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February 1996, Vol 53, No. 2 >
Article | February 1996

Agoraphobia, Simple Phobia, and Social Phobia in the National Comorbidity Survey

William J. Magee, PhD; William W. Eaton, PhD; Hans-Ulrich Wittchen, PhD; Katherine A. McGonagle, PhD; Ronald C. Kessler, PhD
Arch Gen Psychiatry. 1996;53(2):159-168. doi:10.1001/archpsyc.1996.01830020077009
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References
Comments

Background:  Data are presented on the general population prevalences, correlates, comorbidities, and impairments associated with DSM-III-R phobias.

Methods:  Analysis is based on the National Comorbidity Survey. Phobias were assessed with a revised version of the Composite International Diagnostic Interview.

Results:  Lifetime (and 30-day) prevalence estimates are 6.7% (and 2.3%) for agoraphobia, 11.3% (and 5.5%) for simple phobia, and 13.3% (and 4.5%) for social phobia. Increasing lifetime prevalences are found in recent cohorts. Earlier median ages at illness onset are found for simple (15 years of age) and social (16 years of age) phobias than for agoraphobia (29 years of age). Phobias are highly comorbid. Most comorbid simple and social phobias are temporally primary, while most comorbid agoraphobia is temporally secondary. Comorbid phobias are generally more severe than pure phobias. Despite evidence of role impairment in phobia, only a minority of individuals with phobia ever seek professional treatment.

Conclusions:  Phobias are common, increasingly prevalent, often associated with serious role impairment, and usually go untreated. Focused research is needed to investigate barriers to help seeking.

REFERENCES

1 +
Kessler RC, McGonagle KA, Zhao S, Nelson CB, Hughes M, Eshleman S, Wittchen H-U, Kendler KS.  Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States: results from the National Comorbidity Survey . Arch Gen Psychiatry . 1994;;51:8-19.
2 +
Wittchen H-U, Zhao S, Kessler RC, Eaton WW.  DSM-III-R generalized anxiety disorder in the National Comorbidity Survey . Arch Gen Psychiatry . 1994;;51:355-364.
3 +
Warner LA, Kessler RC, Hughes M, Anthony JC, Nelson CB.  Prevalence and correlates of drug use and dependence in the United States: results from the National Comorbidity Survey . Arch Gen Psychiatry . 1995;;52:219-229.
4 +
World Health Organization. Composite International Diagnostic Interview (Version 1.0). Geneva, Switzerland: WHO; 1990.
5 +
Kessler RC, Wethington E.  The reliability of life events reports in a community survey . Psychol Med . 1991;;21:1-16.
6 +
Wittchen, H-U.  Reliability and validity studies of the WHO-Composite International Diagnostic Interview (CIDI): a critical review . J Psychiatr Res . 1994;;28:57-84.
7 +
University of Michigan. OSIRIS VII . Ann Arbor, Mich: Institute for Social Research, The University of Michigan; 1981;.
8 +
Norusis MJ. SPSS Advanced Statistics User's Guide . Chicago, Ill: SPSS Inc; 1990;.
9 +
SAS Institute. SAS 6.03. Cary, NC: SAS Institute; 1988.
10 +
Woodruff RS, Causey BD.  Computerized method for approximating the variance of a complicated estimate . J Am Stat Assoc . 1976;;71:315-321.
11 +
Koch GG, Lemeshow S.  An application of multivariate analysis to complex sample survey data . J Am Stat Assoc . 1972;;67:780-782.
12 +
Davidson JRT, Hughes DL, George LK, Blazer DG.  The boundary of social phobia: exploring the threshold . Arch Gen Psychiatry . 1994;;51:975-983.
13 +
Agras S, Sylvester D, Oliveau D.  The epidemiology of common fears and phobias . Compr Psychiatry . 1969;;10:151-156.
14 +
Wittchen H-U, Essau CA, von Zerssen D, Krieg CJ, Hecht H.  Lifetime and six-month prevalence of mental disorders in the Munich follow-up study . Eur Arch Psychiatry Clin Neurosci . 1992;;241:247-258.
