精神科医からみた不安神経症(不安と心身症第22回日本心身医学会総会シンポジウム)

抄録

It is said that in anxiety neurosis morbid anxiety emerges as somatic symtoms with no defense mechanism and is experienced as anxiety itself. Anxiety neurosis is not a psychosomatic disease in a narrow sense, but this disorder helps us to consider the relationship between anxiety and psychosomatic disease. The author's definion of anxiety neurosis includes the followings : 1) Sudden onset of anxiety attack 2) Anxiety in intermittent phases 3) Anticipation anxiety-which sometimes culminate in subattacks 4) Phobic avoidance i.e. secondary agoraphobia The subjects consisted of 42 anxiety neurotics (22 males, 20 females) who visited our clinics. In 34 of them (81%) their onset was in their young adult age (20-35 years). The author investigated the situations at the time of onset as well as the premorbid personality features of these 34 cases (19 males and 15 females. 14 males and 13 females were married). As to situations at onset, overwork by overestimating their bodily strength was seen in 7 male cases. Four female patients were not satisfied with their husbands who were said not to meet their dependency needs. With regard to premorbid character, a contradictory self-profile was delineated, i.e. strongminded and bold on the surface but dependent and neurotic inside. It seems that they want to live more freely than those who later suffer from depression. Thus we can assume that these patients have a dependence-independence conflict, and that they had enjoyed "freedom"which was depended on their parents or bodily strength in premorbid days. It seems that taking responsibility or playing the role as adults and being unable to depend on others or their own strength no longer, precipitate the onset. Thus anxiety neurosis has a basic conflict, anticipation anxiety and secondary phobic defense which are considered the characteristics of neurosis. At this point it differs from PSD which is characterized by the defense mechanisms of denial of anxiety, or somatization. But the first anxiety attack manifests itself as a somatic symptom without the patient's anticipation and therefore it can not be regarded as pure anxiety. It is assumed that anxiety neurosis may also have similar mechanisms to those of depression (as Mendels says, 1974) or PSD.