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Hans-Ulrich Wittchen, PhD; Victoria Reed, PhD; Ronald C. Kessler, PhD

Arch Gen Psychiatry. 1998;55:1017-1024.

Background  Data are presented on the prevalence of DSM-IV panic and agoraphobia in a community sample of adolescents and young adults in Munich, Germany.

Methods  A total of 3021 respondents aged 14 to 24 years were assessed with a revised version of the Composite International Diagnostic Interview (CIDI). Respondents classified as having agoraphobia without panic were subtyped by number of agoraphobic trigger situations and subjected to a clinical review.

Results  Lifetime prevalence of DSM-IV agoraphobia in the revised CIDI was higher (8.5%) than that of panic attack (4.3%) or panic disorder with (0.8%) or without (0.8%) agoraphobia. Marked differences in symptomatology, course, and associated impairments between panic disorder and agoraphobia were found. Most patients with agoraphobia reported neither full nor limited attacks or uncued paniclike experiences. Clinical review revealed that many respondents classified by the CIDI as having agoraphobia actually have specific phobia, resulting in a corrected agoraphobia prevalence of 3.5%. Number of agoraphobia trigger situations was identified as a useful way of differentiating patients with true agoraphobia from those with simple phobia. Even after correcting for overdiagnosis, however, the majority of respondents with confirmed agoraphobia were found not to have a prior history of panic.

Conclusions  The results call into question the assumed key pathogenic role of panic attacks in the onset of agoraphobia. Consistent with findings that agoraphobia without panic is rarely seen in clinical settings, we find that such patients seldom seek professional treatment.

From the Department of Clinical Psychology, Max Planck Institute of Psychiatry, Munich, Germany (Drs Wittchen and Reed); and the Department of Health Care Policy, Harvard Medical School, Boston, Mass (Dr Kessler).

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