Clinical Aspects of Anxiety State and Hysteria

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THE object of this discussion is to offer a simple and practical clarification of the common variety of neuroses and some data in reference to differential diagnosis. Elaborate and exquisite psychodynamic elements in these neuroses are minimized to avoid confusion and to eliminate material which is too theoretical.

Anxiety state is the neurosis most frequently encountered in private practice at the present time. Generally, factors indicative of physical defects are lacking in this type of neurosis. The patient has undoubtedly consulted many doctors who have failed to reassure him or to minimize his persistent symptoms. He describes these in detail and expresses his apprehensions or fears about the cause of his disease. Frequently the attending physician gets the impression that the patient enjoys relating his symptoms but such aeration is probably more relieving than actually productive of pleasure. The attitude of the patient with anxiety symptoms is one of dependence upon the physician, which is secured by emphasis on the psychosomatic tensions. Although the physical symptoms of anxiety state are numerous, they center primarily about the visceral organs. Anxiety neurosis is usually characterized by attacks of dyspnea, tachycardia, sweating and chronic fatigue. The patient accurately and graphically describes “fast heart,” “loose bowels,” “lump or butterflies in the stomach,” “numbness of the hands,” or exhaustion. These symptoms frighten the patient and he finds that he is unable to concentrate on his work; he has a constant sense of foreboding, and at times a sense of impending death or insanity. The degree. . .



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