On the neurosis of fear: causes, signs, and therapeutic measures. Anxiety neurosis: symptoms and treatment of fears Treatment of phobic neuroses

Phobias and various fears are very diverse, they are the most common. At the same time, the nature of the behavior of patients is appropriate. It is not difficult to determine the signs of anxiety neurosis, since the patient's behavior demonstrates them quite eloquently. For example, a patient begins to be afraid to relate to certain objects, he asks loved ones to remove this object from him as far as possible. In the event that a person is afraid of closed spaces, then he can hardly tolerate public transport, cannot stay indoors if it is closed, especially alone.

In fear of contamination, the patient can wash his hands all day, without even stopping when the skin begins to change. At the same time, such people constantly try to boil towels, linens, various rags, achieving their sterility. If the neurosis of fear is expressed in heart phobia, then such a person is constantly afraid that a heart attack may overtake him on the street, and no one will notice this and will not provide assistance. In this regard, the patient chooses such a route to work, which runs close to pharmacies or clinics. But if such a person sits in a doctor's office, then he understands that fears are unfounded, and calms down.

Thus, the neurosis of fear is due to various phobias associated with specific situations, a group of ideas. Basically, obsessive actions are in the nature of the necessary actions taken above, when a person cannot tolerate a closed room, fears open areas, and so on. Sometimes patients say that they are inexplicably drawn to count windows, train carriages, passing cars of a certain color, and so on. Some ticks, especially complex ones, can be attributed to the same category.

In anxiety neurosis, obsessive states can be subdivided into obsessions, fears and thoughts, but such measures are conditional. The fact is that each obsessive phenomenon is very conditional, since it contains certain ideas, drives and feelings that have a close connection with each other. Many sufferers have their own rituals and obsessions. The anxiety neurosis observed in psychosthenic psychopaths is considered as a special form of neurosis called psychasthenia. Among the main features of psychasthenics are fearfulness, indecision, constant doubt, a state of anxious suspiciousness. In particular, they are characterized by such qualities as an increased sense of duty, anxiety.

The basis is lowered mental stress, and as a result, full-fledged higher mental acts are replaced by lower ones. Anxiety neurosis can be expressed in the inability to perform a certain function, since a person constantly fears that he will fail. Moreover, this can relate to absolutely any area. More often this has to do with public speaking, sexual functions, and so on. In addition, anxiety neurosis has no age restrictions; both children and the elderly are susceptible to it. For example, speech impairment can occur due to the fact that there was an unsuccessful reading of a report in public, during which a person was worried, and speech inhibition occurred. Not surprisingly, in the future, the anxious expectation of failure in public speaking is reinforced, and goes to any normal setting.

According to the same principle, the development of the expectation of failure during intercourse occurs, when one of the partners felt not at his best. Anxiety neurosis is always accompanied by significant anxiety, this is its main symptom. Fear itself is not dependent on the situation or some ideas, rather it can be called empty, lacking motivation. Such fear is primary and psychologically incomprehensible; it is not derived from other experiences, but arises on its own. Sometimes, under the influence of such fear, anxious fears arise that have nothing to do with this fear. Anxiety neurosis is often associated with a hereditary predisposition. A significant role in the formation of the disease is assigned to the first attack, which is the onset of the disease.

The occurrence of this disease can be influenced by certain somatic reasons, the presence of traumatic and psychogenic factors is also important. A special variant of this disease is considered an affective-shock neurosis, otherwise it is called a neurosis of fright, which has its own forms. The simple form is characterized by a delayed course of mental processes, as well as certain somato-vegetative disorders. The course of the disease is acute, it occurs after a mental shock trauma that signals danger. In this case, a person turns pale, tachycardia occurs, blood pressure fluctuates, the nature of breathing is rapid.

