Anxiety disorder

“ Approximately 40 million American adults ages 18 and older, or about 18. [1] percent of people in this age group in a given year, have an anxiety disorder. [1] Anxiety disorders frequently co-occur with depressive disorders or substance abuse. [1] Most people with one anxiety disorder also have another anxiety disorder. Nearly three-quarters of those with an anxiety disorder will have their first episode by age 21.5 [5] Panic Disorder Approximately 6 million American adults ages 18 and older, or about 2.7 percent of people in this age group in a given year, have panic disorder. ”

“ For the other chief form of functional nervous disorder no more appropriate term can be found than that which I have used in this report. The meaning of anxiety-neurosis is also at once apparent. It indicates in direct fashion that anxiety is both the main factor in causation and at the same time one of the leading symptoms. ”

“ When we have constructed a true psychological pathology, we shall understand clearly why and how it is that fear can turn the hair gray in a single night; that a mother's milk can be poisoned by a moment of terror; that the heart may be paralyzed by a sudden joy or sorrow; that dyspepsia, paralysis, and many other diseases are produced by mental worry and fret and the brain-fag of overwork and anxiety. ”

“ More frequently, however, the voluntary repression of fears or apprehensions only adds to the strain and fatigue which has led to the failure of suppression. The fears become stronger and call for still stronger efforts of repression. Through the vicious circle thus set up there is produced a state of persistent anxiety in which even ordinary incidents of life, incidents wholly devoid of danger, come to be viewed with apprehension. ”

“ The body, sense, intellect, and will are all profoundly affected by the irresistible sweep of the fear instinct, as manifested in the overwhelming feeling of anxiety. The fear instinct and its offsprings—hesitation, anxiety, conflicts and repressions—weaken, dissociate, and paralyze the functions [48] of the body and mind, producing the various symptoms of psychopathic diseases. The fear instinct keeps on gnawing at the very vitals of the psychopathic patient. ”

“ In the healthy person anxiety is a state which comes into existence in consequence of some prospective misfortune or danger, but in morbid conditions it shows itself in the form of more or less continuous apprehension colouring the whole mental life, so that even the most ordinary occurrence are seen in the blackest light as sources of trouble or danger.
Suppression and repression in relation to fear. -- In the form of reaction to danger which seems to be characteristic of the normal healthy man, there is a complete absence of fear. ”

“ The fear instinct, when aroused and cultivated in early childhood, becomes associated in later life with particular events, objects, and special states.
When the instinct of fear is aroused in connection with some future impending misfortune, the feeling of apprehension with all its physiological changes, muscular, respiratory, cardiac, epigastric, and intestinal, goes to form that complex feeling of anxiety so highly characteristic of the acute varieties of psychopathic maladies. When fear reaches its acme, the heart is specially affected ”

“ Morbid anxiety is certainly the commonest neurotic symptom, and the theory of its pathogenesis has been the occasion of a very great deal of investigation,15 with, in my opinion, very fruitful results. We meet it in the form of a general apprehensiveness of impending danger and evil, as the anxiety-neurosis, and also in hysteria in the form both of apparently causeless attacks of dread and of innumerable specific phobias. ”

“ In bad cases the periodic changes of mood may become stronger and stronger, and lead eventually between the fortieth and sixtieth year to actual ‘folie circulaire.’ Anxiety is, of course, common to all nervous people, but in many cases it plays the prominent part.... ”

“ It is not anxiety for your reputation,—that is established; nor for your fortune,—that is made; it is not anxiety for a patient or you would scarcely be here. But anxiety it is,—an anxiety that is remote from your profession, that touches your heart and is new to it! ”

“ Anxiety-neurosis, on the other hand, is a state or process in which the conflict has not been solved but is unduly active, the controlling social factors having been weakened by exhaustion, illness, strain or shock, so that the motives arising out of the instinct of self-preservation have gained in power, while in many cases the social factors have produced new conflicts and causes of anxiety which may be as potent as the primary conflict with the instinct of self-preservation. ”