15 +
Angst J, Dobler-Mikola A.  The Zurich Study, V: anxiety and phobia in young adults . Eur Arch Psychiatry Clin Neurol Sci . 1985;;235:171-178.
16 +
Costello CG.  Fears and phobia in women: a community study . J Abnorm Psychol . 1982;;91:280-286.
17 +
Uhlenhuth EH, Balter MB, Mellinger GG, Cisin IH, Clinthorpe J.  Symptom checklist syndromes in the general population: correlations with psychotherapeutic drug use . Arch Gen Psychiatry . 1983;;40:1167-1173.
18 +
Robins LN, Helzer JE, Croughan JL, Ratcliff KS.  National Institute of Mental Health Diagnostic Interview Schedule: its history, characteristics and validity . Arch Gen Psychiatry . 1981;;38:381-389.
19 +
Bland RC, Orn H, Newman SC.  Lifetime prevalence of psychiatric disorders in Edmonton . Acta Psychiatr Scand . 1988;;77:24-32.
20 +
Dagonda M, Angst J.  The Zurich Study, XX: social phobia and agoraphobia . Eur Arch Psychiatry Clin Neurosci . 1993;;243:95-102.
21 +
Robins LN, Helzer J, Weissman MM, Orvaschel H, Gruenberg E, Burke JD Jr, Regier DA.  Lifetime prevalence of specific psychiatric disorders in three sites . Arch Gen Psychiatry . 1984;;41:949-958.
22 +
Schneier FR, Johnson J, Hornig C, Liebowitz M, Weissman M.  Social phobia: comorbidity and morbidity in an epidemiologic sample . Arch Gen Psychiatry . 1992;;49:282-288.
23 +
Wacker HR, Mullejans R, Klein KH, Battegay R.  Identification of cases of anxiety disorders and affective disorders in the community according to ICD-10 and DSM-III-R using the Composite International Diagnostic Interview (CIDI) . Int J Meth Psychiatr Res . 1992;;2:91-100.
24 +
Stein MB, Walker JR, Forde DR.  Setting diagnostic thresholds for social phobia: considerations from a community survey of social anxiety . Am J Psychiatry . 1994;;151:408-412.
25 +
Wittchen, H-U, Zhao, S, Abelson, JM, Abelson, JL, Kessler, RC.  Reliability and procedural validity of UM-CIDI DSM-III-R phobic disorders . Psychol Med . In press.
26 +
Ost L-G.  Age of onset of different phobias . J Abnorm Psychol . 1987;;96:223-229.
27 +
Burke KC, Burke JD, Rae DS, Regier DA.  Comparing age at onset of major depression and other psychiatric disorders by birth cohorts in five US community populations . Arch Gen Psychiatry . 1991;;48:789-795.
28 +
Boyd JH, Rea DS, Thompson JW, Burns BJ, Bourdon K, Locke BZ, Regier DA.  Phobia: prevalence and risk factors . Soc Psychiatry Psychiatr Epidemiol . 1990;;25:314-323.
29 +
Chen C, Wong J, Lee N, Chan-Ho M, Lau JT, Fung M.  The Shatin Community Mental Health Survey in Hong Kong, II: major findings . Arch Gen Psychiatry . 1993;;50:125-133.
30 +
Hwu HG, Yeh EK, Chang LY.  Prevalence of psychiatric disorders in Taiwan as defined by the Chinese Diagnostic Interview Schedule . Acta Psychiatr Scand . 1989;;79:136-147.
31 +
Joyce PR, Bushnell JA, Oakley-Browne MA, Wells JE, Hornblow AR.  The epidemiology of panic symptomatology and agoraphobic avoidance . Compr Psychiatry . 1989;;30:303-312.
32 +
Bourdon KH, Boyd JH, Rae DS, Burns BJ, Thompson JW, Locke BZ.  Gender differences in phobias: results of the ECA community survey . J Anxiety Disord . 1988;;2:227-241.
