The epidemiology of panic attacks, panic disorder, and agoraphobia in the National Comorbidity Survey Replication

Context: Only limited information exists about the epidemiology of DSM-IV panic attacks (PAs) and panic disorder (PD). Objective: To present nationally representative data about the epidemiology of PAs and PD with or without agoraphobia (AG) on the basis of the US National Comorbidity Survey Replication findings. Design and Setting: Nationally representative face-to-face household survey conducted using the fully structured World Health Organization Composite International Diagnostic Interview. Participants: English-speaking respondents ( N = 9282) 18 years or older. Main Outcome Measures: Respondents who met DSM-IV lifetime criteria for PAs and PD with and without AG. Results: Lifetime prevalence estimates are 22.7% for isolated panic without AG ( PA only), 0.8% for PA with AG without PD (PA-AG), 3.7% for PD without AG ( PD only), and 1.1% for PD with AG (PD-AG). Persistence, lifetime number of attacks, and number of years with attacks increase monotonically across these 4 subgroups. All 4 subgroups are significantly comorbid with other lifetime DSM-IV disorders, with the highest odds for PD-AG and the lowest for PA only. Scores on the Panic Disorder Severity Scale are also highest for PD-AG (86.3% moderate or severe) and lowest for PA only (6.7% moderate or severe). Agoraphobia is associated with substantial severity, impairment, and comorbidity. Lifetime treatment is high ( from 96.1% for PD-AG to 61.1% for PA only), but 12-month treatment meeting published treatment guidelines is low ( from 54.9% for PD-AG to 18.2% for PA only). Conclusion: Although the major societal burden of panic is caused by PD and PA-AG, isolated PAs also have high prevalence and meaningful role impairment.