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After reading this article you will learn about:- 1. Subject-Matter of Anxiety Neuroses 2. Physical Symptoms of Anxiety Neuroses 3. Theories 4. Treatment.
Subject-Matter of Anxiety Neuroses:
Otherwise known as anxiety states, anxiety reaction etc., anxiety neuroses is one of the most common forms of neuroses consisting approximately about 30 to 40 per cent of all neurotic disorders. Anxiety is an internalized fear, aroused by an impulse to commit. It is a danger signal to the ego that dangerous impulse is about to break. It is, in fact, an unconscious reaction to depressed tendencies.
Ross defines anxiety as a “series of symptoms which arise from faulty adaptation to the stresses and strains of life.” An anxiety is a painful emotional experience produced by excitations in the internal organs of the body. In general, it is characterized by over concern which may turn over to panic or severe fear.
In fact, it is a form of fear not based upon present alone, but also upon the actual or imaginative experience of the past and future. The victim shows anxiety under different situations without any specific reason. Such anxiety is called free floating.
Physical Symptoms of Anxiety Neuroses:
When a person encounters dangerous situation or experiences anxiety, he is bothered with physical symptoms like heavy sweating, trembling of lips and hands, rapid breathing or breathing difficulty, rapid heart-beat, increased pulse rate, dryness of mouth and frequent urination etc. Also dizziness, muscular fatigue and tension are common symptoms.
While describing the physical symptoms of anxiety neurotic, Gunn (1962) has commented “There may be mild nausea, loss of appetite and some loss of weight. He may have heart palpitation without apparent reason and there may be cardio-vascular changes such as low blood pressure and an increased irritability.”
According to Coleman (1981) “The anxiety neurotic’s high level of tension is often reflected in strained postural movements, over action to sudden or unexpected stimuli, continual nervous movements of one sort or another and gastro intestinal upsets. He frequently complains of muscular tightness especially in the neck and upper shoulder region, chronic mild diarrhoea, frequent urination and difficulties in digestion, concentration and sleep. The excessive use of alcohol, tranquilizing drugs or sleeping pills may further complicate the clinical picture.”
I. Psychological Symptoms:
Persons suffering from anxiety attacks are sensitive to criticism and are quickly discouraged. Tenseness, irritability, and fear arising out of fantasies or imagined danger, acute panic and loss of sleep, mild depression, lack of concentration and inability to make decision are other common psychological symptoms.
There is experience of terrible danger such as the feeling that he is going to die or face some terrible calamity.
The individual is not able to continue his work or social obligation. Vague feelings arising out of anxiety make them continuously upset and uneasy leading to feelings of discomfort. They worry unnecessarily over possible errors. When one worry is removed they find another until relatives and friends lose all patience with them.
Freud preferred the term anxiety to fear and he described three forms of anxiety such as:
(a) Reality or objective anxiety,
(b) Neurotic anxiety and
(c) Moral anxiety.
These three types of anxiety only differ from each other in respect to their sources.
The common significant quality of these three types of anxiety is that they are unpleasant:
(a) Reality Anxiety:
The source of danger or anxiety lies in the external world in reality anxiety. It protects the individual from real danger. Fear for snakes, tigers, crocodiles and sharks are the examples of source of danger which bring about reality anxiety.
(b) Neurotic Anxiety:
Neurotic anxiety is directly experienced and the patient does not know the cause behind his so called floating anxiety. The danger in neurotic anxiety is instinctual object choice of the Id.
According to Marks and Lader (1973) the person classified as an anxiety neurotic appears to be lacking any effective means of dealing with anxiety.
As a result three forms of anxiety neuroses may appear:
(i) Free floating or neurotic anxiety:
It is characterized by no real reason but mild constant apprehension. Such persons always apprehend something dreadful to happen.
(ii) Anxiety attack:
It is more severe with sudden experience of intense anxiety usually in some specific circumstances. Panic or near Panic reactions appear all of a sudden with no apparent provocation. The physical accompaniments of anxiety attack are difficulty in breathing, chest pains, restlessness and signs of extreme fear.