In particular, this form is characterized by increased frequency of urination, loss of appetite, dryness occurs in the mouth. A person can lose weight, his hands begin to tremble, and weakness in his legs is felt. Thought processes are also inhibited, verbal-speech reaction worsens. Recovery is gradual, but disturbed sleep is the most difficult to recover. In the asensitized form, the onset of anxiety is typical, there is motor restlessness, verbal and speech reactions are also slowed down. The stupor form of anxiety neurosis is combined with

Anxiety neurosis is a special form of neurosis (exhaustion of the nervous system under the influence of stress factors), in which the feeling of fear is more pronounced than other symptoms, such as, for example, irritability or fatigue. This psychological disease also has another name - anxiety neurosis or anxiety neurosis.

The development of the disorder can be triggered only by one strong stressful circumstance, or by several long-term traumatic situations that gradually awaken anxiety neurosis.

There are three groups of main factors that can influence the development of the disease.

Stress- occurs when a person cannot control some aspects of public or personal life (loss of work, family discord, unrequited love, misunderstanding on the part of others, etc.).
Intense events in life- situations when a person is required to show control over their emotions (exam, first visit to kindergarten or school, moving, changing jobs, having a child, losing a loved one, and others).
Hereditary predisposition- a person can be born with a tendency to increased anxiety. If there are a lot of stress and difficult circumstances in his life, then an anxious neurosis will surely arise.

Symptoms of anxiety neurosis

Anxiety neurosis is manifested not only by changes in behavior. It affects the entire body as a whole, affecting health and vital processes in the body.

The main mental symptoms of the disease include:

anxiety;
fear;
Agitation (anxiety, manifested in excessive mobility or talkativeness);
depression;
obsessive thoughts;
hypochondria (fear for your health);
insomnia or increased sleepiness;
aggression - harm to physical or psychological health;
biting nails, thumb sucking are common in children.

Somatic manifestations:

headache;
dizziness;
increased heart rate (more than 90 beats per minute);
hypertension or hypotension;
heart rhythm disorder;
breathing disorder (the need to breathe deeply);
dyspnea;
nausea;
constipation or diarrhea;
trembling feeling;
chills;
loss of appetite;
tinnitus;
enuresis.

How to treat

Unfortunately, many patients with anxiety neurosis turn to a specialist too late. They either go to a therapist complaining of headaches or suspected ailments, or they self-medicate without worrying too much about their health.

If you notice one or more of the above symptoms in yourself or a person close to you, you should immediately consult a psychiatrist.

The treatment takes place in two stages:

Psychotherapy.
Prescribing medicines.

Psychotherapy methods

Psychotherapy is used for mild neurosis. The main criterion for success in treatment is the establishment of a trusting relationship between the doctor and the patient.

The psychotherapist must find out the circumstances that led to the appearance of the neurosis, and also find a way to healing with the help of psychotherapeutic methods:

Belief- a change in the patient's attitude to the situation that caused the disease. In the case of successful psychotherapy, fears and anxieties lose their significance.
Direct suggestion- impact on the patient's consciousness through verbal or emotional constructions (for example: "I will count to five and it will happen ...", "You came to me, sit now in this soft chair, listen to my voice, today you will feel much better" will place everything that is necessary in places ").
Indirect suggestion- the use of an additional stimulus (prescribing a homeopathic remedy or physiotherapy procedure). The patient, in this case, will associate success in treatment with him.
Self-hypnosis- information addressed to oneself. It allows you to evoke the sensations and emotions necessary for treatment, as well as pictures from the past.
Autogenic training- the use of muscle relaxation, through which the restoration of control over the patient's health is achieved.
Therapy will be more effective in combination with other methods of eliminating a mild form of neurosis, such as remedial gymnastics, massage sessions and hardening.

Medicines

In the middle of the twentieth century, 2 agents were used to treat neuroses, including anxiety, - sodium bromide and potassium bromide as a sedative, and caffeine, which in large doses can suppress the nervous system.

Today psychotherapists are using new means that can defeat neurosis.

Tranquilizers

are aimed at relieving emotional stress, feelings of anxiety and fear, they have a calming and hypnotic effect;
have a pronounced anti-anxiety, anti-phobic effect, and also reduce muscle tone;
stop (suppress) all types of anxiety with neuroses, panic attacks, sleep disturbances, obsessive-compulsive disorder with the presence of rituals (movements invented by the patient to protect themselves from their fears, as well as calming);
relieve somatic symptoms such as nausea, dizziness, sweating and fever.

