Diagnosis and Epidemiology of Agoraphobia and Social Phobia

Summary: The subdivisions of phobias are based on empiric findings, mostly those of Marks, who delineated four subtypes of phobias: agoraphobia, social phobia, animal phobia, and specific phobias. Most of the research has been devoted to agoraphobia and, to a much lesser extent, social phobia. The revisions of the international classifications of mental disorders have provided operationalized diagnostic criteria for these disorders, allowing a more precise definition of cases that preclude all epidemiologic studies. Despite these definitions, some diagnostic problems still remain regarding more precise delineation of fears and phobias and assessment of the level of impairment in nonclinical samples. To date, results are available from recent epidemiologic studies that have been conducted in the general population in different countries. These studies have found that phobic disorders are the most common mental disorders in the community. Most of them have reported the highest rate for simple phobia and then agoraphobia, even when a wide variation in prevalence rates has been observed. Regarding risk factors, a clear preponderance of females has been found for simple phobia and agoraphobia, and a less pronounced preponderance for social phobia. Simple phobia begins early in life, whereas agoraphobia occurs in young adulthood. The age of onset of social phobia, according to the Epidemiologic Catchment Area data, has a bimodal distribution. Epidemiologic and clinical studies have consistently found a high comorbidity rate within phobic disorders and with other anxiety disorders. Other comorbidity patterns of phobic disorders with depressive disorders and substance use and abuse have been reported in many studies. Comorbid diagnoses appear to have a major influence in the explanation of risk factors such as impairment and quality of life. An epidemiologic study of agoraphobia and social phobia has been conducted in a French general population. Prevalence rates, age at onset, and comorbidity are reported. Suicidality, family history, and health services use in women are analyzed with and without adjustment for depression.