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

Arch Gen Psychiatry. 2006 Apr;63(4):415-24. doi: 10.1001/archpsyc.63.4.415.


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.

Publication types

  • Comparative Study
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Agoraphobia / diagnosis
  • Agoraphobia / epidemiology*
  • Agoraphobia / psychology
  • Comorbidity
  • Female
  • Health Surveys
  • Humans
  • Male
  • Mental Health Services / statistics & numerical data
  • Middle Aged
  • Panic Disorder / diagnosis
  • Panic Disorder / epidemiology*
  • Panic Disorder / psychology
  • Prevalence
  • Psychiatric Status Rating Scales
  • Reproducibility of Results
  • Severity of Illness Index
  • Social Class
  • United States / epidemiology