DSM-IV AND THE DISAPPEARANCE OF AGORAPHOBIA WITHOUT A HISTORY OF PANIC DISORDER - NEW DATA ON A CONTROVERSIAL DIAGNOSIS

Objective: This analysis describes subjects who met vigorous criteria for DSM-III-R agoraphobia without a history of panic disorder and make s inferences from these data regarding relationships among agoraphobia without a history of panic disorder, panic disorder, and panic disord er with agoraphobia. Method: Twenty-six subjects (seven men and 19 wom en) with agoraphobia without a history of panic disorder were identifi ed from among 711 subjects recruited for a multicenter, longitudinal a nxiety disorder study. Narrative transcripts prepared by raters from s tudy evaluations were coded for limited symptom attacks, situational p anic, catastrophic cognitions, and possible precipitants and stressors , course, and somatic and psychosocial treatments received. Results: S ixty-five percent of the subjects reported experiences consistent with situational panic attacks, and 57% had definite or probable limited s ymptom attacks; these attacks usually preceded or appeared at the same time as avoidance behavior. Eighty-one percent had catastrophic cogni tions associated with agoraphobia. Twenty-six percent reported a likel y 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. Cou rse was relatively unchanged across the follow-tip period. Conclusions : These data support a view of agoraphobia without a history of panic disorder on a continuum with uncomplicated panic disorder and with pan ic disorder and agoraphobia, rather than as a separate diagnosis.