Antidepressants

Such medicines reduce feelings of melancholy, lethargy, anxiety and apathy, increase mood, activity, and improve sleep and appetite.

They are used in the treatment of diseases with depressive symptoms:

Tricyclic antidepressants- amitriptyline, imipramine. Treatment begins with a small dose of the drug, which increases over time. The effect of such drugs is visible after 1.5-2 weeks of use.
Selective inhibitors serotonin reuptake - fluoxetine, sertraline, paroxetine and citalopram. This is the latest generation of antidepressants. They have a minimum of side effects and are only effective with long-term use.
Herbal preparations- are made on the basis of St. John's wort. You can buy them over the counter without a prescription, but these antidepressants have a lot of special guidelines, such as banning sunbeds and the beach and not drinking alcohol.

It should be noted that all medications must be used after consulting a doctor. Only a specialist can correctly diagnose and prescribe treatment.

Childhood anxiety neurosis

The main causes of childhood fear neurosis are conflicts in the family or with peers, less often - physical trauma, serious illness or severe fright.

If a child has recently experienced one of the above circumstances, it is necessary to be attentive to his mental state.

Parents should be concerned about the following manifestations of the disease in children:

constant anxiety;
obsessive fears (fear of death, darkness);
emotional depression;
chronic fatigue;
frequent hysterical crying for no serious reason;
tics and stuttering.

Treatments for childhood anxiety neurosis differ from those used for adults. Psychotherapists rarely use drug treatment, more often they use the following methods:

Art therapy- is a method of treatment using artistic creativity (drawing, modeling, composition). This is a very effective and, at the same time, safe way. Art therapy affects the psycho-emotional state of the child, resolving all internal conflicts. This method promotes the development of self-expression and self-knowledge. With the help of creativity, the child depicts his inner fears, which leads to their gradual disappearance.
Family therapy- teaching all family members the correct interaction with each other. Psychotherapists using this method are convinced that the sources of neurosis lie in relationships in the family, therefore, the patient can be cured only if the cause is removed.

With timely diagnosis and proper treatment, anxiety neurosis has a favorable outcome. But no less important is the support and understanding from loved ones.

Video: Treatment of anxiety neurosis

As described above, obsessive fears, or phobias, are varied and common. The behavior of patients takes on a corresponding character.

Symptoms A patient with fear of certain objects asks relatives to remove them away from him, and a patient who is afraid of a closed space will avoid staying in a room, transport, especially alone. With an obsessive fear of contamination, patients wash their hands all day, despite the fact that the skin on the hands has begun to change. Rags, towels, linens are constantly boiled so that they are "sterile". An infarctophobic patient is afraid that a heart attack will happen in her street and no one will help her. Therefore, she chooses a route to work that runs past hospitals and pharmacies, but she sits in the doctor's office without fear and fear, realizing its unfoundedness.

Thus, a phobia is fear associated with a particular situation or group of beliefs.

Obsessive actions are most often in the nature of the measures expected above to overcome phobias (often washing their hands, bypassing open areas, not staying in a closed room, etc.)
etc.). Often there are obsessive tendencies to count objects or windows, or women in red slippers, etc.

This also includes some tics, especially difficult ones, but not violent. The division of obsessive states into obsessions, thoughts, fears and actions is very conditional, since each obsessive phenomenon, to one degree or another, contains ideas, feelings and drives that are closely related to each other. The patient may have a number of obsessions and rituals.

Obsessive-compulsive disorder in psychasthenic psychopaths can be regarded as a special form of neurosis - psychasthenia. The main character traits of psychasthenics are indecision, fearfulness, a tendency to doubt, anxiety-suspicious state. They are characterized by an increased sense of duty, a tendency to anxiety, fear. This is based on the lowering of "mental stress", as a result of which higher full-fledged mental acts are replaced by lower ones.

