ANXIETY AND ITS INCONSEQUENTLY DEFINED FACETS

ABSTRACT: 

The paper underlines the fact that anxiety is the psychological phenomenon which, on one hand, is involved in everything the human being does and, on the other hand, starting from what Freud called “angstneurosen” in 1895, has become part of the denomination of almost 20 diagnostic entities. Nevertheless, some aspects regarding its semantics, the delimitation normal-ab-normal, anxiety-fobia, anxiety-obsession, anxiety-depression, as well as those regarding the status of various individual clinical entities are far from reaching a total consensus. This situation is due to a) its omnipresence, b) its complexity, c) the time and the conceptions through which it has been dealt with d) and especially the close connection between anxiety and psychological and psychopatological fenomena ment to help define it but incapable of having unanimously accepted meanings. What is more, together with those fenomena, anxiety builds complexes from which it can be separated only artificially.

Anxiety is a concept that, by itspresence or absence, is itnplied in, and is expressed through everything that the human beings endeavour.

INTRODUCTION

Anxiety is one of the few concepts, which, in spiţe of being simple and ordinary at first glance, offers so many important but inconsistently defined facets. Among its facets without unanimous consent, we shall mention the semantic field, the borders with other psychological and psychopathological entities and the clinical framework. The situation is even more sensitive, as anxiety is a constant presence both in our normal, every day life and in the psychic and somatic pathology. One may say that anxiety is the most common psychological phenomenon not only in clinical practice but also in normality. In order to support this idea, it is enough to point out that anxiety is an intrinsic part of the economy of both stress and psycho-emotional distress: the alarm reaction is the first phase of the response of the individual who is conscious of being threatened.

From the beginning, we must make it clear that, in practice, from a paedo-psychiatric perspective, due to a child’s limited capacity to discriminate and to speak about their experiences, and because of the incessant age-related transformations of the child’s assessment tools at this level, clear-cut boundaries among the concepts connected to anxiety are less funcţional for the clinician.

l.THE SEMANTIC FACET AND ANXIETY’S BORDERS WITH OTHER CLOSE PSYCHOLOGICAL AND PSYCHOPATHOLOGICAL NOTIONS

We shall begin with this facet because it bears the most numerous inconsistencies. In fact, in relation to anxiety, many terms may be included within its mean-ing sphere, designed to provide boundaries, clarifica-tions and nuances, and to help shape the concept and concrete manifestations of anxiety but unable not only to firmly delineate anxiety but also to separate clearly one from the other and have a generally ac-cepted meaning. Here, one must mention not only the notions of normal and abnormal anxiety, separa-tion anxiety and anguish, but also indefinite or vague feelings of restlessness or worry, anticipatory inse-curity, insurmountable imminent danger, fright, fear and alertness, stage fright, shyness, caution, panic and even phobia, depression or obsession.

1.1 Anxiety

Is a fundamentally unpleasant emoţional state that varies in different degrees from caution, care and mild anxiety to intense terror. It has a fundamental char-acter as part of wide experiences that modulate an individual’s relationships with the world and with his inner universe. In 1972, the Encyclopaedia of Psychiatry for General Practitioners defines anxiety as “one of the most common and mobile terms in psychiatry” that lacks a precise definition.

That, in Leigh et al.’s opinion (1972), is a conse-quence of its use in both lay and medical language and of gradual changes suffered by its meaning after the word has been translated into various languages. To these we may add:

— its historic evolution and that of the concepts from whose perspective anxiety has been analysed,
— its complexity,
— the large number of concepts revolving around it, which give it its nuances in an attempt to its boundaries,
— the fact that the latter have themselves un-clear contours,
— the combination of some of them into real complexes which only artificially can anxiety be re-moved from.

Among these newly combined complexes, we must mention normal – abnormal anxiety, anxiety
– anguish, anxiety – phobia, anxiety – depression and even anxiety – obsession.
Provided in 1913, Jasper’s simplified definition (quoted by Pichot) that anxiety is ‘fright without an object’, has become classic. It is an operaţional form, attractive by its simplicity and to which reference is often made.
In fact, the reality is not as simple as it seems. The definition, is neither satisfactory nor followed strictly, even if it is supplemented with additional explana-tory details such as, “without apparent object” – ( by J. Deley quoted by Sârbu, 1979) – while we would prefer “without a present object”) “irrational nature”, “without an externai threat”, “an embarrassing state of expectation”, “indefinite imminent danger” This is because:

