The present study was conducted to investigate various types of agoraphobic situations in patients with and without panic disorder. Here, the highest frequency of agoraphobic situations was related to leaving home alone (34.73%) and being home alone (32.63%). In the study by Bienvenu et al. in 1920 subjects, the rate of leaving home alone and being home alone were both 27%, which were lower than the reported rate in the present study. In the present study, the prevalence of fear of being in a crowd and standing in line (17%), fear of using the bus, subway, or car (1.05%) were less than the reported rate in the above study (34% and 24%), respectively. In the current study, none of the patients reported their fear of crossing bridges as an agoraphobic situation; while, in the study by Bienvenu, the fear of crossing bridges was reported by 34% of the patients. In the abovementioned study, bathroom phobia, elevator phobia, fear of not finding a toilet, imbalance, and falling, and nausea and emetophobia were not investigated as agoraphobic situations [10]. However, in our study, 10.53% of patients’ bathroom phobia, 3.15% elevator phobia, 2.1% the fear of not finding a toilet, the fear of imbalance and falling, and the fear of nausea in the public and eremophobia were reported each 1.05%.
In the study by Wittchen in 1998, the fear of being in a crowd and standing in line was reported 31%. However, in our study, the fear of being in a crowd and standing in line was 26%, which was a little lower than the study by Wittchen. Moreover, in this study, the majority of the patients\( \left(\frac{2}{3}\right) \) mentioned leaving home alone and using public transportation as their agoraphobic situation [12] while in our study, these situations were mentioned as agoraphobic by 34.73% of the patients, which was less than \( \frac{2}{3} \). In the study by Wittchen, being home alone was not investigated, while it was reported by 32.63% of patients in our study [12, 18].
In the diagnostic criteria of DSM-IV, being home alone was not mentioned as an agoraphobic situation [3]. However, in other sources being alone at home is considered an agoraphobic situation, we added this situation to our assessment checklist as well [19].
Therefore, in the present study, 34.73% of patients reported the fear of being home alone due to the fear of having no escape and being helpless in case of an emergency. The differences could be due to the cultural and social differences of the society under study and the statistical population of the mentioned studies. In addition, considering that 50% of our patients were homemakers, this difference is explainable. Moreover, phobic situations are poorly understood all around the world.
In the present study, 28% of participants reported no history of panic disorder or panic attacks. However, in the study by Wittchen in 2008, it was indicated that AG exists as an anxiety disorder independent from PD and most patients have not experienced panic attacks [20].
On the other hand, some researches revealed that almost 50% of AG cases have experienced PA and PD symptoms [10]. It was 28% in our study, which was less than the above-mentioned study.
In the present study, multiple logistic regression analysis indicated that bathroom phobia and having more than one psychiatric comorbid disorder have increased the risk of panic disorder, 1.32 and 6.25 times, respectively. Moreover, a trend was found between the rising of agoraphobic situations and panic attacks, but it was not statistically significant. Limited studies focus on the relationship between agoraphobia and panic attacks [21]. Hayward and et al. were found that negative affect is a risk factor for panic attacks and depressive disorders [21]. Likewise, our results are in agreement with Peter et al.’s study [22]. The same findings have been reported in the study by Ronald et al. They found that the major burden of panic disorder is caused by agoraphobic situations [23]. In the present study, the majority of agoraphobic patients were female, with a female-male ratio of 2.2.
In a review study by Godwin et al. among studies conducted in Europe, the prevalence rate of agoraphobia in females was 2–3 times that of males, which is in agreement with the present study (2.2) [4]. In the study by Wittchen in 2008 and 2006, high prevalence of AG was observed in females, and AG was rarely observed in males, which comply with the present study [2].