Anxiety (anxiety)
If we draw a continuum of anxiety according to its severity, one end of the spectrum is severe symptomatic anxiety and the other end is anxiety-free state. Ordinary anxiety lies in the middle.
As a psychiatric symptom, anxiety is distressing and also significantly impairs psychological or social functioning. Anxiety symptoms have two main aspects: subjective experience and objective manifestations.
1, anxiety mood: typical anxiety symptoms, the patient experiences fear without a clear object and specific content. Patients are fearful and anxious all day long, always feeling as if a big disaster is coming or danger is imminent, but they also know that there is no real danger or threat, but they do not know why they are so upset.
2. Objective manifestations: There are two kinds of objective manifestations: one is motor restlessness: the patient’s eyes are closed and the arms are stretched forward, and a slight tremor of symmetrical fingers can be seen; muscle tension makes the patient feel head tightness and swelling, stiffness and discomfort or even pain in the back of the neck, and lumbar and back pain in the limbs are also common; in severe cases, the patient is fidgety and has some small movements from time to time, such as scratching the head and rubbing the hands, or even walking back and forth, and cannot sit still for a moment. Another objective manifestation is the various symptoms of plant nervous disorder, especially sympathetic hyperfunction, such as dry mouth, red and white face, sweating, palpitations, shortness of breath, choking feeling, chest tightness, loss of appetite, constipation or diarrhea, bloating, urinary frequency and urgency, and easy to faint.
It usually takes both of these symptoms to determine anxiety symptoms. Only an anxious mood without any objective symptoms is likely to be a personality trait or a reaction that occurs in regular people in certain situations (situational or anticipatory anxiety). It is also wrong to determine anxiety solely on the basis of a disturbance in plant nervous function.
Compared to general anxiety, anxiety disorders are not only severe and persistent, but they are also specific in nature. This is that it is separate from the life event that caused the “anxiety” and goes far beyond the general anxiety reaction (from worry – excessive worry – fear), but also The event that “causes” the anxiety is trivial or even anecdotal (tetanus, fear of death even when the skin is rubbed, or even when the skin is not rubbed but is red). At this point, rather than some trivial event causing anxiety, the anxiety is looking for a far-fetched outlet for a reason. In extreme cases, the anxiety is not linked in the patient’s perception to any definite life event or situation, hence the psychiatric term free-floating anxiety or anxiety without a name.
At the other extreme of the phenomenological spectrum, in contrast to anxiety disorders, is anxiety-free anxiety. This can be either a pathological state of emotional indifference and desirelessness, or a state of “transcendence” achieved by the efforts of individuals. The latter is pursued by people in both ancient and modern times, such as the Taoist’s “quietness and inaction”, the Zen saying “Bodhi is not a tree, the mirror is not a platform, Buddha’s nature is always pure, where there is dust” (Sixth Patriarch Huineng), and the Stoicism of ancient Greece “immovable mind” (ataraxia), etc. The meditation (meditation) of Western religious people, the sitting meditation of Buddhism, and the entering into silence pursued by qigong practitioners, etc., all of them can be said to share the common feature of inner peace, i.e., a mental state free from anxiety.
In fact, the transcendence achieved by effort is often a temporary state. It is for this reason that “even after epiphany one has to practice gradually”. The most extreme anxiety, i.e., intense acute anxiety attacks (also called panic attacks), is also a relatively transient state.
From the perspective of the population, the vast majority of people are in a state between the two extremes of anxiety disorder and immobility. That is, from time to time, they are anxious and worried because of various practical situations. It is never a sign of mental health to be anxious regardless of the situation. Such a species is also unlikely to survive. Anxiety is an intrinsic motivation for personality integration and socialization, and is an antidote to settling for the status quo and not seeking progress. If you have desires, you will have anxiety. We all expect the future to be better than the present, but the objective world is not so obedient, life is full of risks, and the future is uncertain, which is the root of the so-called existential anxiety.
From a psychopathological point of view, the level of general anxiety depends more on the degree of satisfaction of what A.H. Maslow (1970) called basic needs than on the current situation and certain past events in life. It is well established that anxious patients seen in clinical settings have evidence of unmet basic needs in their personal histories. Overprotective, overcontrolling, and demanding parents (especially mothers) are a major cause of their children’s tendency to grow up to be anxious.
In addition to the characteristic manifestations of chronic anxiety described above, anxiety disorders are also characterized by acute anxiety episodes as the main feature of panic disorder.
If the anxiety outlet locks onto a specific target and produces avoidance behavior, it becomes a phobic disorder. Patients with phobias have a defined external object as the object of fear. A single phobia (e.g., fear of enclosed spaces – claustrophobia) is clearly distinct from a chronic anxiety state, but there are various transitional forms between the two. It is difficult to draw a sharp dividing line between polymorphic phobias and anxiety disorders that fluctuate significantly with situation.
One of the more specific types of phobias is fear of people, also known as social anxiety or social phobia. A continuum can also be formed between it and general social tension.
The anxiety of hypochondriacs is focused on their own body and illness, while that of anxiety disorders is diffuse, but a mixed state of both is not uncommon, i.e., both hypochondriacal and anxiety without a name.
