Psychosocial predictors of agoraphobia, simple phobia, and social phobia onset in a United States national sample.

The effects of a wide range of psychosocial factors on onset of agoraphobia, social phobia and simple phobia are investigated with data from the National Comorbidity Survey. The initial chapters present a descriptive epidemiology of each phobia. Estimates of lifetime prevalence of agoraphobia (6.6%) and simple phobia (11.3%) are generally consistent with previous research, but the prevalence of social phobia (13.3%) is much higher than in previous research. Discrepancies are attributed to methodological improvements in the assessment of phobias by the Composite International Diagnostic Interview (CIDI) compared to the diagnostic instruments used in previous studies. All estimates are weighted to reflect prevalence in the population, and standard errors are adjusted for design effects. Discrete-time event history models of the effects of sociodemographic factors, parental psychopathology, childhood environment, traumatic life events, and previous mental illnesses on onset of each phobia are constructed. These analyses permit the identification of variables which have direct and indirect effects on each phobia. The results of these analyses are consistent with the idea that some factors are associated with general vulnerability to phobia and other are unique to each phobia. Unique associations are interpreted as resulting from the effects of exposure to threatening events in the past on expectancy and sensitivity to harmless events which have similar abstract characteristics. The irrationality of phobias stems in part from the abstract nature of these associations. Events which are sudden and cannot be prevented (e.g., natural disasters, accidents) are associated with agoraphobia but not with other phobias after other risk factors are controlled. Agoraphobia involves fear of being in places from which escape might be difficult or embarrassing if symptoms (e.g., panic attacks) were suddenly to occur. Exposure to events such as rape, which might be prevented in the future if vigilance and escape routes are maintained, have direct effects on simple phobia (e.g., claustrophobia, animal phobia, etc.) but not the other phobias. Experiences which might be associated with criticism but are not necessarily physically threatening, such as parental neglect and witnessing a severe accident, have direct effects on social phobia but not the other phobias.PhDSociologyUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttp://deepblue.lib.umich.edu/bitstream/2027.42/103811/1/9409759.pdfDescription of 9409759.pdf : Restricted to UM users only