Expectation neurosis is expressed in the difficulty of performing a particular function due to the obsessive fear of failure (speech, walking, writing, reading, sleeping, playing a musical instrument, sexual function).
It can occur at any age. For example, speech impairment may occur after an unsuccessful public speech, during which, under the influence of an agitated patient situation, the speech function was inhibited. Later, a feeling of anxious expectation of failure developed when it was necessary to speak in public, and then when speaking in an unusual setting.

In a similar way, the neurosis of expectation develops with an unsuccessful sexual intercourse, where one or the other partner did not feel at their best.

In anxiety neurosis, the main symptom is anxiety or fear. Fear does not depend on any situation or any ideas, it is unmotivated, meaningless - "freely floating fear." Fear is a primary and psychologically comprehensible way, not deduced from other experiences.

Often, under the influence of fear, psychologically associated anxious fears appear, which depend on the strength of the fear. Hereditary predisposition plays an important role in the development of anxiety neurosis.
The first attack of fear, which laid the foundation for the disease, has a large role in the formation of the disease; it can be both a somatic factor in various diseases, and a traumatic, psychogenic factor.

A special variant of the neurosis of fear is the affective-shock neurosis, or neurosis of fear, which is subdivided into the following forms:

A simple form, which is characterized by a slow course of mental processes and a number of somatovegetative disorders. The disease occurs acutely, following the action of shock mental trauma, which signaled a great danger to life. There is pallor of the face, tachycardia, fluctuations in blood pressure, rapid or shallow breathing, increased urination and defecation, dry mouth, loss of appetite, weight loss, trembling of hands, knees, feeling of weakness in the legs. Inhibition of thought processes and verbal-speech reactions, sleep disturbance is noted. Recovery gradually occurs, but sleep disturbance lasts the longest;

The asensitized form is characterized by the development of anxiety and motor restlessness with a slowdown in verbal and speech reactions, thought processes with autonomic disorders inherent in a simple form;

Stuporous form in combination with mutism, i.e. numbness and numbness;

Twilight form (a twilight state of consciousness appears, unawareness of muttering, misunderstanding of the location).

Fright neurosis is especially easy in children. It most often occurs in infantile children and young children. The disease can be caused by new, unusual stimuli, for example, a sharp sound, bright light, a person in a fur coat or mask, an unexpected imbalance. In older children, fear can be associated with a fight scene, the sight of a drunk person, or the threat of physical harm.

At the moment of fright, short-term stuporous states ("numbness" and "numbness") or a state of psychomotor agitation with trembling are observed. Further, this fear can gain a foothold. Young children may experience a loss of previously acquired skills and abilities. The child may lose speech function, walking skills and neatness skills. Sometimes children start urinating at the sight of a drunk person, biting their nails, etc.

The course of the disease in most cases is favorable, the impaired functions are restored. In children over 5-7 years old who have undergone fright, it can give rise to the formation of phobias, i.e., obsessive-compulsive disorder.

At the end of the 19th and the beginning of the 20th centuries, Janet and anxiety neurosis were distinguished from Beard neurasthenia as an independent form of psychasthenia. The latter was first described by S. Freud in 1892, that is, several years before he created psychoanalysis.

In Germany this form became known as apd-stneurosen(fear neurosis), in Anglo-American countries - anxiety neurosis(anxiety neurosis), in France - neuroses d "angoisse(anxious and melancholy state). In domestic monographs, the neurosis of fear was not described, and states of fear were described as symptoms that can occur in various neuroses, hypothalamic disorders and psychosis.

The main symptom of the disease is the appearance of a feeling of anxiety or fear. Most often it occurs acutely, suddenly, less often - slowly, gradually increasing. Having arisen, this feeling does not leave the patient throughout the day and often lasts for weeks or months. Its intensity fluctuates between a slight feeling of anxiety and a pronounced fear, followed by attacks of horror.

Fear is substandard (which, as we will see, is its main difference from phobias), that is, it does not depend on any situation or any perceptions, it is unmotivated, meaningless, devoid of a plot ("free floating fear" - free floating anxiety states). Fear is primary and cannot be deduced from other experiences in a psychologically understandable way.

