Specific vulnerability and risk factors for the onset of panic disorder, agoraphobia and other phobias

Background: On the background of the ongoing debate whether agoraphobia is a conditioned reaction to biologically elicited panic attacks as proposed by Donald Klein, or whether agoraphobia is accompanied by panic attacks just like other phobias as suggested by Isaac Marks, we aim to study the common and the specific nature of vulnerability/risk factors of panic disorder [PD], agoraphobia [AG], social [SOC] and specific phobia [SPE]. Method: Analyses are based on 3021 participants from a 10-year prospective-longitudinal community survey (14–24 years old at baseline). Lifetime DSM-IV diagnoses and syndromes were assessed via standardized M-CIDI interview. Vulnerabilities in three domains (socio-demographic, family and behavioral-emotional) were assessed. Results: (1) Subjects with PD, SOC and SP were at higher risk for AG, and subjects with AG and SP were at higher risk for panic attacks/disorder. 2) All syndromes were associated with behavioral inhibition (fear). 3) Only phobias, but not PD, were associated with temperament (harm avoidance), behavioral inhibition (social), gender, parental mood disorder, and separation from parents. 4) Parenting style (rejection) was associated to SOC and SP, but not to AG or PD. Discussion: There is some evidence that phobias (particularly AG and SP) are similar with respect to anxiety comorbidity patterns and associations with socio-demographic, family and behavioral-emotional factors, and that these associations are not accounted for by anxiety comorbidity. Risk factors for PD might be rather unspecific and accounted for by comorbid phobias.