Background. Anxiety disorders are associated with considerable disability in the domains of (1) work, (2) social, and (3) family and home interactions. Psychiatric comorbidity is also known to be associated with disability. Methods. Data from the Cross-National Collaborative Panic Study was used to identify rates of comorbid diagnoses, anxiety and depression symptom ratings, and Sheehan disability scale ratings from a clinical sample of 1165 adults with panic disorder. Results. Comorbid diagnoses of agoraphobia, major depression, and social phobia were associated with disability across the three domains of work, social, and family and home interactions. The symptom of agoraphobic avoidance makes the largest contribution to disability but there is no single symptom cluster that entirely predicts impairment and disability. Limitations. The findings about the relative contributions that comorbid diagnoses make to disability only apply to a population with panic disorder. Conclusions. Although panic disorder is not generally considered to be among the serious and persistent mental illnesses, when it is comorbid with other diagnoses, it is associated with considerable impairment. In particular, the presence of agoraphobic avoidance should alert the clinician to the likelihood of important functional impairment. When measuring the functional impact of comorbid anxiety disorders, both the categorical and the dimensional approaches to diagnosis make valuable contributions. 1. Background Epidemiological studies have demonstrated that panic disorder is associated with significant morbidity and impairment [1]. Community samples have also confirmed that agoraphobia, among the different phobias, is particularly associated with impairment. Panic disorder with agoraphobia is associated with increased self reports of disability compared to either agoraphobia or panic disorder alone [2]. Agoraphobia is also associated with higher rates of help seeking and medication use compared to simple phobia and social phobia [3]. Several epidemiological studies also confirmed that comorbidity is associated with impairment. In the National Comorbidity Survey, those with comorbid anxiety or phobic disorders were more symptomatic than those with pure disorders [3] as measured by perceived role impairment, help seeking, and medication use. Interestingly, this study also found that perceived role impairment was less prevalent amongst those with agoraphobia than those with simple or social phobia; however, this difference disappeared amongst those who also have panic attacks. Amongst
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