“The state of fear does not leave me all the time,” said one of our patients. - I experience all day a feeling of vague anxiety, then fear. At the same time, what I am afraid of, what I am waiting for - I myself do not know. Just fear ... ”It is often noted that there is an expectation of some kind of undefined danger, misfortune, something terrible that is about to happen. “I understand,” said this patient, “that nothing terrible should happen and there is nothing to be afraid of, but I am seized, consumed by a constant feeling of fear, as if something terrible is about to happen.”

Often, under the influence of fear, disturbing fears arise, psychologically understandably associated with it. They are unstable. The degree of their intensity depends on the strength of the fear.

“Sometimes fear intensifies,” said another patient, “and then I start to be afraid of everything: if I’m standing at the window - what if I throw myself out the window, if I see a knife - what if I hit myself, if I’m alone in the room - I’m afraid that if they knock , I will not be able to open the door, or if it becomes bad, then there will be no one to help. If a husband or child is not at home at this time, then the thought arises - has something terrible happened to them. Once, during a fit of fear, I saw an iron. A thought flashed - what if I turn it on and forget to turn it off. " With the disappearance or weakening of the feeling of fear, these fears also disappear. Anything that increases feelings of anxiety, fear, can cause or exacerbate these fears. So, unpleasant sensations in the area of the heart or hearing a story that someone died of myocardial infarction, cerebral hemorrhage, cancer or "went crazy" can give rise to corresponding fears. In this case, fear is primary, and the fear of dying from a heart attack, cerebral hemorrhage, cancer or mental disorder is secondary. It is not a persistent overvalued hypochondriacal idea or phobia, but only anxious fear. Under the influence of persuasion, the patient often agrees that he is not in danger of death "from heart paralysis," but fear persists and either immediately changes

it emits a storyline (“well, I don’t know, maybe it’s not a heart attack, but another terrible disease”), or it temporarily becomes empty, “free-floating” fear.

Sometimes, depending on the content of anxious fears, patients take certain measures of "protection" - more or less adequate to the content of the fear, for example, they ask not to leave them alone, so that there is someone to help if "something terrible" happens to them, or they avoid physical activity, if they fear for the state of the heart, they are asked to hide sharp objects, if there is a fear of going crazy (there are no rituals).

The state of fear can periodically sharply intensify, giving way to attacks of horror with unmotivated fear or, more often, with the expectation of death, for example, "from paralysis of the heart", "cerebral hemorrhage."

In connection with the domination of feelings of anxiety or fear, patients note the difficulty of concentrating on any activity, increased excitability, affective instability. At times they are anxious, agitated, looking for help. Often they have painful, unpleasant sensations in the region of the heart or epigastrium, which give the feeling of fear a vital shade. Blood pressure during the period of illness in patients remains within the normal range or at its lower border. At the height of the affect of fear, it rises somewhat. At this time, there is an increase in heart rate and breathing, dry mouth, and sometimes an increase in the urge to urinate.

During illness, appetite is reduced. Due to the constant feeling of anxiety and decreased appetite, patients often lose weight, although not very dramatically. Sex drive is usually low. Many have difficulty falling asleep, restless sleep with nightmares. The galvanic skin component of the orienting reaction often arises spontaneously and is inextinguishable throughout the study. Here is a typical observation.

Patient M., nurse, pyknotic constitution. She first entered a psychiatric clinic at the age of 30. Prior to that, she lived happily with her husband for 8 years. Has two children - 6 and 4 years old. By nature, imperious, impatient, quick-tempered, sociable, honest, principled. Since childhood, I was afraid to spend the night alone in a room.

Suddenly she found out that her husband was married and was paying child support from his first marriage. I was shocked by this. Had a painful conversation with his first wife, listened to undeserved insults from her. His first wife did not pretend to be a sick husband, and that same evening she went to her place in another city. The patient stayed with her husband, but he became disgusted with her, and she immediately pushed him away from her, although before that she loved him very much and experienced a strong sexual attraction to him. Was in a state of confusion.

