Anxiety sensitivity: a missing piece to the agoraphobia-without-panic puzzle

This article reviews the controversy surrounding the diagnosis of agoraphobia without panic attacks and proposes a key role for anxiety sensitivity in explaining agoraphobic avoidance among those who have never experienced panic. Although rare in clinical samples, agoraphobia without panic is commonly observed in population-based surveys, including more recent studies in which misclassification bias is addressed. Differential treatment seeking may partially explain these discrepant findings; however, it remains unclear why agoraphobic avoidance develops in the absence of panic. Because anxiety sensitivity is a dispositional analogue of panic, it is proposed that high anxiety sensitivity is a risk factor for agoraphobic avoidance in the absence of frank panic attacks. Preliminary evidence to support this contention is reviewed.