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Classification of Anxiety

Published online by Cambridge University Press:  29 January 2018

Peter Tyrer
Peter Tyrer*
Affiliation:
Mapperley Hospital, Nottingham NG3 6AA
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Summary

Current psychiatric classifications of anxiety are examined critically. In the European literature a specific cluster of symptoms is diagnostic of anxiety neurosis and their subsidiary classification is based on precipitating factors and duration of symptoms. In the American literature, exemplified by DSM-III, greater emphasis is placed on symptomatic classification and panic is given separate diagnostic status, both alone and in conjunction with agoraphobia. In both classifications generalized anxiety is at the bottom of a diagnostic hierarchy so that all other symptoms take precedence. It is argued that neither classification properly identifies a discrete syndrome of pathological anxiety that is recognizable in clinical practice.

Type
Research Article
Information
The British Journal of Psychiatry , Volume 144 , Issue 1 , January 1984 , pp. 78 - 83
Copyright
Copyright © 1984 The Royal College of Psychiatrists 

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References

American Psychiatric Association (1980) DSM-III: Diagnostic and Statistical Manual of Psychiatric Disorders, 3rd Edition. Washington: American Psychiatric Association.Google Scholar
Bowlby, J. (1973) Attachment and Loss, 2: Separation, Anxiety and Anger. London: Hogarth Press.Google Scholar
Brown, F. (1936) The bodily complaint: a study of hypochondriasis. Journal of Mental Science, 82, 295–359.Google Scholar
Finlay-Jones, R. & Brown, G. W. (1981) Types of stressful life events and the onset of anxiety and depressive disorders. Psychological Medicine, 11, 803–15.CrossRefGoogle ScholarPubMed
Foulds, G. A. (1976) Hierarchical Nature of Personal Illness; London: Academic Press.Google Scholar
Freud, S. (1894) The justification for detaching from neurasthenia a particular syndrome: the anxiety neurosis. In Collected Papers (translated by Strachey, J.), 1, 76–106. London: Hogarth Press, 1924.Google Scholar
Freud, S. (1895) The psychotherapy of hysteria. In Complete Psychological Works, Vol. 2, (trans, by Strachey, J.), pp. 255–305. London: Hogarth Press, 1955.Google Scholar
Freud, S. (1926) Inhibitions, symptoms and anxiety. In Complete Psychological Works, Vol. 20 (ed. Strachey, J.), pp. 87–172. London: Hogarth Press, 1959.Google Scholar
Gelder, M. G., Marks, I. M., Wolff, H. H. & Clarke, M. (1967) Desensitization and psychotherapy in the treatment of phobic states: a controlled inquiry. British Journal of Psychiatry, 113, 53–73.Google Scholar
Goldberg, D. & Huxley, P. (1980) Mental Illness in the Community: The Pathway to Psychiatric Care. London: Tavistock.Google Scholar
Hallam, R. S. (1978) Agoraphobia: a critical review of the concept. British Journal of Psychiatry, 133, 314–9.Google Scholar
Hecker, E. (1893) Ueber larvirte und abortive Angstzustände bei Neurasthenic Zentralblatt fur Nervenheilkunde (Berlin), 16, 565–72.Google Scholar
Huxley, P. J., Goldberg, D. P., Maguire, P. & Kincey, V. (1979) The prediction of the course of minor psychiatric disorders. British Journal of Psychiatry, 135, 535–43.Google Scholar
Johnstone, E. C., Cunningham Owens, D. G., Frith, C. D., McPherson, K., Dowie, C., Riley, G. & Gold, A. (1980) Neurotic illness and its response to anxiolytic and antidepressant treatment. Psychological Medicine, 20, 321–8.Google Scholar
Klein, D. F. (1964) Delineation of two drug-responsive anxiety syndromes. Psychopharmacologia, 5, 397–408.Google Scholar
Klein, D. F. (1976) Diagnosis of anxiety and differential use of antianxiety drugs. In Drug Treatment of Mental Disorders (ed. Simpson, L. L.), pp. 61–72. New York: Raven Press.Google Scholar
Klein, D. F. & Fink, M. (1962) Psychiatric reaction patterns to imipramine. American Journal of Psychiatry, 119, 432–8.CrossRefGoogle ScholarPubMed
Leckman, J. F., Weissman, M. M., Merikangas, K. R., Pauls, D. L. & Prusoff, B. A. (1983) Panic disorder increases risk of depression, alcoholism, panic and phobic disorders in families of depressed probands. Archives of General Psychiatry, in press.Google Scholar
Lewis, A. (1970) Paranoia and paranoid: a historical pespective. Psychological Medicine, 1, 2–12.CrossRefGoogle Scholar
Liebowitz, M. R. (1983) Tricyclic therapy of the DSM-III anxiety disorders: a review with implications for further research. Journal of Clinical Psychopharmacology, in press.Google Scholar
Lopez Ibor, J. J. (1969) Anxiety and its importance for psychiatry. In Studies of Anxiety (ed. Lader, M. H.), pp. 163–6. London: Royal Medico-Psychological Association.Google Scholar
McNair, D. M. & Kahn, R. J. (1981) Imipramine compared with a benzodiazepine for agoraphobia. In Anxiety: New Research and Changing Concepts (ed. Klein, D. F. and Rabkin, J.), pp. 69–80. New York: Raven Press.Google Scholar
