Panic disorder and agoraphobia

Introduction Panic disorder (PD) is a common and debilitating anxiety disorder, with lifetime prevalence ranging from 1.3% (with agoraphobia) to 4.7% (without agoraphobia). Women are affected more often than men (Kessler et al. 2006). Importantly, many epidemiologic estimates of agoraphobia without panic disorder significantly overestimate prevalence, due to the use of criteria that erroneously also capture social and simple phobia (Mannuzza et al. 1990, Horwath et al. 1993). Since these evaluations are conducted largely by non-clinicians using a checklist, both false positives and false negatives occur. Clinical cross-checks are rare and have their own methodological problems. Therefore, epidemiological findings cannot be accepted at face value and do not clarify the nosology of panic disorder and agoraphobia. There is a bimodal age of onset of PD, with the first, largest peak in the early twenties and a second, smaller peak around age 30 (Pollack 2002). PD is highly comorbid with other psychiatric and medical disorders (Katon 1996, Candilis et al. 1999). Severe PD has been linked to an increased risk of suicide attempts (not completed suicides) and substance abuse problems (Weissman et al. 1989, Kessler et al. 1998). Systematic research of PD over the past 40 years has led to enormous advances regarding our understanding of the disorder.