“ Anxiety and the anxious frame of mind is in readiness to take fright in connection with our most vulnerable points on all occasions of apprehension or uncertainty. As no one’s future can be clear throughout, there is never wanting the matter of anxiety to a mind susceptible of this state. ”

“ Events that threaten the impulse of self-preservation of the individual, such as misfortunes, shocks, losses, tend to bring about psychopathic states, on account of the aroused fear instinct, on account of the impulse of self-preservation, and sudden inhibition [356] of the stores of reserve energy. Events that may lead to dissolution of personality are, hence, attended with intense anxiety. ”

“ The excitement of fear in the mind still more accelerates heart action and respiration, intensifies the local congestion and greatly increases the morbid accumulations in the system. In the last chapters of this volume we shall deal especially with the deteriorating influence of fear, anxiety, anger, irritability, impatience, etc., and explain how these and all other destructive emotions actually poison the secretions of the body. ”

“ A person, we will say, has acquired—owing to no matter what psychogenetic factor—a recurrent fear. This fear, or, in less obtrusive form, anxiety, or apprehension, is, we will say, of disease—heart disease or insanity or fainting or cancer or epilepsy or what not. It recurs from time to time when awakened by some thought or stimulus from the environment. At once there is an outburst of physiological, i.e., functional disturbances, in the form of an “attack.” ”

“ This is not the only way in which the anxiousness, usually latent but constantly lurking in consciousness, can manifest itself. On the contrary it can also suddenly break into consciousness without being aroused by the issue of an idea, and thus provoke an attack of anxiety. ”

“ In extreme psychasthenia the difficulty of "making up the mind", of deciding, becomes so great that a person may suffer agonies of internal debate about crossing the street, putting on his clothes, eating his meals, doing his work, about every detail of his coming, going, doing, and thinking. A restless anxiety results, a fear of insanity, an inefficiency, and an incapacity for sustained effort that results in the name that is often applied,—"anxiety neurosis." ”

“ In the dormant, subconscious states the fear instinct gradually extends to other subconscious states. The fear instinct acts like a malignant growth, like a fermenting enzyme. The subconscious fear instinct gradually infiltrates, diffuses, irradiates its affective state throughout the subconscious life of the patient, finally giving rise to a psychopathic [143] disposition with its selfishness, apparent repressions, apprehension, anxiety, anguish, terror, and panic. ”

“ He is easily influenced by all depressing, discordant and jarring conditions. He catches the expressions of fear and anxiety in the looks, the words, gestures and actions of his attendants, relatives and friends and these intensify his own depression and gloomy forebodings. ”

“ Thus, to take one special instance, if inability to draw deep breath, fluttering of the heart, and that peculiar epigastric change felt as “precordial anxiety,” with an irresistible tendency to take a somewhat crouching attitude and to sit still, and with perhaps other visceral processes not now known, all spontaneously occur together in a certain person; his feeling of their combination is the emotion of dread, and he is the victim of what is known as morbid fear. ”

“ But on the other hand, what danger to the peace of mind, what destruction of happiness in life may be caused if the knowledge that such a disease has begun to develop is imparted to the patient without being combined with the consoling information as to the nature and course of the benign forms of this trouble! In unceasing anxiety and fear, in daily expectancy of some fresh symptoms, of some increase or aggravation of his troubles, does the poor man waste his life ”

“ This is a state in which the patient fears everything or nothing, where anxiety, instead of being riveted on one object, floats as in a dream, and only becomes fixed for an instant at a time, passing from one object to another, as circumstances may determine. ”

“ Many persons who cannot be termed ill show this tendency to anticipate disaster. We blame them for being over-anxious or pessimistic. A striking amount of expectant fear is characteristic of a nervous condition which I have named "anxiety neurosis," and which I group with the true neuroses.
A second form of fear in contrast to the one we have just described is psychologically more circumscribed and bound up with certain objects or situations. It is the fear of the manifold and frequently very peculiar phobias. ”