— Firstly, even if anxiety is mainly a genuine emoţional state, its manifestation does not mean only that. It implies other mental functions too, being a very complex phenomenon. In this line of argument, Quetin and Peyrouset (1964) consider that anxiety consists of three fundamental psychic deficiencies: in-security (affective disorder), uncertainty (mental disorder) and indecision (willpower disorder. Kammerer, in 1965, and then Bonora et al. (1997) speak of
— a sense of imminent danger, which is unde-termined (and accompanied by the development of tragic fantasies which enhance the images to dramatic proportions for Kammerer), while for the latter it is real or indefinite.
— an attitude of expectation and anticipation of the danger;
— a state of disorganization related to the belief in the inability to cope with the situation.

In his turn,Teodorescu (1999) emphasizes the in-volvement of thinking (an interpretive distortion), of attention (a selective hyper-vigilance) and of memory (easy access to some instances of one’s own life ex-perience). It is obvious that the above take into con-sideration only the abnormal form of anxiety, which is not enough. However, they provide three essential explanations that should be emphasised. Anxiety is considering a danger, which, on the one hand, is not actually present but only anticipated and, on the other hand, it is insurmountable, and, in addition, it involves several areas of the psyche.Thus, as Predescu and Io-nescu (1988) consider, anxiety “is more potential than actual, and sometimes it is more thought than lived”. This statement underlines the essential contribution of thinking, as it is the case in phobias, but especially in obsessions. Indeed, thinking is the only factor ca-pable to identify a danger, and especially to anticipate it. Moreover, it is the one, which affected in its turn, “sees” danger even where there is none, thus granting it an insurmountable character, that erroneously as-sesses the situation as uncontrollable. Of course, one should not overlook the fact that this time the anx-ious background is able to prevent thinking to be fully raţional while the defence instinct and former experi-ence make it choose prudence and even exaggerate.

AII these make us believe that just to simplify things at this level, DSM-IV (1994), avoids nominating the psychic sphere in this case, speaking instead of “apprehensive anticipation of a danger or misfortune accompanied by dystrophic mood or by somatic symptoms of tension.”

— Secondly, anxiety is accompanied obliga-torily by a sequence of somatic, neurovegetative and endocrine-humoral, motor and behavioural events characteristic to states of fear. Such events urge us to consider that there is more in anxiety than a strictly psychological phenomenology.

— Thirdly, it is difficult to accept the absolute lack of an “object” even if the specification is added that anxiety has a primary, diffuse and non-defined character (a valid aspect perhaps only for generalized, free or floating anxiety), that there is no real externai, clearly identifiable and present cause but only an internai one. In fact, anxiety is considering something, anything ca-pable of constituting a threat.That something is at least one current mental representation of a threat, of something that is only vaguely outlined but it is capable to determine a damage and sooner or later, transient or stable, to get easily a real character. This makes the de-limitation of anxiety from phobia (defined as “fright with an object”) to be relative in many cases. In fact, there are authors who ignore this delimitation. We give the examples of R. Spitz (1887-1974), who de-fines “separation anxiety” as a negative reaction that ap-pears around the age of eight months at the sight of to strangers; of Bowlby, who considers that the origin lies in the fear of losing the main attachment figure; and of DSM-IV-™(1994), that indicates the possibility that the origin of the threat is either internai or externai.

Furthermore, anxiety itself may generate percep-tion disturbances that can fuel or justify anxiety, or their presence, from whatever cause, can in turn induce anxiety— Fourthly, anxiety is a manifestation of a constant presence both in normality and in the context of various psychiatric or somatic disorders. Suffice it to mention phobias, depression, obsessions, agitation states, epilepsy, drug abuse, angina pectoris, myocardial infarction, heart failure, oedema and pulmonary em-bolism, pneumothorax, asthma, hyperthyroidism, and even renal colic. In fact, any somatic disease threat-ening an individual’s existence, once it is realized, it has anxiety generating potential. Being independent, background, accompanying or secondary phenom-enon, anxiety bears the imprint of the different con-texts in which it manifests itself in and with which it often intertwines. It gives those cases features and nuances; they make it clinically heterogeneous in ap-pearance and difficult to stay within strict limits.

