Panic Disorder and Agoraphobia

The current diagnostic criteria for panic disorder, according to the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV, American Psychiatric Association, 1994), are comprised of recurrent unexpected panic attacks, and anxiety about future panic attacks or their consequences, or a significant behavioral change because of the panic attacks. The additional anxiety about panic, combined with catastrophic cognitions about panic sensations, contributes to the differentiation between the person with panic disorder and the person with occasional panic attacks (e.g., Telch, Lucas, and Nelson, 1989). Agoraphobia refers to avoidance or endurance with dread of situations from which escape might be difficult or help unavailable in the event of a panic attack, or in the event of developing symptoms that could be incapacitating and embarrassing, such as loss of bowel control or vomiting. Typical agoraphobic situations include shopping malls, waiting in line, movie theaters, traveling by car or bus, crowded restaurants, and being alone. In the general population, the 12-month prevalence estimate for panic disorder across the United States and several European countries is about 2% in adults and adolescents (Goodwin, Fergusson, and Horwood, 2005; Kessler et al., 2005b). Lower estimates have been reported for some Asian, African, and Latin American countries, ranging from 0.1 to 0.8% (Lewis-Fernandez et al., 2010). Across all studies, females are more frequently affected than males at a rate of approximately 2 : 1 (Kessler et al., 2005b). Although panic attacks occur in children, the overall prevalence of panic disorder is low prior to 14 years of age (<0.4%) (Craske et al., 2010). The rates of panic disorder show a gradual increase during adolescence, particularly in girls, and possibly following the onset of puberty (Craske et al., 2010). The modal age of onset is late teenage years and early adulthood (Kessler et al., 2005a), although treatment is usually sought at a much later age, around 34 years (e.g., Noyes et al., 1986). The