Typically, fear, panic and anxiety are manifestations of a pathological condition called phobic neurosis in medicine. By phobia we mean a psychological state of strong fear, which leads to neuroses, including those of a phobic nature.

Most often, pathology is detected in adolescents and young men. During this period, the child’s body undergoes active hormonal changes, which leads to various mental disorders. Anxious phobic neurosis is expressed in timidity, shyness, and suspiciousness.

If an illness develops, the child has little conversation with peers. When they start talking to him, this leads to panic and even hysteria. The child subsequently tries to exclude communication with people, which leads to various mental disorders.

At the initial stage of the development of the disease, the appearance of fear is due to a number of factors, but soon its occurrence occurs when any situation or object is mentioned. Subsequently, the person begins to be pathologically afraid of everything. Even though he understands his illness, he fears everything against his will. People who have a problem in the form of phobic manifestations try to protect themselves from panic attacks throughout their lives.

In addition, with phoboneurotic disease, other unpleasant symptomatic signs may appear in the form of headaches, dizziness, depression, heart pathologies and some others. Seeing something that evokes terrible associations, a person again becomes susceptible to phobias. The patient is very tense and cannot relax, no matter how hard he tries.

People prone to phobias diligently avoid the conditions that caused the pathology. They try to think about other situations and objects.

A person is susceptible to phobostates in the following situations:

• if there is a negative association about the subject;
• if you have had bad experiences in the past.

Manifestations of the disease may occur due to:

• dysfunction of the body's endocrine system;
• a number of hereditary factors;
• increased anxiety, constant worry, excessive responsibility, suspiciousness;
• emotional stress and physical exhaustion;
• dysfunction of sleep processes;
• improper nutrition and daily routine;
• infectious pathogenic conditions;
• excessive drinking of alcoholic beverages, smoking tobacco products, drug use and other bad habits that are incredibly harmful to the human body.

The emergence of phoboneuroses is due to the development of other pathological psychostates, including schizophrenic, obsessive-compulsive, and psychoasthenic manifestations.

Phobic neuroses arise at certain stages of a person’s life path. Particularly at risk are people in adolescence, young adulthood, and also before the onset of menopause.

Types of neurosis

When a person is struck by fear at the sight of people or objects, he develops a phobic condition. Sometimes the patient only needs to remember something to begin to fear and be afraid of everything. In the modern world, the development of phobias occurs in two ways:

1. If a person performed some work unsuccessfully and this contributed to the emergence of negative consequences, then this served to develop the primary reflex. For example, a person burned himself on the surface of a hot iron and is now afraid to iron clothes.
2. The appearance of fears is caused by a secondary reflex. For example, a patient is afraid to talk on the phone because some time ago during the conversation a fire or accident occurred.

Modern man is becoming susceptible to agoraphobia, the fear of open space. He is afraid to leave the room. A person may also experience claustrophobia, which is expressed in a strong fear of enclosed spaces. The patient attempts to visit only spacious rooms and stay in outdoor conditions.

If a person develops a fear of heights, this leads to acrophobia. When there is a fear of various living beings, a zoophobic phobostate occurs. When a person is the center of attention, they talk about the presence of social phobia.

In the modern world, there are a large number of psychoneurotic phobostates, which are united by one thing - dysfunction of mental processes.

Experts distinguish 3 types of panic fear:

1. The person tries not to touch the objects that caused his panic fear.
2. A person expects to touch the object that caused the phobic state.
3. Patients imagine touching an object, after which fear appeared, which leads to the onset of psychophobic states.

Real examples

Agoraphobia and nosophobia are rare in nature. There is no close connection with panic psychostates.

But sometimes agoraphobic manifestations may occur due to panic attacks. Such phenomena can arise out of the blue, a person begins to worry, fear everyone and everything. A person understands a panic attack as a catastrophic threat to life. At the same time, there is a weak expression of vegetative symptoms.

Panic attacks occur in the second variant of phobic disorders along with obsession and hypochondriacal symptoms. At this time, the patient tries to eliminate the factors that led to panic. Patients develop certain rules, compliance with which will not lead to the development of the disease. People often write a letter of resignation and change their working conditions, area of ​​residence, adhere to the correct daily routine, and do not communicate with anyone outside.

If vegetative-crisis phobostates develop, then the occurrence of panic attacks against the background of residual insufficiency is due to the appearance of severe anxiety and various painful sensations. If psychogenic factors are not eliminated, this leads to rapid heartbeat, sensations of lack of air, and suffocation. The patient does not feel better as the disease progresses. People begin to carefully monitor their health, believing that they are developing a serious pathological illness.

Signs

Experts identify the following general signs of phobic neurosis:

• frequent feelings of panic and fear;
• dysfunction of the heart, blood vessels, respiratory organs and other organs and systems of the human body;
• dysfunction of sleep processes;
• Constant pain and dizziness;
• feeling of general weakness;
• depressive symptoms;
• the person becomes emotionally and mentally tense.

The detection of all of the above signs occurs as a result of contact with an ill person with an object of phobic pathology.