1.2. Normal – abnormal anxiety

It is a widely recognized fact that there is a normal anxiety as a fundamental characteristic inherent to the human condition, with an important protective function. Since DSM-III-1980, American classifica-tions of mental disorders provide a separate chapter entitled Anxiety Disorders, which, as Mihailescu (1999) has highlighted, involves a theoretic agree-ment with its existence as a “state or sequence of normality”. In fact, it is constitutive part and expression of the defence instinct whose basic components are gradually represented by the diffuse uncertainty, alert reaction to new or unexpected stimuli and cautious-ness, phenomena that constitute the support of anxiety in general and of the normal anxiety in particular. “A good guard will help you past a bad danger” is a Romanian piece of folk wisdom that summarizes this level of behaviour designed to provide security. To this conception psychoanalytic conception adds as a source the antagonistic relationships between different mental instances while for O. Rank (1924), the experience of trauma suffered at birth is the prototype of future anguish. It is doubtless that, in the genesis of anxiety, lived experience and the examples given by others have an important role as well as the past or current situational context.

Today it is known that normal anxiety has a bio-logical basis of support and presents itself as a dy-namic, evolutionary process involved in and being influenced by the entire process of an individual’s de-velopment. Rightly, Marcelii and Gal (1996) say that the originality of anxiety in children does not consist in its semiology but in the place, it occupies in the development process. In fact, the child’s normal development cannot be understood without consid-ering the role that the baby’s anguish occupies in its dynamics during the first months of life as described by Melanie Klein. Other terms are separation anxiety, first described by R. Spitz who considers it a second organizer of psychic life and then by Bowlby, castra-tion anxiety, expectation and careful investigation be-haviour or care to avoid risks.

AII these mean that starting from birth, anxiety suffers both a general process of involvement in child development and a particular process of diver-sification, shaping and giving nuances to its forms, of transformation and even of their metamorphosis. It is thus the active element, which, contributes in various ways to the genesis, organization and development of various normal and pathological emoţional states of the individual. As such, in one way or another, in a lesser or a greater extent, in a more obvious or just in a disguised form, anxiety is refiected as a component directly involved in various normal states, either negative or positive. Let us mention only adaptive and defence behaviours such as the conduct to avoid the risks, prudence, moderation of curiosity, mobilizing scene fright, building up of fears that are so neces-sary to ensure security, the satisfaction of overcoming the dangers, the pleasure of watching the unleashed nature, fires, horror scenes, or of facing risks or of par-ticipating in extreme sports.

However, what is difficult, especially in children and adolescents, is drawing the limit where the normal ends. This all the more so as there are no data showing the existence of neuro-vegetative changes that are different in abnormality.

It is stated in general that normal anxiety is a signal that triggers the sharpening of the senses, resulting in mobilization of defences, increase of the individual’s efficiency and effectiveness, it protects and helps ad-aptation, diversification, and refinement of emotions.

Conversely, abnormal anxiety is marked by an in-ability to properly use the available cognitive resourc-es. It is excessive, unrealistic, unjustified or aberrantly justified. It represses the child’s specific curiosity, dis-rupts adaptation, generates negative hesitant, messy behaviours, unnecessary defence reactions and even dangerous ones for others and even for the children themselves, contributes to the genesis of abnormal ti-midity, of phobias and of other mental disorders.

1.3 Anguish and delimitation from anxiety-anguish

Closely related to anxiety, the concept of anguish is inconsistently defined, too.

It is usually regarded as generalized anxiety accompanied by important somato – vegetative and motor manifestations consisting of: inhibition, especially psychomotor agitation, tachycardia, tachypnea, palpi-tations, pale skin, cold sweats, chest tightness sensa-tion, choking, urgency to urinate, tremor, abdominal pain, accelerated bowel transit, etc. Fear of imminent death often objectivises panic. But naturally, these symptoms accompany anxiety, too. That is why quan-titative criteria are sometimes considered emphasiz-ing: that anguish is an extreme form of anxiety, that it is only its somatic expression, or the forms in which they is in the foreground, dominating the clinical picture. There are also options that link anguish only to somatic disorders, limiting it to the anxious manifestations of in the latter. There are many for whom anxiety and anguish are synonymous, the terms being used without distinction or they are considered an in-separable tandem anxiety / anguish. To mention that in German, the language used extensively and consis-tently in this area, there is only one word “angst” for both terms, while in DSM-IV, as remarked by Pelicier (1977), there is only the word “anxiety”. This aspect is particularly important for translators.

