[Panic-agoraphobic spectrum].

Abstract

Current diagnostic classification systems have provided reliable, objective and valid diagnoses of mental disorders. They present both categorical and dichotomous approaches to mental disorders. However, rigid usage of diagnostic criteria may cause high comorbidity rates. Moreover, these classification systems fail to identify subthreshold conditions, atypical signs and symptoms, and personality traits associated with the core symptoms of a given mental disorder. These subclinical manifestations are clinically meaningful in terms of disability and effects on quality of life. For these reasons, many researchers have begun to develop dimensional or spectral approaches for a number of mental disorders. Studies on panic disorder with or without agoraphobia have revealed a substantial clinical heterogeneity. The panic-agoraphobic spectrum concept was defined to overcome these difficulties. This concept includes DSM-IV and ICD-10 diagnostic criteria together with atypical and subthreshold symptoms of panic disorder, and constitutes a broader band of panic and agoraphobia symptoms. The panic-agoraphobic spectrum incorporates eight domains of clinical features: 1) separation sensitivity, 2) panic-like symptoms, 3) stress sensitivity, 4) medication and substance sensitivity, 5) anxious expectation, 6) agoraphobia, 7) illness phobia and hypochondriasis, 8) reassurance orientation. In this article, we reviewed the spectrum conceptualization of panic disorder and agoraphobia, particularly focusing on the domains of the panic-agoraphobic spectrum and their assessment.