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Both agoraphobia and panic disorder are among the group of anxiety disorders listed in the Diagnostic and Statistical Manual of Mental Health Disorders (DSM-IV). Panic disorder is characterised by recurrent uncued panic attacks, worry about further panic attacks, and changes in behavior due to panic attacks. Agoraphobia is defined as anxiety about situations in which it would be difficult to escape, such as in crowds in public places.
In the DSM-IV, two types of panic disorder are listed; panic disorder without agoraphobia and panic disorder with agoraphobia. As you can see, panic disorder and agoraphobia are already intrinsically linked. Panic disorder with agoraphobia is notoriously more difficult to treat though. It's worthy to note that agoraphobia is not solely a disorder that sometimes occurs alongside panic disorder. Both panic disorder and agoraphobia can present as independent disorders, and can also present comorbidly with other disorders.
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How Common Are Mental Health Disorders?
Even with the vast amount of research conducted on mental health disorders, it is difficult to present a true picture of the prevalence of any of the DSM-IV disorders, including panic disorder and agoraphobia. Although data can be relatively easily collected from patients that are receiving treatment, it is thought that only about half of existing cases of mental disorders receive treatment. Despite this, a number of high quality community epidemiological surveys do exist that provide an insight into the prevalence of the disorders listed in the DSM-IV, and this can help answer nagging questions such as whether agoraphobia or panic disorder is more common.
A relatively recent survey was conducted by Kessler et al in 2005. They interviewed 9,282 participants using an expansion of the World Health Organization's Composite International Diagnostic Interview, which is used in almost all major psychiatric epidemiological surveys in the world. Their findings suggest that 26.2% of the United States population suffers from a mental illness at any one time. The three most common mental disorders were found to be specific phobias, social phobias, and major depressive disorder. The most common group of disorders was found to be anxiety disorders (in which panic disorder and agoraphobia are included) with a prevalence of 18.1%.
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Is Agoraphobia or Panic Disorder More Common?
The survey reported that panic disorder had a prevalence of 2.7% and that agoraphobia had a prevalence of 0.8%. This suggests that panic disorder is more common than agoraphobia. Further evidence for panic disorders being more common than agoraphobia is the number of other disorders it is correlated (and tends to be comorbid) with. Both panic disorder and agoraphobia were found to be significantly correlated with eachother and also with:
- specific phobia
- social phobia
- generalised anxiety disorder
- post traumatic stress disorder
- major depressive disorder
- bipolar disorder
- oppositional defiant disorder
- attention deficit hyperactivity disorder
- intermittent explosive disorder.
However, panic disorder was also found to be significantly correlated with separation anxiety disorder and alcohol abuse.
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As previously mentioned, there are many hurdles in trying to determine the prevalence of mental health disorders. The authors of this survey point out further important points which may have contributed to an inaccurate picture of prevalence in their results. Firstly, their sample underrepresents important population segments, such as the homeless and those in institutions, where rates of mental illness may be particularly high. Secondly, those with mental illnesses may be less likely to participate in a mental health survey, and lastly that participants may have underreported details of their mental illnesses. Indeed, it is known that embarrassing behaviours are often underreported. Nonetheless, Kessler et al's study is still considered to be of high quality and is consistent with previous results. These factors are also likely to effect reports on the commonality of panic disorder and agoraphobia as comorbid internalising disorders (including panic disorder and agoraphobia) have been found to be associated with previously married females living in suburbia or outlying non-rural areas - a population segment well represented in the study.
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Kessler, R.C., Chiu, W.T., Demler, O. & Walters, E.E. (2005) Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the national comorbidity survey replication. Archives of General Psychiatry, 62, 617-627.
Kring, A.M., Davison, G.C., Neale, J.M. & Johnson, S.L. (2007) Abnormal Psychology. USA: John Wiley & Sons.