Moreover, as mentioned above, the anguish is re-ferred to when speaking about normal mental development of the infant. Also, let us state that the concept of anxiety has become a favoured theme of existentialist philosophy of which it returned to everyday language with new, subtle and inherent meanings.

From the above, it becomes apparent that the delimitation of anxiety-anguish is a false issue even if, for the most rigorous of the specialists, the literature insists: that anguish has paroxysmal character, that it is dominated by somatic-vegetative phenomena and by psychomotor agitation or, that it relates to meta-physical issues.

1.4. Phobia and its delimitation from fears and anxiety

Phobias or pathological fears are negative emoţional events and more than that.

We shall leave aside the definition of DEX (1984) where the phobia is described as “a pathological state of anxiety and obsessive fear, which lacks a precise or objective cause” because it is incomprehensible. I present it here because it supports the claim in title and because “not all that flies may be eaten” (Romanian proverb).

Making a synthesis of the definitions that we found, we shall say that phobias are irrational fears both for the subject and for others around him/her, persistent, constantly experienced only in the presence of certain “objects” or specific situations. These definitions underline the following aspects:

— phobias have fears as model, which implies the presence of somato-motor and neurovegetative manifestations, too;
— they have an irrational nature, which means that they imply distortions of thinking which is un-able to assess both the real value of the threat and the individual’s capacity to manage it;
— we include here only persistent and irrational fears excepting the accidental or transient ones, that are often present in normality;
— phobias disappear if the object or situation generating them were removed, after which the subject appreciates his/her reaction critically, which excludes fears in subjects whose age or different other reasons prevent them from properly assessing the facts.

With all these details, we saw that delimitation from anxiety is not firmly separated from the idea of the direct presence of an “object” or real life situations. In addition, as a rule, the two emotions are usually re-lated and they interact closely, supporting each other. Thus, anxiety favours the triggering of phobias. The anxious individual seeks and finds an explanation for his/her condition, while the presence of phobias am-plifies anxiety In fact, we are convinced that phobias are often objectified anxiety due to chance, the individual’s need to explain his fears or through mecha-nisms that use the symbols path.

All these are extensively demonstrated by the existence, in the ICD-10, of the group of phobic anxiety disorders (code F-40) and of the diagnosis of “phobic anxiety disorder of childhood” (code F93.1).

Another delimitation, partially solved, too is that be-tween the authentic phobias and their tolerated forms. It is known that in adults, but especially in children, one may note manifestations that having met the required elements of the definition are considered trivial phobias. In fact, there is a continuum, which, starting from the basic resources of anxiety, goes through the protective fear of the unknown, of the dark, of the new, or of everything that the individual has learned, directly or indi-rectly, that it represents a degree of danger. It continues with shyness, with the inability to be spontaneous or natural in the presence of strangers, to demonstrate his real possibilities or his knowledge in situations where the subject is not familiar enough, with stage fright or fear of another person, in order to take appearance of common fears, more or less justified, more or less protective. This continuum then finishes with genuine phobias. Before the latter, there are many fears, appar-ently inexplicable and absurd, which makes them meet the criteria defined above but which are overlooked or minimized. Of course, behind them there are emoţional deficiencies, experiences lived at the age where the individual lacks the ability to understand and handle the situation, but they were forgotten or minimized by the entourage, the fear used as a means of obtaining obedi-ence, models of others, stories or watching films con-taining horror or an inherited vulnerability.

Of course, in order to appreciate their real signifi-cance, one takes into account factors such as age, life experience, cognitive resources, education, models offered by the entourage, contextual and situational factors, antecedents of family history, number and intensity of manifestations, the degree of absurdity, the criticai capacity All these factors are at level vari-ables that vary depending on various factors includ-ing subjective ones. For example, we naturally accept, especially in children, fear of darkness, of animals and even small ones, fear to stay alone in the house or even in their room, great shyness, and so on. There are even adults who live with absurd fears that they conceal adopting avoidance behaviours.

1.5. Obsessions and their delimitation from anxiety and phobias

Obsessions are, primarily thinking disorders. They consist of ideas, thoughts, representations, memories and recurrent and persistent impulses of an unpleas-ant nature, which invade consciousness undermine it from the inside in a strong and unpleasant manner. They are recognized as absurd, the individual strug-gling unsuccessfully to suppress them. In order to re-press them and to free himself temporary from the discomfort (anxiety) which accompanies obsessions, the subject is forced to resort to rituals (voluntary behaviours) that resemble the ones accompanying su-perstitions, with the difference that the former have a strictly personal character.

