Psychoanalytic Approach to Generalized Anxiety Disorder

In 1894 Freud described a symptom complex that gives the name of anxiety neurosis (what today is known as anxiety disorder) because all components can be grouped around the main one that is anxiety. The contribution to psychiatry is this description is crucial, because until then this neurosis was included in a sort of mixed bag, along with many other mental illnesses. Power and isolate it, is the first step for possible therapeutic approach.

Anxiety neurosis can manifest in full or with a rudimentary development ( can produce complete panic attack or some of its individual components: tachycardia, tachypnea, etc.), Likewise, may appear isolated as the sole condition of the patient, or in combination with other neurosis, in which case we speak of mixed neurosis.

The clinical picture has the following characteristics:

A) The general excitability: always arises, and is theoretically very important. A high excitability indicates accumulation always excitement or inability to resist, that is, absolute or relative accumulation of excitation. Within this would for example high excitability auditory hyperesthesia (hypersensitivity with respect to noise) that may cause insomnia.

B) The anxious wait: The wait is agonizing symptom nodular, this is a “quantum” of distress, freely floating, which is ready at any moment to be bound to any idea.
For example: The woman who coughed every time she hears her husband, prone to colds, think about the possibility of contracting a fatal pneumonia, and sees in his imagination go the funeral. Or that other than when to go home see a group of people at his door, he thinks that one of their children has fallen from a balcony, and if you hear the siren of an ambulance, thinks it’s a loved one who is in it. All these ideas are about the wait agonizing. The anxious wait also occurs in normal mitigated, is what we call the tendency to anxiety or pessimistic view of things, but in the anxiety neurosis, always exceeds the normal level.

C) The anxious wait, constantly on the watch, can also break suddenly into consciousness in the form of an anxiety attack or panic attack. The attack can consist only in the sense of anxiety, without any other representations associated or associated with the idea of death or insanity or accompanied by physical sensations (what is called courtship symptomatic distress) such as numbness, palpitations, dyspnea, sweating, binge eating, etc. Often in these cases the patient not describe the feeling of distress or slightly alludes to it, calling discomfort. The combination of these elements in the anxiety attack is infinitely variable, and also each of the symptoms alone can be an anxiety attack and would be equivalent thereof.

D) On the basis of anguished waiting, on one hand, and on the other the tendency to panic attacks and vertigo, phobias develop typical:

Phobias related to locomotion (with movement, with walking). The most typical is agoraphobia (fear of open spaces), which often precedes an attack of vertigo without anxiety, that happens on the street. Locomotion in these patients is not affected except under certain conditions, such as lack of a companion or passing through narrow streets, etc…

E) Several of the above symptoms that accompany or represent the anxiety attack, are also chronically being harder then discover, as the concomitant feeling of anxiety is less accurate than the panic attack.