General psychopathology

An emotional state characterized by an unsubstantial sense of near-disaster, catastrophe. It is accompanied by internal tension, discomfort, motor anxiety, hyperesthesia, accelerated thinking (biological meaning: search for a way out of a threatening situation), characteristic somatovegetative manifestations (preparation of the body for action), sleep disorders (difficulty falling asleep, shallow restless sleep, nightmares are most typical).

Somato-vegetative manifestations during anxiety are associated with the activation of the hypothalamic-pituitary-adrenal system and include, as noted above, physiological changes aimed at increasing the body's readiness for active actions in light of the need to overcome the impending dangers: muscle tension (up to trembling), increased heart rate and breathing, increased blood pressure, blood glucose levels, dry mouth, frequent urination, slowed intestinal peristalsis (hence constipation) or, on the contrary, frequent urges to defecation, sweating or, on the contrary, chills, etc.п.

From the physiological point of view, the optimal level of anxiety is necessary for humans as a means of increasing adaptation to the changing environmental conditions, mobilizing reserves, preparing for the actions necessary in the coming conditions, especially those needed to eliminate the impending danger (see Hans Sellier's classic works on the adaptation syndrome). Whereas excessively high and excessively low levels of anxiety will have a maladaptive value, leading to adverse consequences. In psychopathology, cases of anxiety that is inadequate to the situation (occurs without objective reasons under neutral, non-threatening conditions) or excessive in strength are considered.

Anxiety differs from fear in its objectlessness. The absence of objectivity in anxiety is especially painful and hard to bear, since the person in this state does not see any possible rational way out. Fear is always subjective, concrete ("fear of something and something"). Nevertheless, it is often difficult to differentiate between fear and anxiety, because a person in a state of anxiety often associates it with some specific circumstances, which, even casually, are always abundant, therefore such a person, when describing his or her condition, lists a multitude of different dangers which come to mind at a given moment. People experiencing "fear," on the other hand, are far from always able to identify exactly what they are afraid of.

Anxiety can be of varying severity. In the mildest cases, it is manifested by slight, indistinct tension and discomfort. Further tension grows, hyperaesthesia (heightened sensitivity to irritants - startle at random noises, loud sounds, etc.), somatovegetative manifestations and the experience of a sensation of impending threat attach. At the height of anxiety, there is an increase in motor restlessness, inability to quietly sit still, increased cogitative activity, and anxious concerns increasingly turn into concrete fears, i.e., concrete experiences of various (often multiple) dangers that await in the future. At the height of anxiety, pronounced psychomotor agitation is possible, up to the so-called anxious raptus - an attack of motor agitation during which patients rush from side to side, bite their hands, tear their hair, repeat the same words (anxious verbigations), and may make suicide attempts (suicide in this case is an attempt to avoid the big trouble that seems to await the person in the future).

Also with severe anxiety its somatovegetative manifestations may intensify up to the feeling of drowsiness associated with a significant redistribution of vascular tone and insufficient blood supply to the brain ("preconscious" states), dizziness, palpitation, heart palpitations (extrasystole), shortness of breath, feeling of a coma in the throat, etc. Paroxysmal attacks of severe anxiety (severe anxiety = panic) with vivid somato-vegetative manifestations are called panic attacks.

Anxiety is observed at:

• Many mental disorders. For example, can be combined with depression, delusional syndromes, etc.
• Anxiety assumes the leading value at actually anxious and anxious-phobic disorders (see the corresponding chapter in private psychiatry).
• Anxiety (personal anxiety) - a character trait; a person's tendency to experience frequent and intense states of anxiety, at a low threshold of its occurrence