Obsessions are very different.They take the form of:
— obsessive doubts that require repeated mean-ingless checks;
— strânge, painful, scruples;
— ideas with obscene character or one opposed to accepted beliefs;
— feelings and values to which an individual adheres;
— ruminations and meaningless or answerless questions;
— embarrassing memories;
— impulses related to performing certain unac-ceptable, ridiculous or unreasonable actions;
— pronunciation of meaningless, vulgar or of-fensive words or sentences;
— thoughts that some evil may happen to them, which is why the latter are called phobic obsessions.

Obsessions are inseparably linked on the one hand, to anxiety, and on the other hand, to phobias. They are linked to anxiety in that they are set in a background of anxiety It is mostly the anxiety pro-duced by their presence and by the feeling of being unable to control them, the fear of being discovered by others and humiliate themselves or the fear against undesirable or dangerous compulsions, such as saying obscene words in public, jumping into the void or, for example, performing absurd rituals. More intense is the anxiety caused by phobic obsessions among which hypochondriac ideas are the most common.

In fact, obsessions in general and phobic obsessions in particular are rather an amalgam (not a sum) of abnormal thinking, anxiety and phobias, and per-haps a special type of complex psychopathological manifestation since each of its components bears the imprint of the whole. I say this because in this case, on the one hand, like in anxiety, the danger is anticipated and uncontrollable, but the threat is clearly defined now, and on the other hand, like in phobia, the object or situation causing danger is concrete but it is not present directly. Moreover, while the state is being experienced, as it is not without criticism as in anxiety and in phobia, it is not plenary but only potential, leaving room for a minimum degree of control and for rituals to postpone drama and ease the tension. Also, in obsessions the centre of gravity is owned by mental dysfunctions that do not consist primarily in the inability to assess the situation correct, but in gen-erating and sustaining the whole by phenomena of automatism, redundancy, remanence and inability to leave them behind and move on to other concerns.

1.6. Depression and its relationship to anxiety

Knowing that, in general, the state of depression is characterized by psychomotor inhibition and anxiety by a state of warning, at first sight, the idea of having difEculty in delineating the two emoţional manifestations seems unnatural. In fact, not infrequently, especially in children and adolescents, rigorous delineation is difficult. This is because while anxiety can some-times take the appearance of stuporous states, depression itself can provide an agitated form. Moreover, the association between the two negative emoţional manifestations or the possibility that each masks the other are situations to be taken into account. In fact, phrases like “I am frozen with fear” and the diagnosis of agitated depression (code F32.2) are well known. One should also not ignore the fact that the percep-tion of reality through a depressed mood (including anticipation of danger, amplification of its significance and a false sense that the situation can be overcome) is characteristic, as we have already pointed out, to an anxious person’s thinking, something that links these two disorders. To support this idea, we have to add that anxiolytic and antidepressant medications have positive effect in both types of disorders and, accord-ing to current data, even their neurobiological sub-strates have many points in common. In support of the above comes the study by Bernstein and Gerfin-kel (1986) who found that over 50% of children and adolescents with primary depressive syndromes have distinct anxiety symptoms, too. Moreover, in the same case, both during the day and in evolution, the inten-sity ratio of the two disorders may vary significantly

2. SEMIOLOGICAL FACET

It concerns only the pathological aspect of anxiety Typically, at this level we speak of symptoms and syndromes. What was presented above point out that there can be no such notion as anxiety simply restrict-ed to a symptom belonging to the emoţional sphere. Direct involvement in the anxiety of thinking, atten-tion, memory, psychomotor activity and volition make anxiety a semiological complex that take it closer to the idea syndrome, an issue that was highlighted by Lazarus and Averii in 1972. That this is the situation argues, for example, the attempt to separate anxiety from anguish, the former representing the mental component and the latter, the somatic one. It should be noted however, that today, due to the transition from classical systematization based on clinical entities consisting of standardises groupings of a minimum number, deemed to be sufficient, of disorders extracted from the entire clinical picture, and considered as representative, modern psychiatry has almost left the notion of syndrome to history, replacing it with that of disorder.

3. CLINICAL FACET

Table no. 1 and no. 2. It is also not exempt from suffering under the burden of the above-mentioned ambiguities that put their imprint on it. The fact is amplified by the aetiological a-theoretic nature that modern classifications of mental disorders promote.