There is also a specific manifestation of anxiety that addresses a previous traumatic experience. The repeated intrusion of a horrible traumatic experience, accompanied by marked anxiety and avoidance, can be seen as a delayed post-traumatic anxiety response (post-traumatic stress disorder).
In 1894, Freud first distinguished anxiety from neurosis and described it as a neurotic disorder. Today, the DSM-IV in the United States includes anxiety disorders in addition to the chronic generalized anxiety, panic disorder, phobias, and posttraumatic stress disorder already covered above, and also includes obsessive-compulsive disorder, which is almost equal to the former general category of neurosis, except that the somatic manifestations of hypochondriac disorder and somatoform disorder are additionally divided out.
Anxiety disorders point to the future, to possible danger or misfortune, and are conceptually indeterminate. Depression implies a loss already caused, an irrevocable fait accompli, and is conceptually certain. A mixture of various degrees of anxiety and different degrees of depression can be seen clinically. As far as the diagnosis of status quo is concerned, depression is preferentially diagnosed whenever the degree of depression is sufficient to reach delayed depression. In the case of the “new” depressed group, which is dominated by negative emotions such as irritability, decreased interest, lethargy, and dissatisfaction, the diagnosis of anxiety disorder is more appropriate if the anxiety experience is more typical and predominant in the course of the illness. Then there is the so-called mixed anxiety-depression state, which is often atypical of both and is mainly characterized by distractibility and irritability, with physical symptoms (e.g., poor mood, pain).
If we compare typical anxiety and typical depression to two icebergs next to each other on the water surface, the mixed anxiety-depression state is the ice lump fused together under the water surface, which tends to be more common in non-psychiatric professional institutions such as general hospitals and primary care.
The above is an illustration of typical anxiety symptoms, put back into life as well as back into clinical categories that overlap with each other, in a continuous spectrum approach (phenomenological spectrum). It is hoped that this will help to deepen the understanding of anxiety symptoms and especially help beginners to see atypical situations in their proper perspective.
In the field of psychiatry, anxiety appears not only as a name for a symptom (syndrome) and as a general term for a category of disorders, but the psychoanalytic schools have their particular usage. i. L. Janis (1971), after listing scholars from many different schools and pointing out the fundamental differences in their views, writes that in their description of “anxiety Several common themes run through their descriptions of the behavioral consequences of “anxiety,” suggesting that most (psychoanalytic) theorists use the term “anxiety” as a category that includes fear, shame, and guilt. This use of anxiety is common in the literature, and it should be remembered that it is not to be confused with the clinician’s symptomatological conception of anxiety.
There is a third use of anxiety, which according to S. Freud can be “unconscious. This is not a description of the phenomenon, but rather a particular interpretation of it. For example, Freud uses the term “unconscious anxiety” to explain the mechanism by which many hysterical symptoms occur, considering the somatic symptoms to be “transformations” of “unconscious anxiety,” i.e. The “unconscious” mind itself becomes a somatic symptom. In fact, hysterical people often experience less anxiety than the average person during an episode. This is what French scholars call the “belle indifférence” attitude.
Panic attack
A panic attack is a severe anxiety attack, that is, an intense fear attack with severe vegetative symptoms. The fear does not have a clear objective object; the patient has a sense of near-death or fear of death; or, a sense of loss of control or fear of going crazy; or, an experience of facing a catastrophe or the end of the world; or, an experience of depersonalization. This is the experience of the Chinese people described in the idiom Qiyin Ren Ren Tian.
The common vegetative symptoms of panic attack are: 1) difficulty breathing or choking sensation; 2) dizziness, feeling unstable or fainting; 3) palpitations or rapid heartbeat; 4) tremor or shaking; 5) sweating; 6) nausea or abdominal pain; 7) tingling or pins and needles sensation; 8) flushed or pale chilled skin; 9) pain in the precordial region or chest tightness; 10) unpleasant general discomfort.
The seizures do not last long, a few minutes short or a few minutes long. However, the fatigue after the attack can last for 1 to 2 days.
Panic attacks can be seen in a variety of clinical situations, roughly divided into four major categories: 1, acute physical illnesses triggered by, for example, myocardial infarction, hyperthyroidism, hypoglycemic reaction; 2, drugs, especially the direct physiological effects of psychoactive substances, such as adrenaline-producing drugs, atropine poisoning, drugs; 3, a variety of psychotic disorders accompanied by, for example, acute delusional state, reactive psychosis, schizophrenia; 4, transcendental disorders sexual disorders, such as various phobias, post-traumatic stress disorder, separation anxiety, etc. Finally, after excluding all the above-mentioned conditions, panic disorder can be diagnosed if panic attacks occur repeatedly, with no obvious symptoms other than anticipatory anxiety between attacks, and if they lead to functional impairment.
It is easy to see from the above symptom attributions that any condition that is strong enough to cause a strong physiological disturbance may induce a panic attack in individuals with high susceptibility. In fact, this is true not only for acute episodes of anxiety, but also for the generalized chronic anxiety mentioned earlier. They are just not as prominent and easily identified and attributed as acute anxiety attacks.