4 days after the incident, I woke up at night with a feeling of intense fear. It squeezed the chest, there was an unpleasant sensation in the area of the heart, all trembled, did not find a place for itself, was agitated, it seemed that she was about to die. Cardiac and sedative remedies did not bring relief. Since then, for 9 years, he has been constantly experiencing a feeling of fear, which is often unmotivated. “I don’t know myself what I’m afraid of,” says the patient, “it’s like something terrible is about to happen ... The feeling of anxiety is constantly held”. Sometimes fear is associated with one or another specific fear. So, begins to fear that something might happen to the heart. “I think sometimes,” she says with tears, “that my heartbreak may come from excitement. At times I am afraid to stay at home alone - suddenly something will happen and there will be no one to help me, and when the fear intensifies, I start to be afraid and walk the streets alone. " Anxiety sometimes decreases significantly for 1-2 hours, sometimes sharply increases. “Foolish thoughts often began to creep into my head,” she complained 2 years after the onset of the disease. - Yesterday I suddenly thought that I would die, how they would bury me, how the children would be left alone. If someone told about death or an accident - it gets into your head, you close your eyes - the dead. As soon as there is a knock, anxiety intensifies. I became even more impatient and irritable than before: I can't do one thing for a long time, I don't have the patience to stand in line for a minute. Once in a store I saw cashiers transferring money to each other. There was a fear - suddenly their money would be stolen, the police would come, and I could not stand it from fear. I left the store, and these thoughts were gone, the anxiety became less. "

When he follows a child to kindergarten, a thought appears, what if something happened to him; if the mother is at work, has something happened to her; husband will be delayed - anxiety about this. In the evening, the anxiety usually intensifies, but if guests come, the patient is distracted and the anxiety fades into the background. “For the fourth year now, the fear has not left me,” the patient once complained. - Everything worries me: the mouse will run - and then the wave-

Several times, more often in the morning, without any particular external reason, there were attacks of strong fear with agitation. The patient was seized with horror, it seemed that she was about to die or something terrible would happen, her hands trembled, breathing quickened, felt palpitations, there was an urge to urinate, a painful sensation in the region of the heart. It lasted about an hour. After the attack, there was a sharp weakness.

Throughout the entire period of the illness, she did not leave work and did not tell her colleagues about the illness. She noted that it was easier for her at work. Work distracts from feelings of anxiety, however, even there it does not completely leave the patient. At home, she has a seemingly good relationship with her husband. He is caring, attentive. The patient takes care of children, runs a household. Since the onset of the disease, sexual desire remains low, although he lives with her husband sexually, sometimes experiencing sexual satisfaction.

At the beginning of the disease, the patient went to an inpatient examination at a therapeutic clinic. There were no violations from the somatic sphere. HELL 145/100 hPa, urine and blood tests without pathological changes. From a therapeutic clinic she was transferred to a psychiatric clinic, where during the first two years of the illness she lay twice (1 1/2 and 2 months) with symptoms of anxiety neurosis.

In a psychiatric clinic, at the first admission, blood pressure sometimes approached the lower limit of the norm, ranging from 140/80 to 153/93 hPa. The pulse during alarm was up to 100-110 per minute. There was no connection between the feeling of fear and fluctuations in blood pressure. In recent years, blood pressure 147 / 93-160 / 107 hPa, ECG is always normal.

In the study of the electrical activity of the brain, as well as suppression of the orienting reaction, the symptoms of focal brain damage were not found. a-rhythm dominates in all parts, and, as in the norm, is most distinct in the parietal and occipital. Fluctuations of a-rhythm 11 - 12 per second, amplitude 50 - 70 mV. Areas of spontaneous depression of the a-rhythm are constantly noted. In the anterior and central regions, there are low-amplitude slow oscillations (4 per second) with layering a-oscillations. Opening the eyes and the action of a light stimulus caused incomplete depression of the a-rhythm. Rhythm acceleration (from 3 to 30 light flashes per second) was not observed.

The data presented indicated a weakening of the bioelectrical activity of cortical neurons. The orienting reaction turned out to be very persistent: either it did not fade away at all, or it fade away only in waves.