Table no. 1.  Anxiety as defining disorder for diagnostic formulation in ICD-10 and DSM-IV

Table no 2. Psychiatric disorders in which anxiety is missing from the name though its presence and importance are indisputable

These, relaxed by the lack of criteria (primarily causal ones) required for the establishment of genuine clinical entities, made the diagnosis often a formal, polymorphic framework, where there is no unifor-mity, no stability, no coherence or consistency.

Analysing the two classifications of mental disorders, one may see that there are obvious similarities but also notable differences, too. Thus:

a. Both classifications explicitly value anxiety and recognize
— its importance for the psychiatric clinic;
— its role in building other emoţional disorders with negative tonality;
— the fact that these disorders are joined to-gether in different ways and even overlap in order to achieve mixed forms or certain forms where some of the components mask the others;
— the existence of 18 (ICD-10) and, respec-tively, 16 (DSM-IV™-2000) independent clinical entities, where the presence of anxiety is specifically mentioned. One should remember that, originally, in 1895, Freud described only one entity, the anxiety neurosis.

b. Also, both classifications do well in leaving aside problems such as those listed in Table no. 2 in which anxiety, although present and important can neither represent nor substitute the specific or complexity of these disorders.

But the differences are also notable. Thus, the American classifications provide anxiety with an over valorised status considering it “the flagship” of 11 distinct clinical entities, while in ICD-10, under the caption of “Other anxiety disorders”, this time set apart, it includes the most important six diagnoses where anxiety is a major disorder. This is because the DSM-IV™ -2000, in the chapter “Anxiety Disorders” (see Table no 1) besides first line anxiety disorders includes the whole range of phobias, obsessive-compul-sive disorders and even those that are a consequence of the psycho traumatic situations or are caused by somatic diseases.

Therefore, about the same diagnostic entities are identified in which anxiety occupies a noteworthy place; phobias are usually backed by anxiety; depression also has manifestations with dual psychopatho-logical phenomenology.The notion of anguish is lack-ing even in the case of somatic affections where once it was at home, ICD-10 being one exception when it speaks of the anguish of separation.

This happens although, in our opinion, at least for the last two examples, anxiety is rather a symptom that cannot go ahead of what these conditions have specific in terms of pathogenic and clinical points of view. Perhaps from a practicai perspective, in these cases it is useful to highlight from the start, for those who do not know, the presence of anxiety that usually is dominated and sometimes is hidden by their psychopathological symptoms or specific clinical or causal contexts, which they themselves rather than anxiety create a distinct identity for the clinical reality.

However, we believe that this time the ICD-10 option would be preferable because it grants them autonomy, the same as DSM-IV™ does in the case of the entities listed in Table no. 2. The fact is the more worthy to note since in the case of the two entities above the therapeutic conduct, the progress and the prognosis are subordinated to the context, which DSM-IV™, places on a secondary plane.

Of course, in the case of phobias, it is often difficult to say which disorder is primary because clinical reality on the one hand, argues for an option in some cases and in others for the second. On the other hand, in the case of phobias, interaction with anxiety is so close that the latter is both a source and consequence. In other words, anxiety objectivises itself in phobias while, in turn, they motivate and fuel anxiety As such, we believe that this option of ICD-10 that speaks of phobic anxious disorders, with 5 clinical forms, seems more realistic, too.

Some comments should be made in the case of obsessive-compulsive pathology that the American classifications have subordinated to anxiety, starting with DSM-III (1980). Here, apart from the particular situation of the phobic obsessions, as also shown by Couinard Nelson (1996), anxiety occupies a secondary place. In fact, the first to note that obsessions are clearly separated from anxiety and phobias was Freud. It has been outlined above that the obsessive-compulsive manifestation is primarily a thinking disorder. Of course, we also talked about thinking as being in-volved in the melting pot where the formation process of pathological anxiety takes place. Nevertheless, it is indisputable that in the case of obsessive-compul-sive disorder we are in front of a qualitatively different clinical reality, something that cannot be minimized.

In fact, making a synthesis of literature data, Nelson and Couinard (1996), argue about the existence of biological and therapeutic differences between anxiety and obsessive-compulsive disorder. They advocate for its closeness to chronic tic disorders and to Gilles de laTourette syndrome, and for the award of a special place in the classification of mental disorders, as ICD-10 also proceeds in this case.

