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Monday, April 8, 2019

The Nature of Anxiety


Sources of Anxiety 

in the Personality

By: Henry Kellerman and Anthony Burry

The role of anxiety in personality functioning is considered here from the point of view of the patient’s experience of distress, interference with cognitive and intellectual abilities, and the ways in which anxiety is managed.

Several characteristic methods of handling anxiety are discussed and related to diagnostic states. The conscious experience of anxiety, acting-out, and somatization are considered as major means of coping with anxiety.


Reporting of anxiety in the personality.

Management of anxiety in personality functioning affects:
– Operation of cognitive controls
– Achievement of potential levels of intellectual functioning
– Symptom formation
– Subjective distress


A report should indicate how anxiety is manifested in the individual’s functioning:
– Does the anxiety disturb the patient?
– Does the anxiety generate failure in performance?
– Does the anxiety reduce capacity to deal with frustration?


If anxiety impedes performance, then the patient may show self-defeating behavior, such as:
– Withdrawing from tasks
– Becoming noncommunicative or uncooperative
– Becoming discouraged or depressed
– Engaging in impulsive behavior

If anxiety is not regulated or managed adaptively, then problems may emerge, including:
– Depression, withdrawal, or inhibition of effort
– School failure or job loss
– Irritability and aggression
– Passivity or dependency

Is the anxiety consciously experienced, acted-out, somatized, or understood?
– If consciously experienced, what is the subjective level of distress?
– Does the anxiety generate fantasy, reinforce passivity, or stimulate activity?
– Are phobias or panic states developed?
– Are obsessions developed to generalized anxiety feelings?

A report should describe how anxiety affects the conflict between impulse and control. For example:
– If anxiety is acted-out, the resulting behavior may be ego-syntonic.
– The person may find it difficult to tolerate frustration even though the experience of anxiety is reduced.
– Acting-out also reduces attention span and, therefore, learning capacity.
– When impulsivity increases, an overall action orientation in the subject is seen.

A diagnosis of antisocial personality can be made if qualities of immaturity, underdeveloped superego, and magical thinking are prominent. Other character or personality diagnoses that avoid anxiety include obsessive-compulsive and borderline personalities:
– Schizoid individuals offer few responses
– Passive-aggressive persons express negativism and withholding
– Obsessive-compulsives overfocus on details and offer excessive verbalizations
– Borderline individuals may express angry reactions even to minor frustrations
– Narcissistic persons may express extreme dissatisfaction to frustration of expected entitlements

When anxiety is somatized: – Actual conversion of psychosomatic symptoms may appear as acting-in
– Acting-in frequently relates to anger, hostility, or sexuality
The prevalence of ego-syntonic (comfortable) traits suggests a characterological diagnosis (personality disorder). In contrast, the presence of ego-alien (uncomfortable) symptoms and anxiety experienced in relation to such symptoms suggests a diagnosis in the neurotic range. It is likely that underlying the anxiety is a store of anger.

References

Henry Kellerman and Anthony Burry, Handbook of Psychodiagnostic Testing, Fourth Edition, 2007, Springer ScienceBusiness Media, LLC.

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