Caratterizzata da: A) comportamento "fobico"; B) personalità di base: astenico-anancastica.
Phobia: it is the fear of a situation or an object (animated or inanimate)
that is devoid of any intrinsic value of real danger. Phobia is a type of
disorder that manifests itself with constant, recurrent and unreasonable fear
towards an object, a situation, an animal, a specific event. Since the phobia
occurs within a very specific context, in general, one is led to think that it
is less invalidating than other types of problems. Being such a peculiar and
specific disorder, however, it may happen that sometimes the person manages to
avoid totally, to keep away from his daily life the phobic object, until, there
is an opportunity, a situation, a change in the life of the person that leads to
having to "deal" with the object of his own phobia. Phobic behavior therefore
includes 3 elements:
1) the object (or the phobic or better phobogenic situation);
2) the non-rational fear of the subject, and criticized by them, of this object
or situation;
3) avoidance behavior of the object or situation to defend against the
aforementioned fear (counter-phobic measure).
The most frequent forms to be found in practice are: the phobia of open spaces (agoraphobia):
the subject does not move away from a place considered safe, has difficulty
crossing the road alone, can not remain alone in open places; the phobia of
means of transport (dromophobia); the phobia of closed places and cramped spaces:
crowds, crowded closed places, elevators (claustrophobia); the phobia of heights
(acrophobia); phobia of approaching patients for fear of contagion (nosophobia);
phobia of death with consequent avoidance behavior of objects, places,
situations connected in some way to death (tanatophobia).
Avoidance is a psychic defense aimed at removing the individual from an
anxiogenic stimulus through the simple mechanism of not coping with this
stimulus. The consequence is an increase in the perception of danger of the
avoided stimulus. This type of defense is, for cognitive psychology, at the base
of phobias and the maintenance of dysfunctional beliefs (beliefs of
dangerousness of objects or events). The more an individual avoids exposing
himself to objects or situations that cause him fear, the more will be confirmed
in him the belief that this object or situation is really dangerous. Exposure
techniques (gradually exposing the individual in a conscious way to the dreaded
stimulus) make it possible to considerably reduce the danger belief of the
dreaded object.
At the base of the phobic neurosis there is a conflictual anguish which involves a painful and unbearable feeling of inter threat. which derives from the struggle between instinctual elements (thoughts, desires) incompatible with the system of values of the subject and the defenses that the ego puts in place to keep repressed these drives. By transferring the threatening meaning to a datum external to the subject (that is, with the formation of a phobia) the ego realizes the "advantage" of moving the source of anguish from within, and of transforming it into fear, though irrational, of a concrete thing from which one can defend actively by avoiding it. It should be noted that in this "choice" of the phobic object often shines the quality of inner conflict: that is, the phobia has a symbolic value.
They are characterized by the fact that avoiding behavior of objects or
situations takes on the aspect of avoidance compulsion for fear that an idea or
a desire or an obsessive impulse can arise almost always with the value of
aggression towards others and oneself (ex. obsessive phobia of weapons, knives
and objects generally endowed with intrinsic damage). The French authors give
this kind of phobias the name of phobia fidi impulse "to distinguish them from
the" situation "phobias typical of phobic neurosis.
B) Basic personality
Alongside the typical characteristics of the asthenic personality, phobic
subjects present characteristic elements of the "anancastic personality": a
tendency to doubt, to control and to perseveratory iteration.
Differential diagnosis
Phobic syndrome is so characteristic that the differential diagnosis offers no
particular problems. Exceptions are some bizarre phobias of schizophrenics who
can hide feelings of influence or represent the pseudo-neurotic outcome of
delusions.
It is characterized by: 1) obsessive symptoms (obsession); 2) coactive behavior
of obsessive symptom control; 3) basic personality ("psychasthenics").
1) Obsession (obsessive symptom): it is the sudden appearance in the field of
consciousness of a content (idea, feeling, representation) of value and meaning
generally unpleasant or in contrast with the personality of the subject, outside
the will of the subject himself and that he experiences as a stranger to the
normal course of his thought. This obsessive content is affirmed and imposed
itself reappearing iteratively despite the efforts of the subject to get rid of
it, to produce an inter-active coercion, a real psychic parasitism.
2) The experience of imposition and interactive coercion and the negative
quality of the "obsession" provoke an affective reaction of the subject, which
can go from discomfort and annoyance to serious conditions of anxiety with
considerable moral suffering. From this unbearable situation a defensive
elaboration proceeds which is expressed in a behavior of control of appearance
and ritualistic flavor. This ceremonial soon became rigid, executed in a
scrupulous manner. It can come to completely dominate the ideation and the whole
life of the subject. Frequently encountered in practice are: meticulous and
extremely long washing ceremonials for the obsessive idea of dirt or contagion;
ceremonials of repetition of gestures and / or phrases for propitiatory purposes,
such as cabalistic formulas to combat obsessive, obscene and blasphemous ideas.
S. Obsessive is the most serious of neurotic syndromes and the most resistant
and rebellious to therapies. They are not infrequent in its long course of the
intervening phases of the depressive type.
3) Basic personality: psychasthenics (obsessive-anancastic)
Psicasthenia is a term introduced in psychiatry by Janet who with it wanted to
understand the presence in certain subjects of a lowering of the tone and level
of superebral brain functions. Because of this "psychic asthenia" the subjects
have particular characteristics:
a) "slowness" in the ideative and motor manifestations;
b) a tendency to doubt due to uncertainty and affective ambivalence in the face
of situations of choice between two alternatives;
c) tendency to psychic elaboration, to inter-rumination. and to the control of
acts and thoughts;
d) rationalization tendency made with meticulousness, fussiness; for marked
feudism (perseveratory tendency);
e) rigid and controlled activity with a strict and orthodox moralism that
regulates its existence.
Psychodynamic interpretation. The character traits of the obsessive should be
understood as reactive formations (defensive models) against anxiety. They would
control unacceptable impulses of a sexual and aggressive nature. The obsessive
symptoms manifest themselves when the character defenses fall due to various
causes (increases of instinctual drives, emotional traumas). The psychodynamic
defense mechanism invoked in the pathogenesis of s. obsessive is basically the
displacement (that is, the emotional cause is moved by the removed object on one
of the verse) and various other mechanisms such as isolation and symbolization.
Differential diagnosis: 1) with the so-called "cold obsessions" of the
pseudonevrotic forms of schizophrenia; 2) obsessive syndromes that appear as
patoplastic aspects of personality in the case of reactive or more often
endogenous depressions.
The most effective treatment for all types of neurosis is psychoanalysis or psychotherapy, sometimes hypnosis. Anxiolytics and antidepressants can be useful to reduce the disturbances and the phenomena of somatization of discomfort, considering that often the neuroses affect the social relationships, the sexual sphere and every other aspect of everyday life. The psychotherapeutic treatments are tailor-made, with the aim of establishing a relationship of empathy between the patient and the specialist
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