THE PANIC AGORAPHOBIC SPECTRUM - A DESCRIPTIVE APPROACH TO THE ASSESSMENT AND TREATMENT OF SUBTLE SYMPTOMS

Objective: Psychiatric classification is still a topic of considerable discussion and debate in spite of major advances in the past two deca des. The debate involves categorical versus dimensional approaches, cu toff numbers of symptoms to define a case, degree of impairment, objec tive diagnostic criteria versus more theoretically based criteria, epi sodic versus trait-like symptoms, and the role of atypical and subclin ical symptoms. All of these issues have been raised for the anxiety di sorders and depression. This article presents the conceptualization of a relatively novel and testable approach to the diagnosis and classif ication of panic and agoraphobia, the panic-agoraphobic spectrum, and pilot data on a new questionnaire to assess it. Method: Pilot testing of the Panic-Agoraphobic Spectrum Questionnaire was undertaken with 10 0 inpatients who had lifetime diagnoses of panic disorder, unipolar de pression, comorbid panic and unipolar depressive disorders, or an eati ng disorder. The instrument emphasizes impairment related to 144 behav iors and experiences in seven panic-agoraphobic symptom domains. Resul ts: Patients with panic disorder scored highest on the questionnaire, and those with comorbid depression showed even greater severity of ill ness. The scores of the patients with eating disorders and of the depr essed patients differed from those of the other groups but also differ ed from 0. Conclusions: The spectrum model of panic and agoraphobia is a flexible and comprehensive means of describing this clinical comple x. The proposed model, complementary to the categorical approach, pres umably expresses a unitary pathophysiology. Its usefulness is discusse d in terms of its value for patient-therapist communication, outcome m easures, identification of subtle personality traits, and subtyping of patients for research and treatment.