Symptoms

Experts divide symptomatic signs into several groups:

1. The appearance of panic attacks. The patient is afraid and expects a speedy death. All this occurs accompanied by an increase in sweat production, heart rate dysfunction, and the appearance of dizziness. The person begins to feel sick, suffocates and feels the unreality of the situations occurring.
2. The emergence of agrophobia, manifested by fear of large crowds of people, open space. If the disease has reached a severe stage, then he is afraid to leave his own home.
3. If a patient is afraid of any disease, then he may develop the pathology of hypochondriacal phobia. It seems to him that an incurable disease has already affected his body.
4. In the modern world, one can often encounter social phobias, expressed in fear of the attention of others, fear of criticism or ridicule.

Treatment

Anxiety-phobic neurosis is often treated in a complex. Specialists prescribe psychotherapeutic measures and treatment methods.

Elimination of the condition is possible with the help of psychotherapeutic influence. Patients are taught to avoid the phobic objects and use relaxation techniques. Behavioral therapy and hypnosis are sometimes used. Patients are trained to withstand fearful objects and use a variety of relaxation techniques.

Panic attacks are eliminated with the help of antidepressants. Neurosis is effectively treated with the help of Anafranil (Clomipramine), Fluvoxamine, Sertraline, Fluoxetine.

If social neurosis develops, treatment is carried out with Moclobemide (Aurox).

In addition to antidepressant medications, it is necessary to take tranquilizers in the form of Meprobamate, Hydroxyzine, Alprazole and Clonazepam. They can only sometimes lead to side effects. If the drugs are used for a long period of time, then drug dependence is not observed. It is necessary to strictly monitor the use of Diazepam and Elenium, as a person soon gets used to them.

It is possible to use antipsychotic medications, especially Triftazin, Haloperidol and others.

The appearance of phobic disorders often occurs due to various factors, which can only be eliminated by a neuropsychiatrist after examination and prescribing various methods of treatment procedures. If the patient ignores the psychological state, then undesirable consequences for the human body may occur, therefore, at the first appearance of fear, it is better to consult a doctor.

Phobic (or anxiety-phobic) neurosis is one of the many types of neuroses. The main manifestation of this disorder is an uncontrollable feeling of fear and anxiety as a reaction to a specific object (object, action, memory, etc.). This feeling is so strong that a person is unable to control himself, even if he realizes that the fear is groundless and his life and health are not in danger.

Phobic neurosis is associated with an uncontrollable feeling of fear

A person can develop a phobia in two cases:

• if a person directly had a bad experience in the past regarding some thing, action, place and other similar objects. For example, after accidental painful contact with a hot iron, fear of hot objects may develop in the future;
• if the object is associated with thoughts and memories of a negative nature. For example, in the past, while talking on the phone, there was a fire or someone got hurt.

The development and occurrence of phobic neuroses are influenced by:

• heredity;
• human character: increased anxiety, constant state of worry, excessive responsibility, suspiciousness;
• emotional stress and physical exhaustion;
• disturbances in the functioning of the body's endocrine system;
• sleep disturbance and poor diet;
• infections and bad habits that cause significant harm to the body.

Often these disorders occur against the background of another disease: schizophrenia, obsessive-compulsive disorder, psychasthenia, obsessional neurosis.

The risk of phobic neurosis increases during certain periods of a person’s life: during puberty, early adulthood and immediately before menopause.

Types of phobic neuroses

The most common phobia at the moment is the fear of open spaces - agrophobia. A person suffering from this disorder, depending on the severity of the disease, either tries not to leave the house unnecessarily, or is unable to force himself to even leave his own room.

Claustrophobia - fear of closed and enclosed spaces

The opposite of this phobia is claustrophobia. A person is seized with fear at the moment when he is in a closed space. This is especially true for elevators.

According to the severity of manifestation, phobic neuroses are divided into three groups:

• mild degree– fear arises from direct contact with the object of fear;
• average degree– fear arises in anticipation of contact with the object of fear;
• severe degree– just the thought of the object of fear seizes a person into panic.

Most often, phobias arise in adolescence against the background of hormonal changes in the body, and then they can develop into obsessive fears or, conversely, disappear. The beginning of such disorders is always direct or indirect contact with a future object of fear, which is negative in nature. Patients are critical of their illness and may realize the groundlessness of their own fears, but at the same time they are not able to get rid of them.

Signs of phobic nephrosis

Common symptoms of phobic neuroses include:

• panic attacks;
• disturbances in the functioning of the autonomic organ system (cardiovascular system, respiratory system, etc.);
• headache;
• general weakness;
• sleep disorders;
• depression;
• emotional tension.

All these signs are easy to detect when the patient comes into contact with the subject of the phobia.

Depression may be one of the symptoms of phobic neurosis

In medicine, all symptoms are divided into 4 groups:

1. Panic attacks are intense fear and a feeling of imminent death, accompanied by increased sweating, heart rhythm disturbances, dizziness, nausea, difficulty breathing and a feeling of the unreality of what is happening.
2. Agrophobia is a fear of open spaces, large crowds of people, and in severe cases, fear of leaving one’s own home or room.
3. Hypochodriac phobias are the fear of contracting some disease or the feeling that a person is already terminally ill.
4. Social phobias are the fear of being the center of attention, being criticized or ridiculed.