33 +
Canino GJ, Bird HR, Shrout PE, Rubio-Stipec M, Bravo M, Marinez R, Sesman M, Guevara LM.  The prevalence of specific psychiatric disorders in Puerto Rico . Arch Gen Psychiatry . 1987;;44:727-735.
34 +
Eaton WW, Dryman A, Weissman MM.  Panic and phobia . In: Robins LN, Regier DA, eds. Psychiatric Disorders in America: The ECA Study . New York, NY: The Free Press; 1991;:155-179.
35 +
Brown DR, Eaton WW, Sussman L.  Racial differences in prevalence of phobic disorders . J Nerv Ment Dis . 1990;;178:434-441.
36 +
Escobar JI, Karno M, Burnam AH, RL, Golding J.  Distribution on major mental disorders in an US metropolis . Acta Psychiatr Scand . 1988;;78( (suppl) ):45-53.
37 +
Wittchen H-U, Essau CA, Kreig J-C.  Anxiety disorders: similarities and differences of comorbidity in treated and untreated groups . Br J Psychiatry . 1991;;159( (suppl) ):23-33.
38 +
De Ruiter C, Rijken H, Garssen B, van Schaik A, Kraaimaat F.  Comorbidity among the anxiety disorders . J Anxiety Disord . 1989;;3:57-68.
39 +
Sanderson WC, DiNardo PA, Rapee RM, Barlow DH.  Syndrome comorbidity in patients diagnosed with a DSM-III-R anxiety disorder . J Abnorm Psychol . 1990;;99:308-312.
40 +
Dick CL, Sowa B, Bland RC, Newman SC.  Phobic disorders . Acta Psychiatr Scand . 1994;;89( (suppl) ):36-44.
41 +
Weissman MM, Myers JK, Harding PS.  Psychiatric disorders in a US urban community . Am J Psychiatry . 1978;;135:459-462.
42 +
Weissman MM, Merikangas KR.  The epidemiology of anxiety and panic disorders: an update . J Clin Psychiatry . 1986;;47:11-17.
43 +
Wittchen H-U.  Zum Spontanverlauf unbehandelter Falle mit Angst-storungen und Depressionen . In: Wittchen H-U, von Zerssen D, eds. Verlaufe Behandelter und Unbehandelter Depressionen und Angst-storungen . Heidelberg, Germany: Springer Verlag; 1988;.
44 +
Weissman MM, Leaf PJ, Blazer DG, Boyd JH, Florio L.  The relationship between panic disorder and agoraphobia: an epidemiologic perspective . Psychopharmacol Bull . 1986;;22:787-791.
45 +
Horwarth E, Lish JD, Johnson J, Hornig CD, Weissman M.  Agoraphobia without panic: clinical reappraisal of an epidemiologic finding . Am J Psychiatry . 1993;;150:1496-1501.
46 +
Klein DF, Gorman JM.  A model of panic and agoraphobia development . Acta Psychiatr Scand . 1987;;76( (suppl) ):87-95.
47 +
Klein DF, Klein HM.  The nosology, genetics, and theory of spontaneous panic and phobias . In: Tyrer PJ, ed. Psychopharmacology of Anxiety . New York, NY: Oxford University Press; 1989;.
48 +
Schuckit MA, Hesselbrock V.  Alcohol dependence and anxiety disorders: what is the relationship? Am J Psychiatry . 1994;;151:1723-1734.
49 +
Angst J, Vollrath M, Merikangas KR, Ernst C.  Comorbidity of anxiety and depression in the Zurich cohort study of young adults . In: Maser JD, Cloninger CR, eds. Comorbidity of Mood and Anxiety Disorders . Washington, DC: American Psychiatric Press; 1990;:123-138.
50 +
Lesser IM, Rubin RT, Pecknold JC, Rifkin A, Swinson RP, Lydiard RB, Burrows GD, Noyes R Jr, DuPont RL Jr.  Secondary depression in panic disorder and agoraphobia . Arch Gen Psychiatry . 1988;;45:437-443.
