Predictors of the Development of Phobic Avoidance. [CME]
J Clin Psychiatry 2000;61(8):618-623
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Background: Panic disorder and agoraphobia are
closely linked. There are indications that uncontrolled panic
attacks often lead to the rapid development of phobic avoidance,
but our ability to predict which individuals with panic will
develop avoidance has been limited. The purpose of this study was
to identify independent predictors of the development of phobic
avoidance and the time course of that development.
Method: We conducted a secondary analysis of
survey data from the community-based Panic Attack Care-Seeking
Threshold Study. The presence of panic attacks was confirmed in
97 randomly selected adults from randomly selected households
screened using the Structured Clinical Interview of DSM-III-R
(SCID). The presence of limited and extensive phobic avoidance
was measured using the SCID, while rapidity of development (lag
time) was measured as the difference between onset of panic and
onset of avoidance. Predictors considered included panic
characteristics, psychiatric comorbidity, cognitive appraisal,
family characteristics, illness attitudes, symptom perceptions,
and coping style.
Results: Thirty-six subjects (37%) had at least
mild phobic avoidance, with 81% (N = 29) of those developing the
avoidance less than 1 year after the onset of panic attacks. The
development of phobic avoidance was associated with the presence
of panic disorder (beta = 1.36), the number of comorbid
psychiatric disorders (beta = 0.69), and the number of family
members and/or friends available to discuss health concerns (beta
= 0.87). Further progression to agoraphobia was predicted by the
presence 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 a
life-threatening symptom (beta = 1.56).
Conclusion: The development of phobic avoidance
is closely linked to panic attacks and often develops soon after
panic onset. Full-blown panic disorder and psychiatric
comorbidity are important in this development. Depersonalization
is also key to the development of avoidance and the rapidity of