There are many types of phobias

Treatment of phobic neuroses

If you have a question about the consequences and treatment of phobic neurosis, you need to consult a doctor, and not self-medicate and rely on Internet resources for everything. Ill-informed treatment can only worsen the situation.

For mild forms of phobias, you can limit yourself to attending sessions with a professional psychoanalyst.

For more advanced cases, cognitive behavioral therapy is considered the most effective method. Its main task is to teach the patient to manage his own emotions and fears through a detailed examination of the situations in which an attack occurs, identifying the causes and ways to get rid of such reactions.

Drug therapy is used in combination with any psychotherapy. It is impossible to overcome a phobia with medications alone.

A therapist can help treat phobias

In addition to basic treatment methods, doctors usually recommend relaxing massage, yoga or meditation, herbal medicine, short regular rest in sanatoriums, and acupuncture.

A type of neurosis characterized by obsessive thoughts (obsessions), often flowing into ritual actions (compulsions), is called obsessive-phobic syndrome. This type of disorder is treatable. But each patient goes through the stages of healing individually. The specifics of therapy can only be determined by an experienced doctor based on a questionnaire and a series of tests.

Description of the syndrome

OFS is characterized not only by the emergence of obsessive thoughts and ideas, pathological fears, but also by their development. The patient himself understands the meaninglessness of his actions, but cannot cope with the symptoms of the disease on his own. When they appear, you need to start treatment under the guidance of an experienced psychotherapist.

The main causes of neuroses are fears of various origins. For example, the prevailing fear of contracting a serious illness (cardiophobia, cancerophobia, syphilophobia, speedophobia, etc.).

People with neurotic phobic disorders try not to find themselves in situations where they are faced with a far-fetched problem: patients with claustrophobia do not use the elevator, and those suffering from agoraphobia avoid large crowds of people. Less commonly, this disease manifests itself through the occurrence of obsessive thoughts, which are difficult for patients to get rid of.

The dynamics of neuroses consists of three stages:

• the occurrence of fear in a person only when he is afraid of something;
• the emergence of fear when thinking about this situation;
• the emergence of obsessive fear when a conditionally pathogenic stimulus occurs (words associated with a phobia, an image, etc.).

A characteristic feature of neuroses in some patients is the manifestation of panic attacks. They provoke an attack of fear, which is accompanied by shortness of breath, loss of consciousness, rapid heartbeat, etc.

Such patients have a fear of recurrence of attacks, and they avoid going out unaccompanied. Symptoms may appear due to stress or overwork. In a psychiatric clinic, the above manifestations are described as diencephalic syndrome. The development of neuroses is protracted, turning into a neurotic formation of the patient.

Signs and causes of the disorder

The disease often begins after psychological trauma or as a result of a prolonged state of psychological discomfort. The disease can be identified by specific signs.

There are several causes of this disease:

• biological;
• psychological;
• social-public.

Experts attribute the following factors to the biological causes of obsessive syndrome:

• disorders in the autonomic nervous system;
• features of the functioning of electronic brain impulses;
• disruptions in the functioning of neurons, metabolic processes in nerve cells of the brain;
• consequences of traumatic brain injury;
• infection with viral infections;
• the predisposition is hereditary.

The psychological and social causes of nervous disorders include the following factors:

• traumatic family and social relationships;
• features of strict or religious upbringing;
• stress situations in the family and at work;
• fear and anxiety due to a situation experienced that really threatened life.

Manifestations of panic fear can arise as a result of imposition by society or as a result of personal traumatic experience. For example, a person has watched crime news and is haunted by obsessive thoughts about being attacked by criminals.

If a person cannot overcome such obsessions on his own, and he again performs control rituals (looks back every few steps, checks whether the door is closed, etc.), you need to turn to specialists.

The sooner psychotherapeutic treatment of such an illness is started, the greater the chance of protecting the human psyche from neurosis, which without the necessary treatment can turn into a paranoid syndrome.

The following criteria will help recognize the presence of neurosis:

• constant occurrence of obsessive thoughts and actions that cause anxiety;
• regular occurrence of obsessive grievances and thoughts in situations that do not involve their occurrence;
• frequent attempts to ignore obsessive experiences and thoughts, replacing them with others, switching to other useless actions;
• obsessive anxieties have nothing to do with reality, a person understands this, but continues to be in a restless state;
• there is an acute feeling of an irresistible desire to perform certain ritual actions in order to avoid the occurrence of any event, but the person is aware of the illogicality of his actions.

If you notice similar behavioral deviations in yourself or your loved ones, psychiatric help is needed to establish an accurate diagnosis and prescribe comprehensive treatment for phobic neurosis.

Treatment of the disorder

Diseases associated with various kinds of neuroses can sometimes occur in completely healthy children and adults. You need to be attentive to your body in order to recognize the onset of the disease in time.