51 +
Murphy JM.  Diagnostic comorbidity and symptom co-occurrence: The Stirling County Study . In: Maser JD, Cloninger CR, eds. Comorbidity of Mood and Anxiety Disorders . Washington, DC: American Psychiatric Press; 1990;:153-176.
52 +
Hagnell O, Tunvia K.  Prevalence and nature of alcoholism in a total population . Soc Psychiatry . 1972;;7:190-201.
53 +
Vaillant G. The Natural History of Alcoholism . Cambridge, Mass: Harvard University Press; 1983;.
54 +
Thompson JW, Burns BJ, Bartko J, Boyd JH, Taube CA, Bourdon KH.  The use of ambulatory service by persons with and without phobia . Med Care . 1988;;26:183-198.

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
Kessler RC, McGonagle KA, Zhao S, Nelson CB, Hughes M, Eshleman S, Wittchen H-U, Kendler KS.  Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States: results from the National Comorbidity Survey . Arch Gen Psychiatry . 1994;;51:8-19.
2 +
Wittchen H-U, Zhao S, Kessler RC, Eaton WW.  DSM-III-R generalized anxiety disorder in the National Comorbidity Survey . Arch Gen Psychiatry . 1994;;51:355-364.
3 +
Warner LA, Kessler RC, Hughes M, Anthony JC, Nelson CB.  Prevalence and correlates of drug use and dependence in the United States: results from the National Comorbidity Survey . Arch Gen Psychiatry . 1995;;52:219-229.
4 +
World Health Organization. Composite International Diagnostic Interview (Version 1.0). Geneva, Switzerland: WHO; 1990.
5 +
Kessler RC, Wethington E.  The reliability of life events reports in a community survey . Psychol Med . 1991;;21:1-16.
6 +
Wittchen, H-U.  Reliability and validity studies of the WHO-Composite International Diagnostic Interview (CIDI): a critical review . J Psychiatr Res . 1994;;28:57-84.
7 +
University of Michigan. OSIRIS VII . Ann Arbor, Mich: Institute for Social Research, The University of Michigan; 1981;.
8 +
Norusis MJ. SPSS Advanced Statistics User's Guide . Chicago, Ill: SPSS Inc; 1990;.
9 +
SAS Institute. SAS 6.03. Cary, NC: SAS Institute; 1988.
10 +
Woodruff RS, Causey BD.  Computerized method for approximating the variance of a complicated estimate . J Am Stat Assoc . 1976;;71:315-321.
11 +
Koch GG, Lemeshow S.  An application of multivariate analysis to complex sample survey data . J Am Stat Assoc . 1972;;67:780-782.
12 +
Davidson JRT, Hughes DL, George LK, Blazer DG.  The boundary of social phobia: exploring the threshold . Arch Gen Psychiatry . 1994;;51:975-983.
13 +
Agras S, Sylvester D, Oliveau D.  The epidemiology of common fears and phobias . Compr Psychiatry . 1969;;10:151-156.
14 +
Wittchen H-U, Essau CA, von Zerssen D, Krieg CJ, Hecht H.  Lifetime and six-month prevalence of mental disorders in the Munich follow-up study . Eur Arch Psychiatry Clin Neurosci . 1992;;241:247-258.
15 +
Angst J, Dobler-Mikola A.  The Zurich Study, V: anxiety and phobia in young adults . Eur Arch Psychiatry Clin Neurol Sci . 1985;;235:171-178.
16 +
Costello CG.  Fears and phobia in women: a community study . J Abnorm Psychol . 1982;;91:280-286.
17 +
Uhlenhuth EH, Balter MB, Mellinger GG, Cisin IH, Clinthorpe J.  Symptom checklist syndromes in the general population: correlations with psychotherapeutic drug use . Arch Gen Psychiatry . 1983;;40:1167-1173.
18 +
Robins LN, Helzer JE, Croughan JL, Ratcliff KS.  National Institute of Mental Health Diagnostic Interview Schedule: its history, characteristics and validity . Arch Gen Psychiatry . 1981;;38:381-389.
