Predictors of the Development of Phobic Avoidance.

Background: Panic disorder and agoraphobia areclosely linked. There are indications that uncontrolled panicattacks often lead to the rapid development of phobic avoidance,but our ability to predict which individuals with panic willdevelop avoidance has been limited. The purpose of this study wasto identify independent predictors of the development of phobicavoidance and the time course of that development.

Method: We conducted a secondary analysis ofsurvey data from the community-based Panic Attack Care-SeekingThreshold Study. The presence of panic attacks was confirmed in97 randomly selected adults from randomly selected householdsscreened using the Structured Clinical Interview of DSM-III-R(SCID). The presence of limited and extensive phobic avoidancewas measured using the SCID, while rapidity of development (lagtime) was measured as the difference between onset of panic andonset of avoidance. Predictors considered included paniccharacteristics, psychiatric comorbidity, cognitive appraisal,family characteristics, illness attitudes, symptom perceptions,and coping style.

Results: Thirty-six subjects (37%) had at leastmild phobic avoidance, with 81% (N = 29) of those developing theavoidance less than 1 year after the onset of panic attacks. Thedevelopment of phobic avoidance was associated with the presenceof panic disorder (beta = 1.36), the number of comorbidpsychiatric disorders (beta = 0.69), and the number of familymembers and/or friends available to discuss health concerns (beta= 0.87). Further progression to agoraphobia was predicted by thepresence of depersonalization during panic attacks (beta = 0.50).Rapid onset of avoidance (panic avoidance lag time < 1 year)was predicted by the perception that depersonalization is alife-threatening symptom (beta = 1.56).

Conclusion: The development of phobic avoidanceis closely linked to panic attacks and often develops soon afterpanic onset. Full-blown panic disorder and psychiatriccomorbidity are important in this development. Depersonalizationis also key to the development of avoidance and the rapidity ofthe development.