Is Parental Death a Selective Precursor to Either Panic Disorder or Agoraphobia?

-In a controlled chart-review study of the separation anxiety hypothesis (SAH) of agoraphobia or panic disorder, the incidence of parental (maternal and paternal) deaths was recorded from the histories of 40 patients, each with panic disorder, agoraphobia, and a control group of simple phobics. The overall incidence of parental loss was low in all three groups. and there were no significant differences among them either in terms of the incidence of parental death or in patient ages at the time of parental death. It is concluded from these results and on a review of other studies on the SAH that the hypothesis is not well supported and should be abandoned in the DSM-IV. It is often contended in the psychiatric and psychological literature on anxiety disorders that parental loss is a specific precursor to some conditions. For example, the DSM-III (American Psychiatric Association, 1980) states that for both agoraphobia and panic disorder, “Separation anxiety disorder in childhood and sudden object loss apparently predispose to the development . . . (of these conditions)” (pp. 226, 231). This ‘separation anxiety hypothesis’ (SAH) has been modified in the DSMIII-R to read, “Separation anxiety disorder in childhood and sudden loss of social support or disruption of important interpersonal relationships apparently predisposes to the development of . . . [panic disorder or panic disorder with agoraphobia]” (American Psychiatric Association, 1987, p. 237). In turning to the DSM-III-R description of separation anxiety disorder, the document reads that “In most cases the disorder develops after some life stress, typically a loss, the death of a relative . . .” (American Psychiatric Association, 1987, p. 60). This separation anxiety hypothesis for panic disorder and agoraphobia seems intuitively compelling, given the apparent similarities between the Address correspondence and reprint requests to Bruce A. Thyer, Ph.D., School of Social Work, University of Georgia, Athens, GA, 30602.