ABSTRACT
The form of neurosis described in this chapter is very common, and the name anxiety state may be applied to those cases in which the symptom of anxiety or angoisse is the most prominent and significant feature of the illness. A vast deal has been written about this symptom (angoisse or Angst), which is present at some time or other in all neurotic illness. Its manifestations, which are both mental and physical, are the invariable accompaniment of conflict within the personality. The absence of this symptom in certain hysterical cases is referred to and explained in the discussion on hysteria on page 172 but, as will be seen there, the exception is more apparent than real. Pathological anxiety is an intensification of normal anxiety—itself a conflict within the personality between the emotions of hope and fear with concomitant physical manifestations. The most characteristic of these is a spasm or irregular muscular action of the diaphragm, sometimes referred to by patients as “their insides turning over,” “a sinking in the pit of the stomach,” and so on. At the same time palpitation and other cardiac irregularities, sometimes accompanied by anginous pain, are very common, while pains in the head, giddiness, and swishing noises are often complained of. Less universally present symptoms are nausea and even vomiting, peristaltic irregularities, diarrhoea and tenesmus, “spasms” of all sorts, vaso-constrictions with cold extremities, asthma, air hunger or suffocation and disturbances of sweating salivation and other secretions, which may rarely be unilateral. The mental symptoms comprise intense apprehension and fear, sometimes with no specific object, but often with the emotion attached rather loosely and expressing itself as a dread of death, heart disease, insanity, etc. These more definite anxieties are however secondary, and the results of suggestions emanating from one or more of the physical accompaniments. Sleep is practically always disturbed and nightmares are present.