In the clinic, only general strengthening treatment was prescribed, attempts were made to hypnotherapy (the patient could not concentrate, did not fall asleep); drug psychotherapy, treatment with chlorpromazine were carried out. So, during the second year of illness, a three-month course of treatment with chlorpromazine (up to 450 mg per day and then maintenance doses of up to 100 mg) was carried out in a hospital and partially outpatient. During treatment, I felt drowsy, with high doses I slept a lot, but as soon as I woke up, the anxiety resumed. In general, chlorpromazine reduced this feeling a little. Sometimes andaxine reduced anxiety to a large extent, although usually its sedative effect is much weaker than that of chlorpromazine. However, it also happened that even large doses of andaxin (8 tablets per day) did not give an effect. Tofranil did not relieve anxiety. It decreased significantly when the patient began to take nosinan (50 mg per day) and stelazine (20 mg per day), and later amitriptyline.

So, in this case, anxiety neurosis arose after severe mental trauma. The peculiarity of this trauma was that it not only had a shock mental effect, but also caused a severe mental conflict associated with the coexistence of conflicting tendencies (a feeling of love for her husband and indignation at his behavior). The feeling of fear that arose sometimes remained isolated and was experienced as unreasonable, meaningless, sometimes it radiated, reviving the corresponding ideas.

Under the influence of fear, the patient revived, first of all, those associations that in this situation were the most recent, strong. So, as soon as someone told about death from heart disease, the fear of dying from the same appeared. As soon as the mother was late at work, the thought appeared, and whether something terrible had happened to her.

The patient's previous heightened fearfulness (from childhood she was afraid to be alone in the room in the evening) could contribute to the emergence of fear and its fixation. Certain characterological features (honesty, adherence to principles), as well as the patient's ethical and moral attitudes, made her especially sensitive to this particular trauma. The strength of the traumatic impact

Viya, moreover, increased from the unexpectedness of the message, and the unexpectedness of the message, leading to the "mismatch between the expected and the coming," as we have seen, has a particularly strong emotional impact. Tranquilizers reduced the feeling of fear, but did not completely eliminate it. Below we will focus on the differential diagnosis between anxiety neurosis and obsessive-compulsive disorder. Here we just note that, in contrast to obsessive-compulsive disorder, the patient's fear is empty, atematic, substandard. The fears that arise at the height of an attack are short-term changeable and are close to those fears that, as we know, are characteristic of a healthy person. They are not phobic.

The duration of anxiety neuroses most often ranges from 1 to 6 months, sometimes the disease takes a protracted course and can last for years. In the involutionary period in general, as you know, more often than in other periods of life, states of fear arise. During this period, the neurosis of fear easily takes on a protracted course.

The addition of hypotension, hypertension, cerebral atherosclerosis, heart disease worsens the prognosis and leads to the appearance of mixed somatopsychic forms, in which minor fluctuations in blood pressure or mild cardiac disorders cause a sharp increase in the feeling of fear.

An important role in the emergence of anxiety neurosis is played by hereditary predisposition. The frequency of this neurosis among relatives is 15% (Cohen). According to Slater and Shield, concordance occurs in anxiety neurosis in about half of the cases, while less concordance, and therefore less genetic conditioning, is observed in hysteria and obsessive-compulsive disorder. Biochemical studies have shown that patients with anxiety neurosis have increased blood lactate levels. Pitts and McClure found that, when injected intravenously, lactate produces anxiety symptoms in previously affected individuals as opposed to controls. The introduction of calcium along with lactate prevented the development of these symptoms. Thus, the authors came to the conclusion that patients with anxiety neurosis are persons with chronic hyperproduction of adrenal hormones, deficiency of calcium metabolism and increased lactate secretion. Recently

but Gross and Scharmer confirmed this finding, pointing out, however, that lactate ions are only one of many underlying factors. An important role in the development of the latter belongs, in particular, to bicarbonate ions and blood alkalosis. With the help of a variety of psychological tests, a high degree of inheritance of various personality traits, including "neurotic tendencies", has been shown. G. D. Miner (1973) considers it proved that in the development of anxiety neurosis an important role belongs to genetic factors that determine the specific constitution of patients. However, for the realization of a hereditary predisposition to clinically formed symptoms of neurosis, the action of environmental stress is necessary.