In the initial stages, it is always easier to defeat a disease than to deal with its chronic manifestations. You must analyze the current situation with hysterical phobias and other symptoms of obsessive disorder, try to develop a strategy for your behavior to protect yourself from the disease.

Learn about obsessive-compulsive disorder. Read in detail about the causes, course and treatment of the disease. Compare the symptoms with your behavior by writing them down on a piece of paper. Having spoiled each detected manifestation, draw up an action plan to overcome it. This will help you cope if the alarming situation arises again.

An outside assessment will help you understand the current situation more deeply. A visit to a specialist doctor will help you understand the symptoms, analyze the course of the disease and develop a strategic plan to protect yourself from neurosis.

Look your phobias in the eye. People suffering from neuropsychiatric disorders realize that their fears are fictitious and born only of their imagination. As soon as a new desire arises to once again check whether the door, windows, etc. are locked, just remind yourself that this is a useless ritual and interrupt yourself at the stage of thinking. This method will help get rid of nervousness, you will learn to soberly assess the situation.

Praise yourself constantly. This method will put you in a positive mood. Rejoice at every successful step you take on the road to recovery. Praise yourself even for small victories, and you will feel yourself becoming stronger than the obsessive state. By gaining control over the situation, you will completely get rid of the symptoms of the disease.

When a person does not have enough of his own will to overcome nervous symptoms, it is imperative to organize a trip to a psychologist.

Methods of psychology in solving problems

In modern psychology, this syndrome is most effectively treated through psychotherapeutic sessions. The medical arsenal includes several methods of getting rid of such a disease.

The method of cognitive-behavioral therapy of neurosis is a method aimed at counteracting the syndrome by reducing compulsions to minimal manifestations, and then completely eliminating them.

The technique involves step-by-step instructions, after which the patient fully understands his disorder and analyzes the causes of its occurrence. He takes decisive steps, after which he gets rid of obsessive syndrome forever.

The founder of this technique is the famous psychiatrist Jeffrey Schwartz. With the help of his technique, people are healed from psychological trauma, stressful situations and constant anxiety. It consists of four steps that are successfully used in the treatment of psychoneurological conditions by modern psychologists around the world.

Joseph Wolpe's technique is for a patient with a psychonervous disorder to look at the problematic situation from the outside. The patient recalls the stressful situation he experienced, and immediately after the onset of the obsessive state, the doctor introduces the principle of stopping thought.

The patient begins to be asked certain questions that help the specialist conduct an in-depth analysis of the patient’s behavior in a stressful situation. The patient is able to photograph the analyzed situation and examine it in detail from all angles. The comparative technique helps to restore control over emotions and remove anxious experiences.

There are many other methods for treating neurological conditions, but only the doctor chooses which one to use in each specific case.

Healing with medicines

Cases where medication is used to treat obsessive-compulsive syndrome are called severe. Metabolic disorders affect the functionality of neurons, and this leads to a lack of serotonin in nerve cells.

To recover, the patient is prescribed drugs that slow down the reuptake of serotonin by neurons. Among the drugs that have a slowing effect, several effective drugs can be identified: Fluvoxamine, Escitalopram, tricyclic antidepressants, Paroxetine, etc.

A number of studies in the field of neurology have discovered the therapeutic effect of the following drugs: Memantine, Riluzole, Lamotrigine, Gabapentin, N-acetylcysteine, etc.

In the chronic form of obsessive-compulsive syndrome, the patient is prescribed atypical antipsychotic therapy. The combination of drug treatment with psychotherapy enhances the effect several times, and the patient successfully passes the stages of treatment.

Psychoprophylaxis as relapse prevention

There are many preventive methods to prevent relapses of obsessive-compulsive disorder.

To protect against the syndrome, you must:

• change the patient’s attitude towards stressful situations through personal conversations, suggestion, self-hypnosis, etc.;
• consult a doctor on time when an exacerbation of neuroses occurs and undergo regular medical examinations;
• increase the brightness of daylight indoors, conduct light therapy sessions; such procedures promote the production of serotonin;
• use vitamin therapy, walks in the fresh air, ensure proper sleep;
• provide adequate nutrition, including foods that contain tryptophan: amino acids can form serotonin; dates, figs, dark chocolate, and dairy products are rich in them;
• monitor all body functions, and in case of violations, treat them; special attention should be paid to the endocrine and cardiovascular systems;
• exclude the use of alcoholic beverages, narcotic and toxic drugs.

Phobic neurosis is a type of disorder in which a person experiences feelings of fear and anxiety associated with an object, phenomenon or memory. The condition is uncontrollable, the person is seized with panic. But at the same time, the person realizes the irrationality of his reactions.

Types of phobic neuroses and causes of occurrence

There are dozens of types of phobias. Let's look at common disorders (the object of fear is indicated in parentheses):

• acrophobia (heights);
• agoraphobia (large open spaces, crowded places);
• claustrophobia (closed spaces);
• nosophobia (deadly disease);
• hypochondria (disease);
• social phobia (fear of being the center of attention);
• Thanatophobia (death).