In such cases, the person is said to be acting with his impulses. This reduces anxiety by relieving the pressure which the id exerts upon the ego.
(iii) Panic reaction:
Being the most intense form of anxiety, the anxiety is unbearable where actual physical pain may be experienced. It is thus characterized by intense irrational fear. The fear is not according to the actual danger of the object.
Examples are screaming at the sight of a spider or hair, restlessness and other signs of extreme fear. In such cases, the person is said to be acting with his impulses. This reduces anxiety by relieving the pressure which the id exerts upon the ego.
The pain at times is so unbearable that people attempt to commit suicide to escape the painful feelings. The dread and terror of experience of this type of anxiety can be realized to some extent by analysing certain personal experience.
In each of these cases, the fear is irrational because the main root of anxiety is found in the id rather than in the external world. Analysis of various personal experiences of anxiety suggests that they feel extremely miserable while experiencing the terror of anxiety and miserably fail to handle it successfully.
According to Duke and Nowicki (1979), “Typically although the origin of anxiety may be hidden by the defence of repression, the emotional impact of the unfounded fear is not. As a result, the person may experience a number of physiological symptoms. He or she may feel weak, faint or sweaty and may sigh, part and frequently show coronary symptoms varying from an intense pounding to a skipping of heart beats. Under the bombardment of these general physiological effects, anxiety neurotics may be frightened and want to run somewhere to hide, but everywhere they go, they take the source of anxiety, right along with them and their flight is to no avail.”
Behind any neurotic fear, there is a primitive wish of the id, and the object of which he is afraid symbolizes something else. Neurotic anxiety thus arises from the ego’s realization that if the sexual and aggressive urges of the id are not checked, the psychological existence of the individual may be threatened.
(c) Moral Anxiety:
Moral anxiety arises out of a kind of shame or guilt in the ego. This feeling of shame or guilt is aroused by a perception of danger from the super ego. The conscience of the individual threatens to punish the person for some sort of morbid thought or action which obviously goes against the ego ideal and rigid values that have been laid out by the parents and society.
The source of threat in moral anxiety is the conscience or super ego. The source of moral anxiety lies in the personality structure, a person in-fact cannot escape the feeling of guilt by running away from them. The conflict is purely intra-psychic and structural one and does not involve a relationship between the person and the world. In short, it is an outgrowth of objective fear of parents.
Moral and neurotic anxiety has close ties with each other. These anxieties are the outcome of rigid discipline of the parents which is mostly directed against expression of sexual and aggressive impulses.
A virtuous person, for example, has a strong and strict super ego. So he experiences more shame and guilt in comparison to an un-virtuous person in the walks of life. In both neurotic and moral anxiety, the danger and apprehension comes from the internal self.
To get relief from the guilt feeling and deep pain, the individual invites punishment to the self from an external service. Neurotic anxiety similarly may lead a person to indulge in an impulsive act. The impulsive deeds are considered less painful than the anxiety itself.
In short, neurotic and moral anxiety are not only signals of impending danger to the ego, they are also themselves the danger. Briefly, the three types of anxiety which the ego experiences are fear of the external world, fear of the id and fear of the super ego.
II. Precipitating Causes of Anxiety Attacks:
Coleman (1981) has described 3 kinds of situations which increase neurotic anxiety and precipitate acute anxiety attacks:
1. Threats to status or goal:
When the occasion for meeting the demands of life and to assume the adult responsibilities arises, threats to status may occur. Competing with others in the face of underlying feelings of inadequacy and inferiority, also leads to anxiety attacks.
Therefore, it has been found that over ambitious, conscientious and in-secured people experience severe anxiety while trying to fulfil their aspirations and achieve well defined and meaningful material goals.
2. When dangerous desires threaten to come out:
The sexual, aggressive and hostile desires may try to come up to the conscious level breaking the barriers and defences of the ego. This leads to serious guilt feelings and create intense anxiety. The individual tries to repress his undesirable wishes to prove himself worthy in the society and to adjust with social values.
