Problems often arise in classifying these disorders,
because many cases are complicated. Several types
of mal-adaptive behavior may occur simultaneously.
Obsessions, compulsions, and phobias might all be
observed in a given individual. Severe panic states
are sometimes followed by periods of psychotic
disorganization in which there is a reduced
capacity to testreality.
I present a case of anxiety and panic and
classifies it in terms of the DSM system. A person
who has had a panic attack develops he or she
becomes worried and tense and is afraid
that the panic will recur. In some cases, this type
of anticipatory anxiety seems to be quite realistic fear.
Drug research has provided an interesting finding
that suggests that panic and anticipatory anxiety have
different sources. However, it seems to have no effect on
the anticipatory anxiety that panic attack s almost always arouse.
DSM relatively few attempts had beenmade to
identify and compare subgroups of anxiety disorders.
I compare these disorders with regard to several bodily symptoms. Subjects with generalized anxiety disorder have fewer bodily symptoms than those with panic disorders. Their histories also show an earlier, more gradual onset. A generalized anxiety disorder has a more chronic course and is more likely to have a favorable outcome. Members of families in which a person suffers from a panic disorder tend to have a relatively high percentage of panic episodes. The comparable percentage for family members of those with a generalized anxiety disorder is much lower.
An Anxious, Precise, Addictive, DemandingMan Seeks Help
Mr. E., 40 years old and recently married, sought clinical
help because he was nervous and worried about his
health and had a porn addiction.
These lifelong concerns became worse during
his courtship and honeymoon.
Mr. E. has trouble falling asleep if the room is too
dark or too light, if he has eaten too much or too
little, if the sheets are cold or wrinkled, if he forgets
his nose spray, or if there is any noise. He fears
nightmares, nocturnal asthma attacks, or dying in
his sleep. He often awakes in a panicky sweat with
nightmares, typically of being chased or
suffocated. He worries that his lost sleep is
shortening his life and ruining his work efficiency.
Mr. E. had always been anxious and worried. He
expects the worst if his spouse found
out about his porn issues, dreads each time
the phonerings lest it be bad news, and now suspects that he
has a serious illness. He experiences frequent
palpitations, shortness of breath, dizziness, and
numb fingers and has had numerous physical
exams and electrocardiograms. The negative
findings do not reassure him as Mr. E. is
convinced that his doctors are withholding
information, and he is determined to have
additional checkups until his condition is
diagnosed. He also has gastrointestinal flutters,
frequent diarrhea or constipation, and occasional
nausea and vomiting. His father died of heart
disease and his mother of cancer, and he feels
confident that he already has, or soon will have,
one or both conditions.
Mr. E. is also extremely anxious about his work. He
is a stockbroker responsible for large financial
transactions and cannot ever relax his
concentration, even on vacations. He has also felt
considerable performance anxiety about his
recently more active sex life and has suffered from
consistent premature ejaculation. There are many
specific situations that make him intolerably
nervous-waiting in line, sitting in the middle of a
row at a movie, riding public transportation,
wearing a pair of pants a second time without
having them cleaned, having dirty dollar bills, and
so forth-but he is able to avoid most of them
without great inconvenience. Mr. E. has panic
attacks at least every few weeks. They tend to
occur whenever something new is expected of
him, when he is forced to do one of the things he
fears, when he must give a talk, and, at times, for
no apparent reason.
Mr. E. is a very precise and demanding man who
is difficult to live or work with (or to treat). He is