Marks, I. M. (1970) The classification of phobic disorders. British Journal of Psychiatry, 116, 377–86.CrossRefGoogle ScholarPubMed
Marks, I. M. (1976) The current status of behavioral psychotherapy: theory and practice. American Journal of Psychiatry, 133, 253–61.Google ScholarPubMed
Marks, I. M. (1983) Antiphobic and anticompulsive drugs: review of the evidence. British Journal of Psychiatry, (in press).Google Scholar
Marks, I. M., Gelder, M. G. & Edwards, G. (1968) Hypnosis and desensitization for phobias: a controlled prospective trial. British Journal of Psychiatry, 114, 1263–74.Google Scholar
Matuzas, W. & Glass, R. M. (1983) Treatment of agoraphobia and panic attacks. Archives of General Psychiatry, 40, 220–2.Google Scholar
Nies, A., Howard, D. & Robinson, D. S. (1982) Antianxiety effects of MAO inhibitors. In The Biology of Anxiety (ed. Mathew, R. J.), pp. 123–133. New York: Brunner/Mazel.Google Scholar
Osler, W. (1912) The Principles and Practice of Medicine, 8th edition. New York: Appleton & Co.Google Scholar
Owen, R. T. & Tyrer, P. (1983) Benzodiazepine dependence: a review of the evidence. Drugs, 25, 385–98.Google Scholar
Paykel, E. S., Parker, R. R., Rowan, P. R., Rao, B. M. & Taylor, C. N. (1983) Nosology of atypical depression. Psychological Medicine, 13, 131–39.Google Scholar
Perley, M. J. & Guze, S. B. (1962) Hysteria—the stability and usefulness of clinical criteria. New England Journal of Medicine, 266, 421–6.Google ScholarPubMed
Petursson, H. & Lader, M. H. (1981) Withdrawal from long-term benzodiazepine treatment. British Medical Journal, 283, 643–5.Google Scholar
Petursson, H. & Lader, M. H. (1983) Withdrawal from Tranquillisers. Maudsley Monograph No. 28. London: Oxford University Press.Google Scholar
Prusoff, B. & Klerman, G. L. (1974) Differentiating depressed from anxious neurotic out-patients. Archives of General Psychiatry, 30, 302–8.Google Scholar
Roth, M. (1959) The phobic anxiety—depersonalisation syndrome. Proceedings of the Royal Society of Medicine, 52, 587–95.Google ScholarPubMed
Prusoff, B. & Mountjoy, C. Q. (1982) The distinction between anxiety states and depressive disorders. In Handbook of Affective Disorders (ed. Paykel, E. S.), pp. 70–92. Edinburgh: Churchill Livingstone.Google Scholar
Sargant, W. (1962) The treatment of anxiety states and atypical depressions by the MAOI drugs. Journal of Neuropsychiatry, 3, Suppl. 1, 96–103.Google Scholar
Sargant, W. & Slater, E. (1962) Introduction to Physical Methods of Treatment Psychiatry, 5th edition. Edinburgh: Churchill Livingstone.Google Scholar
Sheehan, D. V., Ballenger, J. & Jacobsen, G. (1980) Treatment of endogenous anxiety with phobic, hysterical and hypochondriacal symptoms. Archives of General Psychiatry, 37, 51–9.Google Scholar
Sargant, W. (1981) Relative efficacy of monoamine oxidase inhibitors and tricyclic antidepressants in the treatment of endogenous anxiety. In Anxiety: New Research and Changing Concepts (eds. Klein, D. F. and Rabkin, J.), pp. 47–67. New York: Raven Press.Google Scholar
Suinn, R. M. & Richardson, F. (1971) Anxiety management training: a non-specific behavior therapy program for anxiety control. Behavior Therapy, 4, 498–510.CrossRefGoogle Scholar
Tyrer, P. (1982) The concept of somatic anxiety. British Journal of Psychiatry, 140, 325.CrossRefGoogle ScholarPubMed
Tyrer, P., Rutherford, D. & Huggett, T. (1981) Benzodiazepine withdrawal symptoms and propranolol. Lancet, i, 520–22.Google Scholar
Watson, J. P., Gaind, R. & Marks, I. M. (1907) Prolonged exposure: a rapid treatment for phobias. British Medical Journal, i, 13–15.Google Scholar
West, E. D. & Dally, P. J. (1959) The effects of iproniazid in depressive syndromes. British Medical Journal, i, 1491–4.Google Scholar
Wolpe, J. (1958) Psychotherapy by reciprocal inhibition. Stanford: Stanford University Press.Google Scholar
Woodruff, R. A. Jr. (1967) Hysteria: an evaluation of objective diagnostic criteria by the study of women with chronic medical illnesses. British Journal of Psychiatry, 114, 1115–19.Google Scholar
Woodruff, R. A. Jr., Clayton, P. J. & Guze, S. B. (1971) Hysteria: Studies of diagnosis, outcome, and prevalence. Journal of the American Medical Association. 215, 425–8.Google Scholar
World Health Organisation (1978) International Classification of Diseases, (Ninth Revision). Geneva.Google Scholar
Zitrin, C. M., Klein, D. F. & Woerner, M. G. (1978) Behavior therapy, supportive psychotherapy, imipramine and phobias. Archives of General Psychiatry, 35, 307–16.Google Scholar
Zitrin, C. M., Klein, D. F. & Woerner, M. G. (1980) Treatment of agoraphobia with group exposure in vivo and imipramine. Archives of General Psychiatry, 37, 63–72.Google Scholar
Zitrin, C. M., Klein, D. F., Woerner, M. G. & Ross, D. C. (1983) Treatment of phobias: 1-comparison of imipramine hydrochloride and placebo. Archives of General Psychiatry, 40, 125–38.CrossRefGoogle Scholar
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