3. When anxiety arising decisions come out:
The anxiety neurotics are usually indecisive in nature. When there is a conflict between the sexual or aggressive desire and the guilt feeling arising out of it and the person is not able to the make a decision, such indecisive nature leads to development of severe anxiety.
Coleman (1981) states that “in cases where the neurotically insecure person has achieved some degree of real life success and consequently of security, anxiety attacks may develop where his proposed behaviour jeopardizes this security. He further adds, life often poses problems in which the pursuit of increased satisfaction involves giving up present hard own security and taking new risks. For the neurotic this is likely to improve an anxiety arousing conflict situation.”
Theories of Anxiety Neuroses:
Certain theories have been advanced to explain anxiety:
i. Psychoanalytic Theory:
At the early stage Freud considered anxiety as a primary physiological reaction to a chronic inability to reach the organism in sexual relationship. But later on (1936) after continuous analysis of his patients he changed this view and held that anxiety was more likely a specific state of un-pleasure which worked as a danger signal.
According to him the anxiety is experienced at birth because of being left alone, being in dark and finding a stranger in the place of the mother. It is the feeling of the loss of loved object.
Besides, realistic anxiety according to psychoanalysts arises out of the perception of real dangers of the ego in the external world. It acts as an early warning signal to make the individual cautious to protect himself from the dangers coming from the environment.
Neurotic anxiety arises out of the basic conflict between the instinctual desires of the id and the reality principle of the ego. The conflict being unconscious individuals suffering from such anxiety do not know the real causes behind their anxiety symptoms. This is why such anxiety is called free floating.
According to Duke and Nowicki (1979) “Neurotic anxiety arises from the ego’s realization that if the aggressive or sexual urges of the id are not checked by consideration of reality, the psychological existence of the individual may be threatened.”
Moral anxiety arises out of the ego’s interaction with the super ego. Since the super ego like the id has no close contact with the reality, even the thought of id directed activities of the person may bring punishment from the super ego to the ego in the nature of guilt or shame.
This anxiety thus arises when the rule of the super ego is about to be broken or violated. Degree of moral anxiety depends upon the rigidity of the child rearing practices. Parents having a strict and rigid super ego usually help in the development of moral anxiety of the child.
The occurrence of any particular type of anxiety i.e., reality, neurotic or moral depends upon the specific situation in question. For instance, a small girl wants to steal a beautiful piece of jewellery from a shop.
The anxiety aroused in her for the fear of being caught by the shopkeeper is called reality anxiety. If she is anxious because her ego considers this act of stealing as an act representing her hatred towards her mother (symbolized by the shopkeeper), it is called neurotic anxiety.
Finally if she experiences anxiety because she thinks it is morally degrading to steal, it is sin for which she would be punished by God, it is called moral anxiety.
When any of such anxiety is experienced, the ego tries to reduce it by maintaining the id impulses and the super ego desires. For this purpose it may have to use certain defence mechanism.
ii. Learning or Behaviouristic Theory:
According to the behaviourists or learning theorists anxiety is primarily the result of learning and environmental factors. Learning theorists like Sknner (1938), Eysenck (1957) and Ullmann and Krasner (1975) view that the source of anxiety lies in the existing environment of the individual and the anxiety states are classically conditioned and reinforced reactions.
This theory of anxiety is closely connected to the basic phenomenon of motivation, learning and reinforcement. Thus Ellis (1962) views that anxiety neurotics learn irrational thought patterns from their environment which produce anxiety in them.
According to the learning theorists while fulfilling our primary and secondary drives one has to come through the experiences of anxiety. The pain avoidance drive which is biologically programmed for example, leads to anxiety. The very anticipation of the pain before taking an injection is called anxiety.
This type of anxiety is a secondary avoidance drive. Mild anxiety may be helpful for better motivation and greater learning. But if the strength of such anxiety increases it may have adverse effect.
