchen and collaborators at the
University of Dresden.
The aim of this study was to prospectively examine the 10-year natural course of
panic attacks (PA), panic disorder (PD) and agoraphobia (AG) in the first three
decades of life, their stability and their reciprocal transitions. DSM-IV
syndromes were assessed via Composite International Diagnostic Interview -
Munich version in a 10-year prospective-longitudinal community study of 3,021
subjects aged 14-24 years at baseline. At the end of the study, incidence
patterns for PA (9.4%), PD (with and without AG: 3.4%) and AG (5.3%) revealed
differences in age of onset, incidence risk and gender differentiation.
Temporally primary PA and PD revealed only a moderately increased risk for
subsequent onset of AG, and primary AG had an even lower risk for subsequent PA
and PD. In strictly prospective analyses, all baseline groups (PA, PD, AG) had
low remission rates (0-23%). Baseline PD with AG or AG with PA were more likely
to have follow-up AG, PA and other anxiety disorders and more frequent
complications (impairment, disability, help-seeking, comorbidity) as compared to
PD without AG and AG without PA.
Differences in incidence patterns, syndrome progression and outcome, and
syndrome stability over time indicate that AG exists as a clinically significant
phobic condition independent of PD. The majority of agoraphobic subjects in this
community sample never experienced PA, calling into question the current
pathogenic assumptions underlying the classification of AG as merely a
consequence of panic. The findings point to the necessity of rethinking
diagnostic concepts and DSM diagnostic hierarchies.
PSYCHOTHERAPY AND PSYCHOSOMATICS
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