A comparison of DSM-5 and DSM-IV agoraphobia in the World Mental Health Surveys

Annelieke Roest, Ymkje Anna de Vries , Carmen Lim, Hans-Ulrich Wittchen, Dan Stein, Tomasz Adamowski , Ali Al-Hamzawi , Evelyn Bromet , Maria Carmen Viana, Giovanni di Girolamo, Koen Demyttenaere, Silvia Florescu, Oye Gureje , Josep Maria Haro, Chiyi Hu, Elie Karam, José Miguel Caldas‐de‐Almeida , Norito Kawakami , Jean Pierre Lepine, Daphna LevinsonMaria Elena Medina Mora, Fernando Navarro-Mateau, Siobhan O'Neill, Marina Piazza, José A. Posada‐Villa, Tim Slade, Yolanda Torres, Ronald Kessler, Kate Scott, Peter de Jonge

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Background: The Diagnostic and Statistical Manual of Mental Disorders, version 5 (DSM-5) definition of agoraphobia (AG) as an independent diagnostic entity makes it timely to re-examine the epidemiology of AG. Study objective was to present representative data on the characteristics of individuals who meet DSM-IV criteria for AG (AG without a history of panic disorder [PD] and PD with AG) but not DSM-5 criteria, DSM-5 but not DSM-IV criteria, or both sets of criteria. Methods: Population-based surveys from the World Mental Health Survey Initiative including adult respondents (n = 136,357) from 27 countries across the world. The Composite International Diagnostic Interview was used to assess AG and other disorders. Results: Lifetime and 12-month prevalence estimates of DSM-5 AG (1.5% and 1.0%) were comparable to DSM-IV (1.4% and 0.9%). Of respondents meeting criteria in either system, 57.1% met criteria in both, while 24.2% met criteria for DSM-5 only and 18.8% for DSM-IV only. Severe role impairment due to AG was reported by a lower proportion of respondents who met criteria only for DSM-IV AG (30.4%) than those with both DSM-5 and DSM-IV AG (44.0%; χ 2 1 = 4.7; P = 0.031). The proportion of cases with any comorbidity was lower among respondents who met criteria only for DSM-IV AG (78.7%) than those who met both sets (92.9%; χ 2 1 = 14.5; P < 0.001). Conclusions: This first large survey shows that, compared to the DSM-IV, the DSM-5 identifies a substantial group of new cases with AG, while the prevalence rate remains stable at 1.5%. Severity and comorbidity are higher in individuals meeting DSM-5 AG criteria compared with individuals meeting DSM-IV AG criteria only.

Original languageEnglish
Pages (from-to)499-510
Number of pages12
JournalDepression and Anxiety
Issue number6
Early online date6 Feb 2019
Publication statusPublished (in print/issue) - 4 Jun 2019


  • agoraphobia
  • anxiety/anxiety disorders
  • cross-national
  • disorders
  • epidemiology
  • phobia/phobic


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