Do symptom interpretations mediate the relationship between panic attack symptoms and agoraphobic avoidance?

Background: There is little consensus as to whether agoraphobic avoidance in panic disorder is characterized by a prominence of particular symptoms and interpretations of those symptoms. Aims: We sought to clarify the relationship between symptoms and agoraphobic avoidance and to establish whether catastrophic interpretations of symptoms mediate any such relationships. Method: The Symptom Checklist 90-Revised, Agoraphobic Cognitions Questionnaire and Mobility Inventory were administered to 117 patients with panic disorder who were attending an outpatient anxiety disorders clinic. Results: Medium to large associations were found between most symptoms and agoraphobic avoidance and between particular symptoms and the corresponding symptom interpretation items. Some interpretations of symptoms were found to mediate relationships between symptoms and agoraphobic avoidance. Conclusions: These findings suggest that the catastrophic misinterpretation model of panic disorder can to some extent be invoked to explain the extent of agoraphobic avoidance, but that there may also be other pathways leading from symptoms to agoraphobia.