Kim Joonbeom, Seo Yumin, Lee Seungryul, Lee Gayeon, Seok Jeong-Ho, Kim Hesun Erin, Oh Jooyoung
Institute of Behavioral Sciences in Medicine, Yonsei University College of Medicine, Seoul, Korea.
Department of Child Welfare, College of Human Ecology, Chungbuk National University, Cheongju, Korea.
Yonsei Med J. 2025 May;66(5):277-288. doi: 10.3349/ymj.2024.0177.
Panic disorder (PD) and PD with comorbid agoraphobia (PDA) share similar clinical characteristics but possess distinct symptom structures. However, studies specifically investigating the differences between PD and PDA are rare. Thus, the present study conducted a network analysis to examine the clinical networks of PD and PDA, focusing on panic symptom severity, anxiety sensitivity, anticipatory fear, and avoidance responses. By comparing the differences in network structures between PD and PDA, with the goal of identifying the central and bridge, we suggest clinical implications for the development of targeted interventions.
A total sample (n=147; 55 male, 92 female) was collected from the psychiatric outpatient clinic of the university hospital. We conducted network analysis to examine crucial nodes in the PD and PDA networks and compared the two networks to investigate disparities and similarities in symptom structure.
The most influential node within the PD network was Anxiety Sensitivity Index-Revised (ASI-R1; fear of respiratory symptom), whereas Panic Disorder Severity Scale (PDSS5; phobic avoidance of physical sensations) had the highest influence in the PDA network. Additionally, bridge centrality estimates indicated that each of the two nodes met the criteria for "bridge nodes" within their respective networks: ASI-R1 (fear of respiratory symptom) and Albany Panic and Phobic Questionnaire (APPQ3; interoceptive fear) for the PD group, and PDSS5 (phobic avoidance of physical sensation) and APPQ1 (panic frequency) for the PDA group.
Although the network comparison test did not reveal statistical differences between the two networks, disparities in community structure, as well as central and bridging symptoms, were observed, suggesting the possibility of distinct etiologies and treatment targets for each group. The clinical implications derived from the similarities and differences between PD and PDA networks are discussed.
惊恐障碍（PD）和伴有共病场所恐惧症的惊恐障碍（PDA）具有相似的临床特征，但症状结构不同。然而，专门研究PD和PDA之间差异的研究很少。因此，本研究进行了一项网络分析，以检查PD和PDA的临床网络，重点关注惊恐症状严重程度、焦虑敏感性、预期恐惧和回避反应。通过比较PD和PDA之间网络结构的差异，旨在识别核心节点和桥梁节点，我们提出了针对性干预措施发展的临床意义。
从大学医院精神科门诊收集了一个总样本（n = 147；55名男性，92名女性）。我们进行了网络分析，以检查PD和PDA网络中的关键节点，并比较这两个网络，以研究症状结构的差异和相似性。
PD网络中最具影响力的节点是修订后的焦虑敏感性指数（ASI-R1；对呼吸症状的恐惧），而惊恐障碍严重程度量表（PDSS5；对身体感觉的恐惧回避）在PDA网络中具有最高影响力。此外，桥梁中心性估计表明，这两个节点在各自网络中均符合“桥梁节点”的标准：PD组为ASI-R1（对呼吸症状的恐惧）和奥尔巴尼惊恐与恐惧症问卷（APPQ3；内感受性恐惧），PDA组为PDSS5（对身体感觉的恐惧回避）和APPQ1（惊恐发作频率）。
尽管网络比较测试未显示两个网络之间存在统计学差异，但观察到社区结构以及核心和桥梁症状存在差异，这表明每组可能有不同的病因和治疗靶点。讨论了从PD和PDA网络的异同中得出的临床意义。
