Autistic traits and panic disorder severity: a retrospective six-month follow-up study

Panic disorder (PD) exhibits marked clinical heterogeneity, and individual differences in autistic traits may contribute to variability in symptom severity and treatment course. This study examined whether autistic traits are associated with panic severity and agoraphobic avoidance during pharmacological treatment. In this retrospective observational study, 41 adults with DSM-5-diagnosed PD receiving guideline-based pharmacotherapy were followed over six months. Symptom trajectories were assessed using the Panic Disorder Severity Scale (PDSS) at baseline, one month, and six months, while autistic traits were measured using the Autism Spectrum Quotient (AQ) at the six-month visit. Linear mixed-effects models and repeated-measures ANCOVA examined associations between autistic traits and symptom burden while adjusting for age and sex. PDSS total and agoraphobia scores declined significantly over time (p <.001). Higher AQ total scores were associated with greater overall PD severity (p = .043) and more pronounced agoraphobic avoidance (p = .015) across assessments. Exploratory analyses indicated that attention switching and social skills were associated with overall severity, whereas reduced imagination was specifically linked to agoraphobic severity. Age was independently associated with agoraphobic severity but not with overall panic severity. No significant Time × AQ interactions were observed, indicating comparable symptom improvement across trait levels during the six-month treatment period. These findings suggest that elevated autistic traits are associated with persistently higher symptom burden during treatment without altering pharmacological response.