Actual neurosis as the underlying psychic structure of panic disorder, somatization, and somatoform disorder: an integration of Freudian and attachment perspectives.
Starting from a contemporary critique of the DSM-IV, this paper argues that the diagnostic categories of panic disorder somatization, and undifferentiated somatoform disorders can be understood as belonging to a common type of psychopathology--i.e., the Freudian actual neuroses. In addition to their strong clinical similarity, these disorders share an etiological similarity; and the authors propose a combination of Freud's focus on this type of patient's inability to represent an endogenous drive arousal with the post-Freudian focus on separation anxiety. An etiological hypothesis is put forward based on contemporary psychoanalytic attachment theory, highlighting mentalization. Concrete implications for a psychoanalytically based treatment are proposed.
Verhaeghe
Paul
P
Department of Psychoanalysis, Ghent University, Belgium. paul.verhaeghe@UGent.be
Vanheule
Stijn
S
De Rick
Ann
A
D001010:Anxiety, Separation / Q000175:diagnosis / Q000523:psychology / Q000628:therapy; D001143:Arousal; D039721:Diagnostic and Statistical Manual of Mental Disorders; D004328:Drive; D005619:Freudian Theory; D006801:Humans; D009497:Neurotic Disorders / Q000175:diagnosis* / Q000523:psychology / Q000628:therapy; D009769:Object Attachment; D016584:Panic Disorder / Q000175:diagnosis* / Q000523:psychology / Q000628:therapy; D011575:Psychoanalytic Therapy; D013001:Somatoform Disorders / Q000175:diagnosis* / Q000523:psychology / Q000628:therapy