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Panic disorder and its subtypes: a comprehensive analysis of panic symptom heterogeneity using epidemiological and treatment seeking samples

Published online by Cambridge University Press:  18 April 2011

R. Roberson-Nay  and
K. S. Kendler
R. Roberson-Nay*
Affiliation:
Virginia Commonwealth University, PO Box 980489, Richmond, VA 23298, USA
K. S. Kendler
Affiliation:
Virginia Commonwealth University, PO Box 980489, Richmond, VA 23298, USA
*
*Address for correspondence: Dr R. Roberson-Nay, Department of Psychiatry, Virginia Commonwealth University, PO Box 980489, Richmond, VA 23298, USA. (Email: rrobersonnay@vcu.edu)
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Abstract

Background

Panic disorder (PD) is a heterogeneous syndrome that can present with a variety of symptom profiles that potentially reflect distinct etiologic pathways. The present study represents the most comprehensive examination of phenotypic variance in PD with and without agoraphobia for the purpose of identifying clinically relevant and etiologically meaningful subtypes.

Method

Latent class (LC) and factor mixture analysis were used to examine panic symptom data ascertained from three national epidemiologic surveys [Epidemiological Catchment Area (ECA), National Comorbidity Study (NCS), National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), Wave 1], a twin study [Virginia Adult Twin Study of Psychiatric and Substance Use Disorders (VATSPSUD)] and a clinical trial (Cross-National Collaborative Panic Study [CNCPS]).

Results

Factor mixture models (versus LC) generally provided better fit to panic symptom data and suggested two panic classes for the ECA, VATSPSUD and CNCPS, with one class typified by prominent respiratory symptoms. The NCS yielded two classes, but suggested both qualitative and quantitative differences. The more contemporary NESARC sample supported a two and three class model, with the three class model suggesting two variants of respiratory panic. The NESARC's three class model continued to provide the best fit when the model was restricted to a more severe form of PD/panic disorder with agoraphobia.

Conclusions

Results from epidemiologic and clinical samples suggest two panic subtypes, with one subtype characterized by a respiratory component and a second class typified by general somatic symptoms. Results are discussed in light of their relevance to the etiopathogenesis of PD.

Keywords

Exploratory factor analysisfactor mixture modelslatent classpanic disorderrespiratorysubtypes
Type
Original Articles
Information
Psychological Medicine , Volume 41 , Issue 11 , November 2011 , pp. 2411 - 2421
Copyright
Copyright © Cambridge University Press 2011

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