Phobic neurosis develops according to two scenarios:

1. It is formed as a primary conditioned reflex. Fear is associated with negative personal experiences and mental trauma. For example, a person is afraid of dogs because they bit him badly in childhood.
2. Arises as a secondary conditioned reflex. Fear is not associated with the object, conditions, or event itself, but arises against the background of an association. For example, a person is afraid to go outside because he was bitten by dogs as a child.

Cause-and-effect relationships are established arbitrarily and depend on the characteristics of the individual.

The occurrence of obsessive-phobic neurosis is influenced by:

• heredity;
• character accentuations (anxiety, suspiciousness, hyper-responsibility);
• suggestibility (news from the media can cause fear);
• overwork, psychophysiological exhaustion;
• endocrine disorders;
• poor diet, disrupted sleep patterns, bad habits;
• infections, brain injuries that cause disturbances in the functioning of nerve cells;
• mental personality disorders (schizophrenia, psychasthenia, depression).

The likelihood of phobic neurosis increases during periods of natural hormonal changes in the body: adolescence, pregnancy and menopause in women, midlife crisis.

Can phobic neurosis be cured?

Without treatment, fear accumulates and grows like a snowball, over time it takes over a person’s entire life. But you can get rid of obsessive thoughts, memories and fears.

The choice of treatment depends on the symptoms and severity of the neurosis. There are 3 degrees in total:

1. Mild: fear occurs upon contact with an object.
2. Medium: fear arises when waiting for contact.
3. Severe: fear arises from the mere thought of an object.

The earlier treatment begins, the better the prognosis.

Symptoms and treatment of phobic neurosis

Symptoms of neurosis include:

• isolation, avoidance of places, objects, conditions reminiscent of trauma;
• irrational fear and anxiety;
• obsessions, or obsessive thoughts associated with the subject of fear;
• compulsions (obsessive actions), as an attempt to compensate for the feeling of loss of control over the situation;
• panic attacks.

Panic attacks are manifested by a number of somatic symptoms: heart rhythm disturbances, breathing problems, suffocation, sweating, fear of death. The condition is beyond the patient's control.

Obsessive-compulsive disorder often develops due to phobic neurosis. A person comes up with the idea that obsessive actions (rituals) will help cope with anxiety. For example, a patient washes his hands 10 times to get rid of germs, or, when leaving home, checks the switches 6 times to prevent a fire. In advanced cases, people can stand in the shower for hours, waiting for the water to “wash” the obsessive thought out of their heads.

You cannot get rid of obsessions and phobias on your own. You need to see a doctor so that he can tell you how to treat phobic neurosis in a particular case.

Phobias require complex treatment, which includes:

1. Psychotherapy. Fear arises due to psychological trauma. We need to find and eliminate it. The problem is that the reason is hidden in the subconscious and is not realized by the person himself, especially in the case of a secondary origin of neurosis. The doctor will help you find the deep causes of the phobia, break erroneous cause-and-effect relationships, accept negative memories and change your attitude towards them. To work with phobias, cognitive behavioral psychotherapy and neurolinguistic programming (NLP) are used.
2. Drug treatment. The prescription of drugs depends on the characteristics and severity of the neurosis. The doctor may prescribe antidepressants, tranquilizers, and sedatives. Inhibitors may be needed to restore normal brain function.
3. Lifestyle change. It is necessary to normalize diet, sleep and work. You need to relax, carry out calming activities, walk, play sports. All this maintains normal hormonal levels, helps to distract yourself, and relieve tension.
4. The support and love of family and friends. We need to recognize the problem and find like-minded people.

Trying to cope with anxiety on your own only makes it worse. A person accuses himself of being weak-willed, but this has nothing to do with it. Neurosis is a disease, not a character flaw. Therefore, you cannot blame yourself and self-medicate; you need to see a psychotherapist.

lethargic, apathetic, frozen facial expressions, scanty speech, often of absurd content. In bed they take pretentious poses, cover their heads, grimace, make stereotypical movements, imitate animals, eat with their mouths.

Course of hysterical disorders:

Hysteroneurotic psychogenic reactions can be short-term, episodic and disappear spontaneously, without treatment. Long-term, over several years, recording of hysterical manifestations is also possible. After their attenuation, there may remain a tendency to the occurrence of individual hysterical stigmas (paresthesia, unsteadiness of gait, fainting) in situations that cause affective stress. Patients with functional hysteroneurotic disorders require a thorough somatic and neurological examination to exclude organic pathology.

II. Anxiety-phobic neurosis

The problem of phobias and obsessions attracted the attention of clinicians even in the prenosological period of psychiatry. Mentions of obsessions are found in the works of Ph. Pinel (1829). I. Balinsky proposed the term “obsessive ideas”, which has taken root in Russian psychiatric literature. In 1871, C. Westphal introduced the term “agoraphobia,” which denoted the fear of being in public places. However, only at the turn of the XIX-XX centuries. (1895-1903), thanks to the research of Z. Freud and P. Janet, attempts were made to combine anxiety-phobic disorders into an independent disease - anxiety neurosis (Z. Freud). Somewhat later, P. Janet (1911) combined agoraphobia, claustrophobia, and transport phobias with the term “position phobias” [Tiganov A.S., 1999].

