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The Interrelationship of Agoraphobia, Social Phobia, Situational Phobia, and Simple Phobia

Kenneth S. Kendler, MD; Michael C. Neale, PhD; Ronald C. Kessler, PhD; Andrew C. Heath, DPhil; Lindon J. Eaves, PhD, DSc

Arch Gen Psychiatry. 1992;49(4):273-281.

Abstract
• In 2163 personally interviewed female twins from a population-based registry, the pattern of age at onset and comorbidity of the simple phobias (animal and situational) — early onset and low rates of comorbidity—differed significantly from that of agoraphobia—later onset and high rates of comorbidity. Consistent with an inherited "phobia proneness" but not a "social learning" model of phobias, the familial aggregation of any phobia, agoraphobia, social phobia, and animal phobia appeared to result from genetic and not from familial-environmental factors, with estimates of heritability of liability ranging from 30% to 40%. The bestfitting multivariate genetic model indicated the existence of genetic and individual-specific environmental etiologic factors common to all four phobia subtypes and others specific for each of the individual subtypes. This model suggested that (1) environmental experiences that predisposed to all phobias were most important for agoraphobia and social phobia and relatively unimportant for the simple phobias, (2) environmental experiences that uniquely predisposed to only one phobia subtype had a major impact on simple phobias, had a modest impact on social phobia, and were unimportant for agoraphobia, and (3) genetic factors that predisposed to all phobias were most important for animal Phobia and least important for agoraphobia. Simple phobias appear to arise from the joint effect of a modest genetic vulnerability and phobia-specific traumatic events in childhood, while agoraphobia and, to a somewhat lesser extent, social phobia result from the combined effect of a slightly stronger genetic influence and nonspecific environmental experiences.

Author Affiliations
From the Departments of Psychiatry (Dr Kendler) and Human Genetics (Drs Kendler, Neale, and Eaves), Medical College of Virginia/Virginia Commonwealth University, Richmond; the Institute for Social Research, University of Michigan, Ann Arbor (Dr Kessler); and the Department of Psychiatry, Washington University School of Medicine, St Louis, Mo (Dr Heath).

Footnotes
Accepted for publication July 24, 1991.

Reprint requests to Department of Psychiatry, Medical College of Virginia, Box 710, Richmond, VA 23298-0710 (Dr Kendler).

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