Selected papers on hysteria and other psychoneurosesFreud, Sigmund
Science
Selected papers on hysteria and other psychoneuroses
Freud, Sigmund
Hysteria; Neuroses; Psychoanalysis
3. 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.
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. From this combination the patient renders especially
prominent now this and now the other moment. He complains of
“heartspasms,” “heavy breathing,” “profuse perspiration,” “inordinate
appetite,” etc., and in his description the feeling of anxiety is put to
the background or it is rather vaguely described as “feeling badly,”
“uncomfortably,” etc.
4. What is interesting and of diagnostic significance is the fact that
the amount of admixture of these elements in the attack of anxiety
varies extraordinarily, and that almost any accompanying symptom can
alone constitute the attack as well as the anxiety itself. Accordingly
there are rudimentary attacks of anxiety, and equivalents for the attack
of anxiety, probably all of equal significance in showing a profuse and
hitherto little appreciated richness in forms. A more thorough study of
these larvated states of anxiety (Hecker) and their diagnostic division
from other attacks ought soon to become the necessary work for the
neuropathologist.
I now add a list of those forms of attacks of anxiety with which I am
acquainted. There are attacks:
(_a_) With disturbances of heart action, such as palpitation with
transitory arrythmia, with longer continued tachycardia up to grave
states of heart weakness, the differentiation of which from organic
heart affection is not always easy; among such we have the pseudo-angina
pectoris, a delicate diagnostic sphere!
(_b_) With disturbances of respiration, many forms of nervous dyspnoea,
asthma-like attacks, etc. I assert that even these attacks are not
always accompanied by conscious anxiety;
(_c_) Of profuse perspiration, often nocturnal;
(_d_) Of trembling and shaking which may readily be mistaken for
hysterical attacks;
(_e_) Of inordinate appetite, often combined with dizziness;
(_f_) Of attack-like appearing diarrhoea;
(_g_) Of locomotor dizziness;
(_h_) Of so called congestions, embracing all that was called vasomotor
neurasthenia; and,
(_i_) Of paresthesias (These are seldom without anxiety or a similar
discomfort).
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