“ Now, as fear is originally excited by our having experienced pain, and is itself a painful affection, the same quiescence of other fibrous motions accompany it, as have been most frequently connected with this kind of pain, as explained in Sect. XVI. 8. 1. as the coldness and paleness of the skin, trembling, difficult respiration, indigestion, and other symptoms, which contribute to form the cold fit of fevers. Anxiety is fear continued through a longer time, and, by producing chronical torpor of the system, extinguishes life slowly, by what is commonly termed a broken heart. ”

“ Such an attack of anxiety consists of either the anxious feeling alone without any associated idea, or of the nearest interpretation of the termination of life, such as the idea of "sudden death" or threatening insanity; or the feeling of anxiety becomes mixed with some paresthesia (similar to the hysterical aura) ; or finally the anxious feeling may be combined with a disturbance of one or many somatic functions, such as respiration, cardiac activity, the vasomotor innervation, and the glandular activity. ”

“ It is a small price to pay if emotional symptoms can be traced to a physical cause.
It is well known that virtually any serious organic illness or injury can produce emotional suffering, either in the form of physical pain or in the form of anxiety and depression. Chronic pain is a chronic stress and can lead to the same emotional problems as prolonged stress of any variety: anxiety or depression. Similarly, prolonged severe anxiety or depression can cause physical deterioration and make the body more susceptible to disease. ”

“ How far we are perhaps justified in assuming constant relations between individual etiological moments and individual symptoms from the complex of anxiety neurosis, I do not care to discuss here.
(f) The last of the etiological determinants to be mentioned seems, in the first place, really not to be of a sexual nature. Anxiety neurosis originates in both sexes through the moment of overwork, exhaustive exertion, as for instance, after sleepless nights, nursing the sick, and even after serious illnesses. ”

“ As we advance in life, we become instinctively, or by experience, afraid of almost everything. We are afraid of our parents, afraid of our teachers, afraid of our playmates, afraid of ghosts, afraid of rules and regulations and punishments, afraid of the doctor, the dentist, the surgeon. Our adult life is a state of chronic anxiety, which is fear in a milder form. ”

“ Proceeding now to neurotic fear, what are its manifestations and conditions? There is much to be described. In the first place we find a general condition of anxiety, a condition of free-floating fear as it were, which is ready to attach itself to any appropriate idea, to influence judgment, to give rise to expectations, in fact to seize any opportunity to make itself felt. ”

“ Similar intense fears may occur in the first stage or following the administration of an anaesthetic, or attacks of terror may occur in the waking state as part of an anxiety-neurosis. Another pathological form taken by fear is shown by the various phobias, in each of which some special stimulus may arouse fear in one who otherwise may not know what fear means. ”

“ Anxiety quickly demoralizes the whole body, and lays it open to the entrance of disease; ”

“ Thus, we find from different standpoints that the feeling of anxiety with its accompanying phenomena is one of the most potent manifestations of animal instincts, the fear instinct, which is at the basis of all psychopathic, neurotic maladies. ”

“ When this happens, anxiety is linked to stimuli that in themselves are usually harmless. A person may come to feel extremely anxious, for example, when in the presence of people in authority, when in bed with a sex partner, when near dogs or insects, when criticized by others, when in a confined space, or in any number of other situations. Anxiety in these situations is learned, and it gradually becomes an involuntary habit. ”

“ What is particularly destructive about this is that you soon find yourself caught in a vicious circle: a certain situation makes you anxious, you try to avoid the situation and the anxiety it produces in you, and as you do this, you build up secondary anxiety—you get anxious that you'll get anxious. So anxiety compounds, feeding on itself, fueling itself. ”

“ Anxiety then lays hold of us, attenuating the bright side, magnifying the dark, maddening our brain, which is living two lives at once, and tormenting our heart, which is beating as though it would burst. ”