In case of Albert in Watson and Rayner’s experiment (1920) the very loud noise created anxiety in the child anticipating the fear provoking stimulus, the white rat. Here the rat acts as a secondary source of fear for the child through association with the primary stimulus, i.e., loud noise.
The most disturbing aspect of anxiety is that it spreads very rapidly from one anxiety provoking situation to another having some similarity. This is called the generalization of anxiety. The once loved neutral objects or stimuli afterwards become anxiety provoking cues in themselves because of generalization in learning.
Jenkins (1968, 1969) has emphasized the role of familial training and child rearing practices on the development of anxiety of children. He has reported that anxiety neurotics often come from families which set higher expectations and goal strivings for their children, while at the same time rejecting their accomplishments as substandard.
Children brought up in such familial set up and value system turn out to be perfectionistic and self-critical and experience severe trauma of anxiety if they fail.
A boy, for instance, coming from such a family may attempt to commit suicide, when he could not get a good grade in the examination while another boy coming from different type of familial training may consider his failure lightly and may not experience so much anxiety like his former counterpart.
iii. Neo Freudian Theory:
The fear of the dependency, needs not being fulfilled, the insecurity feeling because of loss of protection lead to primary anxiety according to Neo Freudians. White (1964) opines that the process of socialization which includes accepting the social customs, traditions, rules and regulations, gives a threat to the withdrawal or loss of parental love for which the child pines so much may lead to experience of anxiety.
To avoid this primary anxiety they respect their basic desires and behaviours according to the demands of the society and this ultimately frustrates the children and makes them angry, hostile.
According to most Neo Freudians, the core of neuroses lies in how the children deal with this anger. Aggressive behaviour is never accepted or liked by the parents. So children learn to control the expression of their aggression through the development of different defences like repression and denial.
But when the defences are threatened, child experiences anxiety. This is called secondary anxiety which is very closely connected with neurotic behaviours.
iv. Personality Theory:
Persons suffering from anxiety neuroses are usually subservient, compliant, self-controlled, restrained and timid by nature. These personality characteristics lead them to repress emotions like hostility, aggression and anguish etc. Further, the very feeling and anticipation that they may lose control of negative emotions leads to severe anxiety.
According to Eysenck introverted personalities usually suffer from anxiety states.
v. Conflict Theory:
The conflict theory of anxiety introduced by Dollard and Miller (1950) though based on Freudian and Neo Freudian theory, is associated with learning theory explanation of anxiety. Conflict arises when two equally strong and fairly identical drives compete with each other. This indecisiveness or conflict leads to anxiety. The degree of anxiety increases with the increase in the degree of difficulty to resolve the conflict.
Out of the four types of conflict, the approach-approach conflict advanced by Miller and Dollard rarely gives rise to much anxiety. When an organism is simultaneously motivated to pursue two desirable but incompatible goals, it is called approach-approach conflict.
But greater anxiety is produced in an avoidance-avoidance conflict where there is no positively valued choice. For example, when a vegetarian is compelled to choose either between fish or meat, both of which are unpleasant to him, or between jumping off a five storey building or being shot dead, he experiences severe anxiety while choosing one.
Approach avoidance conflict can also create anxiety. For example, when a person is attracted by a beautiful diamond necklace, and wants to grab it and at the same time is afraid of being killed by the electric wire attached to it, there is anxiety.
According to the conflict theorists if conflicts of any of these types can be resolved, anxiety and its negative repercussions can also be eradicated or reduced.
Treatment of Anxiety Neuroses:
Anxiety is a most common problem for modern men. So treatment is essential. Tranquilizing drugs, often give immediate relief to anxiety neurotics. But most of the tranquilizing drugs are effective only against the feeling of anxiety itself and don’t have much effect on the other accompanying symptoms.
Barbiturate may reduce the symptom of insomnia in anxiety neuroses. Psychotherapy works very effectively in anxiety neuroses. But unfortunately, anxiety is rarely completely removed. (Tobin and Lewis, 1960). However, it can be reduced to the extent of enabling them to make satisfactory adjustment with the environment and society at large.