19 +
Bland RC, Orn H, Newman SC.  Lifetime prevalence of psychiatric disorders in Edmonton . Acta Psychiatr Scand . 1988;;77:24-32.
20 +
Dagonda M, Angst J.  The Zurich Study, XX: social phobia and agoraphobia . Eur Arch Psychiatry Clin Neurosci . 1993;;243:95-102.
21 +
Robins LN, Helzer J, Weissman MM, Orvaschel H, Gruenberg E, Burke JD Jr, Regier DA.  Lifetime prevalence of specific psychiatric disorders in three sites . Arch Gen Psychiatry . 1984;;41:949-958.
22 +
Schneier FR, Johnson J, Hornig C, Liebowitz M, Weissman M.  Social phobia: comorbidity and morbidity in an epidemiologic sample . Arch Gen Psychiatry . 1992;;49:282-288.
23 +
Wacker HR, Mullejans R, Klein KH, Battegay R.  Identification of cases of anxiety disorders and affective disorders in the community according to ICD-10 and DSM-III-R using the Composite International Diagnostic Interview (CIDI) . Int J Meth Psychiatr Res . 1992;;2:91-100.
24 +
Stein MB, Walker JR, Forde DR.  Setting diagnostic thresholds for social phobia: considerations from a community survey of social anxiety . Am J Psychiatry . 1994;;151:408-412.
25 +
Wittchen, H-U, Zhao, S, Abelson, JM, Abelson, JL, Kessler, RC.  Reliability and procedural validity of UM-CIDI DSM-III-R phobic disorders . Psychol Med . In press.
26 +
Ost L-G.  Age of onset of different phobias . J Abnorm Psychol . 1987;;96:223-229.
27 +
Burke KC, Burke JD, Rae DS, Regier DA.  Comparing age at onset of major depression and other psychiatric disorders by birth cohorts in five US community populations . Arch Gen Psychiatry . 1991;;48:789-795.
28 +
Boyd JH, Rea DS, Thompson JW, Burns BJ, Bourdon K, Locke BZ, Regier DA.  Phobia: prevalence and risk factors . Soc Psychiatry Psychiatr Epidemiol . 1990;;25:314-323.
29 +
Chen C, Wong J, Lee N, Chan-Ho M, Lau JT, Fung M.  The Shatin Community Mental Health Survey in Hong Kong, II: major findings . Arch Gen Psychiatry . 1993;;50:125-133.
30 +
Hwu HG, Yeh EK, Chang LY.  Prevalence of psychiatric disorders in Taiwan as defined by the Chinese Diagnostic Interview Schedule . Acta Psychiatr Scand . 1989;;79:136-147.
31 +
Joyce PR, Bushnell JA, Oakley-Browne MA, Wells JE, Hornblow AR.  The epidemiology of panic symptomatology and agoraphobic avoidance . Compr Psychiatry . 1989;;30:303-312.
32 +
Bourdon KH, Boyd JH, Rae DS, Burns BJ, Thompson JW, Locke BZ.  Gender differences in phobias: results of the ECA community survey . J Anxiety Disord . 1988;;2:227-241.
33 +
Canino GJ, Bird HR, Shrout PE, Rubio-Stipec M, Bravo M, Marinez R, Sesman M, Guevara LM.  The prevalence of specific psychiatric disorders in Puerto Rico . Arch Gen Psychiatry . 1987;;44:727-735.
34 +
Eaton WW, Dryman A, Weissman MM.  Panic and phobia . In: Robins LN, Regier DA, eds. Psychiatric Disorders in America: The ECA Study . New York, NY: The Free Press; 1991;:155-179.
35 +
Brown DR, Eaton WW, Sussman L.  Racial differences in prevalence of phobic disorders . J Nerv Ment Dis . 1990;;178:434-441.
