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Withdrawal symptoms: an important part of an anxiety neurosis WITHDRAWAL SYMPTOMS: AN IMPORTANT PART OF AN ANXIETY NEUROSIS
Repetitive thoughts form an important part of an anxiety neurosis. These are often provoked by awareness of autonomic over-activity; e.g. a patient who feels his heart beating fast may worry about having a heart attack. Thoughts of this kind probably prolong the condition.
The appearance of a person with an anxiety neurosis is characteristic. His or her face looks strained, with a furrowed brow; the posture is tense; he or she is restless and often tremulous. The skin looks pale, and sweating is common especially from the hands, feet and axillae (armpits).
Readiness to tears, which may at first suggest depression, reflects a generally apprehensive state.
The physical symptoms and signs of an anxiety neurosis result from either over-activity in the sympathetic nervous system or increased tension in skeletal muscles.
The list of symptoms is long, and is conveniently grouped by systems of the body. Symptoms related to the gastrointestinal tract include dry mouth, difficulty in swallowing, epigastric discomfort (under breastbone), excessive wind caused by aerophagy (air swallowing), borborygmi (rumbling of intestinal gases), and frequent or loose motions.
Common respiratory symptoms, include a feeling of constriction in the chest, difficulty in inhaling (which contrasts with the expiratory difficulty in asthma), and over-breathing and its consequences (which are described later).
Cardiovascular symptoms include palpitations, a feeling of discomfort or pain over the heart, awareness of missed beats, and throbbing in the neck.
Common genito-urinary symptoms are increased frequency and urgency of micturition (act of passing urine), failure of erection, and lack of libido.
Women may complain of increased menstrual discomfort and sometimes amenorrhoea (absence of menstruation).
Complaints related to the functions of the central nervous system include tinnitus, blurring of vision, prickling sensations, and dizziness (which is not rotational).
Other symptoms may be related to muscular tension. In the scalp this may be experienced as aching or stiffness, especially in the back and shoulders. The hands may tremble so that delicate movements are impaired.
In anxiety neuroses sleep is disturbed in a characteristic way. On going to bed, the patient lies awake worrying; when at last he falls asleep, he wakes intermittently. He often reports unpleasant dreams.
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