In accordance with ICD-10, psychopathological manifestations of anxiety disorders include the following symptom complexes: panic disorder

disorder without agoraphobia, panic disorder with agoraphobia, hypochondriacal phobias, social and isolated phobias, obsessive-compulsive disorder.

Clinical manifestations:

Anxiety-phobic syndrome develops predominantly in cases where pronounced vegetative-vascular paroxysms were observed in the initial period of the disease. The affect of anxiety and fear, which initially arose in connection with vegetative-vascular paroxysms, becomes more and more constant as the syndrome develops. Against the background of vague anxiety, obsessive fears develop related to the possibility of a repetition of the paroxysm and its tragic consequences. The intensity of obsessive fears is not measured by previous experience, which indicates their groundlessness. Phobic phenomena also intensify under conditions that place increased demands on the vestibular apparatus: when using various types of

transport, industrial vibrations, rhythmic visual stimuli (for example, when a stream of people flashes before the eyes). During periods of exacerbation of the condition, other psychopathological symptoms characteristic of the disease also arise or intensify: senestopathies, psychosensory disorders, derealization disorders.

Anxiety states appear in two main forms. At generalized anxiety disorder anxiety is persistent and not limited to any specific circumstances. The most common complaints are a feeling of constant nervousness, restlessness, trembling, muscle tension, sweating, palpitations, dizziness, discomfort in the epigastric region, accompanied by fears and concerns for their health and the health of their loved ones, as well as other various worries and apprehensions. This disorder is more common in women and is often associated with chronic stress.

At panic disorder(episodic paroxysmal anxiety) anxiety manifests itself in the form of severe panic attacks, which are also not limited to a specific situation and are therefore unpredictable. Dominant symptoms: sudden palpitations, chest pain, a feeling of suffocation, dizziness, a feeling of unreality, often accompanied by fears of death, loss of self-control or madness. Subsequently, the person tends to avoid the situation in which the first panic attack occurred. In addition, he may develop a persistent fear of the attack being repeated. Panic disorder most often determines the onset of the disease. In this case, three variants of the dynamics of psychopathological anxiety disorders manifesting as panic attacks can be distinguished.

1st option: the clinical picture of anxiety-phobic disorders is represented only by panic attacks. Panic attacks manifest themselves as an isolated symptom complex with a combination of signs of cognitive and somatic anxiety and are not accompanied by the formation of persistent mental disorders. The clinical picture of panic attacks expands only due to transient hypochondriacal phobias and agoraphobia phenomena, which are of a secondary nature. Once the acute period has passed and panic attacks have been reduced, concomitant psychopathological disorders also develop in reverse.

Option 2: Anxiety disorders include panic attacks and persistent agoraphobia. Panic attacks occur suddenly, without any warning signs, and are characterized by vital fear, generalized cognitive anxiety with a feeling of sudden, life-threatening bodily catastrophe with minimal severity of autonomic disorders and the rapid (sometimes after the first attack) formation of agoraphobia, phobophobia and avoidant behavior. As panic attacks reverse, a complete reduction of psychopathological disorders does not occur.

3rd option: anxiety-phobic disorders with panic attacks developing as a vegetative crisis (Da Costa syndrome) and culminating in hypochondriacal phobias. Distinctive features of panic attacks

attacks: subclinical manifestations of anxiety, combined with algia and conversion symptoms; psychogenic provocation of seizures; predominance of somatic anxiety with dominance of symptoms from the cardiovascular and respiratory systems without vital fear (“alexithymic panic”); expansion of the picture due to hypochondriacal phobias with minimal severity of phobic avoidance and agoraphobia. Once full-blown panic attacks have passed (acute period), a complete reduction of psychopathological anxiety disorders does not occur. Hypochondriacal phobias (cardio-, stroke-, thanatophobia) come to the fore, determining the clinical picture for months and even years.

Phobic disorders– these are disorders characterized by the occurrence of anxiety primarily in relation to certain situations or external objects. As a result, these situations are avoided or endured with a feeling of fear. The experience of fear is usually accompanied by a variety of autonomic symptoms - palpitations, difficulty breathing, a feeling of lightheadedness, dizziness, weakness in the legs, as well as secondary fears of death or loss of self-control. At the same time, anxiety is not reduced by the knowledge that other people do not consider this situation dangerous or threatening. Subsequently, the mere idea of ​​getting into a phobic situation in advance causes anxiety of anticipation.

There are several types of phobias:

– fear of open spaces (being in a crowd or public places, moving outside the home, traveling alone);

– fear of individual animals;

– fear of heights;

– fear of closed spaces (travelling on airplanes, elevators, subways);

– fear of blood or injury;

– fear of getting a certain disease (myocardial infarction, cancer, venereal disease, HIV, etc.);

– fear of the dark;

– fear of exams, etc.