36 +
Escobar JI, Karno M, Burnam AH, RL, Golding J.  Distribution on major mental disorders in an US metropolis . Acta Psychiatr Scand . 1988;;78( (suppl) ):45-53.
37 +
Wittchen H-U, Essau CA, Kreig J-C.  Anxiety disorders: similarities and differences of comorbidity in treated and untreated groups . Br J Psychiatry . 1991;;159( (suppl) ):23-33.
38 +
De Ruiter C, Rijken H, Garssen B, van Schaik A, Kraaimaat F.  Comorbidity among the anxiety disorders . J Anxiety Disord . 1989;;3:57-68.
39 +
Sanderson WC, DiNardo PA, Rapee RM, Barlow DH.  Syndrome comorbidity in patients diagnosed with a DSM-III-R anxiety disorder . J Abnorm Psychol . 1990;;99:308-312.
40 +
Dick CL, Sowa B, Bland RC, Newman SC.  Phobic disorders . Acta Psychiatr Scand . 1994;;89( (suppl) ):36-44.
41 +
Weissman MM, Myers JK, Harding PS.  Psychiatric disorders in a US urban community . Am J Psychiatry . 1978;;135:459-462.
42 +
Weissman MM, Merikangas KR.  The epidemiology of anxiety and panic disorders: an update . J Clin Psychiatry . 1986;;47:11-17.
43 +
Wittchen H-U.  Zum Spontanverlauf unbehandelter Falle mit Angst-storungen und Depressionen . In: Wittchen H-U, von Zerssen D, eds. Verlaufe Behandelter und Unbehandelter Depressionen und Angst-storungen . Heidelberg, Germany: Springer Verlag; 1988;.
44 +
Weissman MM, Leaf PJ, Blazer DG, Boyd JH, Florio L.  The relationship between panic disorder and agoraphobia: an epidemiologic perspective . Psychopharmacol Bull . 1986;;22:787-791.
45 +
Horwarth E, Lish JD, Johnson J, Hornig CD, Weissman M.  Agoraphobia without panic: clinical reappraisal of an epidemiologic finding . Am J Psychiatry . 1993;;150:1496-1501.
46 +
Klein DF, Gorman JM.  A model of panic and agoraphobia development . Acta Psychiatr Scand . 1987;;76( (suppl) ):87-95.
47 +
Klein DF, Klein HM.  The nosology, genetics, and theory of spontaneous panic and phobias . In: Tyrer PJ, ed. Psychopharmacology of Anxiety . New York, NY: Oxford University Press; 1989;.
48 +
Schuckit MA, Hesselbrock V.  Alcohol dependence and anxiety disorders: what is the relationship? Am J Psychiatry . 1994;;151:1723-1734.
49 +
Angst J, Vollrath M, Merikangas KR, Ernst C.  Comorbidity of anxiety and depression in the Zurich cohort study of young adults . In: Maser JD, Cloninger CR, eds. Comorbidity of Mood and Anxiety Disorders . Washington, DC: American Psychiatric Press; 1990;:123-138.
50 +
Lesser IM, Rubin RT, Pecknold JC, Rifkin A, Swinson RP, Lydiard RB, Burrows GD, Noyes R Jr, DuPont RL Jr.  Secondary depression in panic disorder and agoraphobia . Arch Gen Psychiatry . 1988;;45:437-443.
51 +
Murphy JM.  Diagnostic comorbidity and symptom co-occurrence: The Stirling County Study . In: Maser JD, Cloninger CR, eds. Comorbidity of Mood and Anxiety Disorders . Washington, DC: American Psychiatric Press; 1990;:153-176.
52 +
Hagnell O, Tunvia K.  Prevalence and nature of alcoholism in a total population . Soc Psychiatry . 1972;;7:190-201.
53 +
Vaillant G. The Natural History of Alcoholism . Cambridge, Mass: Harvard University Press; 1983;.
54 +
Thompson JW, Burns BJ, Bartko J, Boyd JH, Taube CA, Bourdon KH.  The use of ambulatory service by persons with and without phobia . Med Care . 1988;;26:183-198.

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