In the systematization of mental disorders belong-ing to the expanded area of anxiety, the new edition of the French Classification of Child and Adolescent Mental Disorders offers an interesting suggestion (Mises and col. – 2002) preferring to talk about disorders with an evolution dominantly anxious, phobic or obsessive. I mention it because such a formulation rec-ognizes the possibility of associating two syndromes, in which one is dominant, the fact that changes can occur during the evolution in the intensity ratio of different components and even in the emergence of new manifestations.

BIBLIOGRAPHY

1. Alexandrescu L (1999). Tratamentul farmacologic al aaxietăţii. In Voi: Actualităţi în tulburările aaxioase, pg: 154-179. Sub red. RTeodorescu. Ed. Cris
2. Berner P (1995) Aaxiete et Nosologie: un apercu histori-quie. Confrontations Psychiatriques 36: 35-52
3. Bernstein G A, Garfinkel B D (1986) School fobia. The overlap of affective aaxiety disorders. J. Am. Acad. Child Psychiatr. 25,2:235-241
4. icţionarul Explicativ al Limbii Române . (1984) Editura Academiei Republicii Socialiste România
5. DSM -III (1980) Diagnostic and Statistical Manual of Mental Disorders (Third Edition ) American Psychiatric Association
6. DSM -III -R (1987) Diagnostic and Statistical Manual of Mental Disorders (Third Edition Revised) American Psychiatric Association
7. DSM IV -TM (1994) Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) American Psychiatric Association
8. DSM – IV-TM -1994 (2000) Manual de Diagnostic şi Statistică Medicală a Tulburărilor Psihice (Ediţia a patra . Asociaţia Psihiatrilor Liberi din România.
9. DSM – IV-TR™ 2000, (2003) Manual de Diagnostic şi Statistică Medicală a Tulburărilor Psihice (Ediţia a patra revizuită). Asociaţia Psihiatrilor Liberi din România.
10. Encyclopedia of Psychiatriy for Genral Practiioners (1972). Leigh D, Pare C.M.B, Marks J. Roche Products Ltd.
11. Bonora L I, Mornd P, Nuss Ph, Ferreri M (1997) Le laby-rinte de 1′ aaxiete. Pharmacia & Upjohn S.A
12. Freud S (1895) Uber die Berechtigungvon der Neurasthenie einenbestimmten Symptomenkomplex als „Angstneirose” abzutrennen. Neurolog. Centralblatt Bd. 14:50-66
13. Geraud M, Brenoit Ph. (1997) Angoisse. In voi: Pelicier Y : Dictionnaire de concepts. Les objets de la psychiatrie. L’ Esprit du Temp
14. Lazarus R, Averill J (1972) Emotion and cognition: With Special Reference to Aaxiety. In: Aaxiety. Current trends in Theory and Research Voi. 2 . Ed. Ch. Spielberger
15. Pichot P (1987) L’Aaxiete. Masson
16. Marcelii D, Gal JM (1996) Du lien â la pensee. Entre 1’angoase de separation et 1’angoase de castration ches l’enfant. In: L’Aaxiete. Confrontation Psychiatriques Nr 36,175-192
17. Mihăilescu R. (1999) Aaxietatea paroxistică. In voi: Actualităţi în tulburările aaxioase. Pg:51-85. Sub red. R Teodorescu. Ed. Cris
18. Mises R, Quemada M, Botbol M, Bursztejn C şi col. (2002) Une nouvelle edition de la classification francaise des trou-bles mentaux de l’enfant et de 1’adolescent: la CFTMAS R-2000. Neuropsyiatr. Enfance Adolesc. 50:1-24
19. Nelson J, Chouinard G. (1995) Le troubles obessionnel-compulsif n’est pas un trouble aaxieux. Confrontations Psychiatriques 36:139-174
20. Ouetin A.M, Peyrousset J.M (1964) Semeiologie de 1’aaxiete pathologiquie. EMC Psychiatrie 37141, A10
21. Rank O (1924) The Trauma of Birth. Harper and Row. New York, 1973
22. Sârbu A (1979) Psihiatrie Clinică – Ghid alfabetic. Editura Dacia, Cluj-Napoca
23. Teodorescu R (1999) Un model cognitiv al aaxietăţii. In voi: Actualităţi în tulburările aaxioase. Pg:31-50. Sub red. R Teodorescu. Ed. Cris.