It is worth noting that anxiety and phobic disorders are very often accompanied by a variety of sleep disorders (difficulty falling asleep, shallow night sleep, early awakening), depression (low mood, decreased self-esteem and self-confidence, poor appetite, loss of interests and the ability to enjoy activities that previously brought such pleasure, a pessimistic vision of the future), neurasthenic symptoms (fatigue, irritability) [Karvasarsky B.D., 1990].

Among the psychopathological manifestations of anxiety-phobic disorders, it is first necessary to consider panic attacks, agoraphobia, hypochondriacal phobias, social phobia and mysophobia, since in the dynamics of these symptom complexes the greatest comorbid connections are found.

Panic attacks- an unexpected and quickly, within a few minutes, growing symptom complex of vegetative disorders (vegetative crisis - palpitations, tightness in the chest, a feeling of suffocation, lack of air, sweating, dizziness), combined with a feeling of impending death, fear of loss of consciousness or loss of control over oneself , madness. The duration of manifest panic attacks usually does not exceed 20-30 minutes.

Agoraphobia, contrary to the original meaning of the term, includes not only the fear of open spaces, but also a whole series of similar phobias (claustrophobia, phobia of transport, crowds, etc.), defined by P. Janet (1918) as phobias of position. Agoraphobia typically occurs in conjunction with (or following) panic attacks and is essentially the fear of being in a situation that risks causing a panic attack. Typical situations that provoke the occurrence of agoraphobia are traveling on the subway, being in a store, among a large crowd of people, etc.

Hypochondriacal phobias (nosophobias)) - obsessive fear of some kind of

yellow disease. The most commonly observed are cardio-, cancer- and stroke-phobias, lissophobia (fear of getting a mental illness), as well as syphilo- and AIDS-phobias. At the height of anxiety (phobic raptus), patients sometimes lose their critical attitude towards their condition - they turn to doctors of the appropriate profile and require examination.

Social phobias– fear of being the center of attention, accompanied by fears of negative evaluation by others and avoidance of social situations. Data on the prevalence of social phobias in the population vary from 3 to 5% [Kaplan G.I., Sadok B.J.., 1994]. These patients come to the attention of psychiatrists relatively rarely. Among those not covered by treatment measures, people with subthreshold social phobias that do not significantly affect daily activities predominate. Most often, those suffering from this disorder, when visiting a doctor, focus on comorbid (mainly affective) psychopathological symptom complexes. Social phobias usually manifest during puberty and adolescence. Often their appearance coincides with unfavorable psychogenic or social influences. In this case, only special situations act as provoking situations (answering at the blackboard, passing exams - school phobias, appearing on stage) or contact with a certain group of people (teachers, educators, representatives of the opposite sex). Communication with family and close friends, as a rule, does not cause fear. Social phobias can occur transiently or have a tendency to develop chronically. Patients suffering from social phobias are more likely than healthy ones to live alone and have a lower level of education.

Social phobias have a high level of comorbidity with other mental disorders. In most cases, they are combined with simple phobias, agoraphobia, panic disorder, affective

pathology, alcoholism, eating disorders, which worsens the prognosis of the disease and increases the risk of suicide attempts. There are two groups of states - isolated and generalized social phobia.

The first of these includes monophobia, which is the fear of not performing habitual actions in public, associated with anxious expectations of failure (fear of public speaking, communicating with superiors, eating in public places), and as a result - avoidance of specific life situations. At the same time, there are no difficulties in communication outside such key situations. This group of phobias includes ereytophobia - the fear of blushing, showing awkwardness or embarrassment in society. Accordingly, shyness and embarrassment appear in public, accompanied by internal stiffness, muscle tension, trembling, palpitations, sweating, and dry mouth.

Generalized social phobia is a more complex psychopathological phenomenon, which, along with phobias, includes ideas of low value and sensitive ideas of relationship. Disorders in this group most often appear within the framework of scoptophobia syndrome. Scoptophobia (Greek scopto - joke, mock; phobos - fear) - fear of appearing funny, of discovering signs of imaginary inferiority in people. In these cases, in the foreground there is an affect of shame, which does not correspond to reality, but determines behavior (avoidance of communication, contact with people). The fear of being embarrassed may be associated with ideas about people’s hostile assessment of the “flaw” attributed to themselves by patients, and corresponding interpretations of the behavior of others (disdainful smiles, ridicule, etc.).

Mysophobia (fear of pollution) . This group of obsessions includes not only the fear of pollution (earth, dust, urine, feces and other impurities), but also the phobia of penetration into the body of harmful and toxic substances, small objects, microorganisms, i.e. phobias of extracorporeal threat. In some cases, the fear of contamination may be limited in nature, remaining for many years at a subclinical level, manifesting itself only in some features of personal hygiene (frequent change of linen, repeated hand washing) or in housekeeping (careful handling of food, daily washing of floors). , "taboo" on pets). This kind of monophobia does not significantly affect the quality of life and is assessed by others as habits [Tiganov A.S., 1999].

Clinically completed variants of mysophobia belong to the group of severe obsessions, in which a tendency to complication and generalization is often found. In these cases, gradually becoming more complex protective rituals come to the fore in the clinical picture: avoiding sources of pollution, touching “unclean” objects, processing things that might have gotten dirty. Staying outside the apartment is also accompanied by a series of protective measures: going outside in special clothing that covers the body as much as possible, special treatment of personal items upon returning home. In the later stages of the disease, patients, avoiding contact with

touching dirt or any harmful substances, not only do not go outside, but do not even leave the confines of your own room.

Mysophobia is also associated with the fear of contracting any disease, which does not belong to the categories of hypochondriacal phobias, since it is not determined by fears of the presence of a particular disease. In the foreground is the fear of a threat from the outside - the fear of pathogenic bacteria entering the body. Fear of infection in these cases sometimes arises in an unusual way: for example, as a result of fleeting contact with old things that once belonged to a sick person.

III. Obsessive-compulsive disorders Clinical manifestations:

The manifestation of clinically defined manifestations of obsessive-compulsive disorders occurs in the age interval of 10 years – 24 years. Obsessions are expressed in the form of obsessive thoughts and compulsive actions, perceived by the patient as something psychologically alien to him, absurd and irrational [Asatiani N.M., 1985]. Obsessive thoughts- painful ideas, images or desires that arise against one’s will, which in a stereotypical form come to the patient’s mind again and again and which he tries to resist. Compulsive actions– repeated stereotypical actions, sometimes acquiring the character of protective rituals. The latter are aimed at preventing any objectively unlikely events that are dangerous for the patient or his loved ones.

Despite the diversity of clinical manifestations, among obsessive-compulsive disorders, delineated symptom complexes stand out: obsessive ideas, thoughts, fears, actions [Svyadoshch A.M., 1982].

1) Obsessive ideas often have the character of vivid intrusive memories. This includes some melodies, words or phrases, from the sound images of which the patient cannot free himself, as well as visual ideas. Sometimes they have a bright sensual coloring, characteristic of sensations, and approach obsessive or psychogenic hallucinations. Obsessive images very often arise in the form of extremely vivid intrusive memories that reflect the traumatic impact that caused them.

2) Intrusive thoughts can be expressed in the form of obsessive doubts, fears, blasphemous or “blasphemous” thoughts and wisdom.

* With obsessive doubts, there is usually a painful uncertainty about the correctness or completion of a particular action, with the desire to check its implementation again and again. Obsessive doubts can sometimes force the patient to spend hours checking the correctness of the action performed until exhaustion. Compulsions in these cases stop only after the internal feeling of completeness of the completeness of the motor act is restored.

* With obsessive fears, patients are painfully afraid that they will not be able to perform this or that action when required, for example, play a musical instrument in front of an audience or remember vocabulary roles, answer without blushing (ereitophobia), fall asleep, start walking, getting out of bed after an illness , swallow squeaks. d.

* Contrasting obsessions (“aggressive obsessions”, according to S.Rasmussen, J.L.Eisen, 1991) – blasphemous, blasphemous thoughts, fear of harming oneself and others. They are distinguished by a feeling of alienation, unmotivated content, as well as a close combination with obsessive drives and actions, which represent a complex system of protective rituals. Patients with contrasting obsessions complain of an irresistible desire to add certain endings to the remarks they have just heard, giving what was said an unpleasant or threatening meaning, to shout out cynical words that contradict their own attitudes and generally accepted morality; They may experience fear of losing control over themselves and possibly committing dangerous or ridiculous actions, auto-aggression, or injuring their own children. In the latter cases, obsessions are often combined with object phobias (fear of sharp objects). The contrast group also partially includes obsessions with sexual content (obsessions like forbidden ideas about perverted sexual acts, the objects of which are children, representatives of the same sex, animals).

* With obsessive philosophizing (“mental chewing gum”), patients are forced to endlessly think about certain things that have no meaning or interest for them, for example, thinking about what will happen if a state of weightlessness occurs on earth, or if humanity were to lose their clothes and everyone had to walk around naked.

3) Obsessive fears (phobias) are the most diverse and occur most often. These include: fear of death (thanatophobia) from various causes: heart disease (cardiophobia), the possibility of committing suicide, etc., fear of contracting syphilis (syphilophobia), cancer (cancerophobia), myocardial infarction (infarction phobia), mental illness (lyssophobia ) and other diseases, fear of pollution (mysophobia), phobia of penetration of harmful and toxic substances, small objects, microorganisms into the body, fear of open space (agarophobia), closed spaces (claustrophobia) and the like. Many patients, trying to make it easier to overcome obsessive fear, perform protective actions (rituals) that should “prevent” what they are afraid of.

4) Obsessive actions relatively rarely appear in isolation, not combined with verbal obsessions. A special place in this regard is occupied by obsessive actions in the form of isolated, monosymptomatic movement disorders. Tics predominate among them, especially often in childhood. Tics give the impression of exaggerated physiological movements. This is a kind of caricature of certain motor acts, natural gestures. Patients suffering from tics may shake their heads (as if checking whether a hat fits well), make movements with their hands (as if