According to N. Laughlin, in the United States, anxiety neuroses (including the so-called states of anxiety) account for about 12-15% of all forms of neuroses and occur in 1 in 300 inhabitants, and in men and women with the same frequency. According to our data, they are rarely observed - 5 times less often than obsessive-compulsive disorder and psychasthenia, and more often in women than in men.

The cause of the disease can be a strong mental shock, as well as less harsh, but more long-lasting traumatic factors leading to the emergence of a conflict (coexistence of conflicting aspirations).

One of the particular causes of anxiety neurosis is the emergence of acute neurovegetative dysfunction caused by the action of a situation in which strong sexual arousal is inhibited by an effort of will, for example, during interrupted sexual intercourse, which has become a system of sexual life. It happens sometimes with strong sexual arousal in a woman who remains dissatisfied, that is, when the release of sexual arousal does not occur.

According to S. Freud, a suppressed, unreleased sexual desire (libido) continuously turns into a seemingly real fear. The conflict of patients with anxiety neurosis, according to N.M. Asatiani (1979), consists in the impossibility of satisfying the sexual instinct by means that do not contradict the moral and ethical norms of society.

The first attack of fear, which laid the foundation for the disease, plays an important role in the formation of neurosis. It can be caused not only by psychogenic, but also by physiogenic reasons, for example, an acute vegetative crisis, vasopathic

disorders leading to hypoxemia and physiogenically conditioned fear. Such a crisis may occur after an infection or intoxication, but the main cause of the disease is still not infection or intoxication, but the traumatic effect of this experience or the influence of a traumatic situation, which led to the fixation of the feeling of fear that has arisen. The following observation is characteristic.

Patient V., 32 years old, an engineer who in the past suffered a brain injury that left behind neurocirculatory disorders, fell ill acutely, suddenly. In the evening I drank about 700 ml of vodka. In the morning I woke up with a strong feeling of fear, felt chills, trembled, there was a sharp sweat, palpitations, a painful feeling in the region of the heart, the head was heavy, as if in a fog; could not find a place for myself. It seemed that he was about to die - he was very much afraid of this.

Vegetative phenomena in about 2 hours smoothed out, but the feeling of fear persisted. It lasted for a month either in the form of unmotivated anxiety, or in the form of expectation of unhappiness with him or his loved ones. I stopped drinking alcohol completely. BP was 180/93 hPa. ECG is normal.

After a course of treatment with tranquilizers in combination with hypnotherapy, the fear stopped.

In this case, an attack of fear arose sharply, suddenly upon awakening from sleep, under the influence of somatogenic causes - alcohol intoxication, which caused a vegetative crisis, probably with neurocirculatory disorders and hypoxemia. Physiogenically conditioned feeling of fear. A strong shock (fright) caused by a vegetative crisis and imperfection of cerebral mechanisms caused by trauma could play a role in its occurrence.

The anamnesis showed that, in addition, the patient had recently been in a state of emotional tension associated with family troubles for a long time. It could also play a role in maintaining feelings of anxiety.

Anxiety neurosis can occur in individuals with different typological characteristics. Fear caused by a strong frightening experience or a complex psycho-traumatic conflict, especially easily arises in people who are fearful, anxious and suspicious, who, even before the illness, had a tendency to passive-defensive reactions. Hypotho-

nia and hypertension, as well as cerebral atherosclerosis and heart disease, often accompanied by an increase in anxiety, can contribute to the emergence of anxiety neurosis.

According to D. M. Levy, the emergence of anxiety neurosis in adults can contribute to the strong emotional upheavals that caused stress experienced in childhood. Their reasons may be fear, separation from parents, a sudden change in the usual environment, worries associated with the fact that little attention is paid to the child in connection with the birth of a brother or sister.

Sometimes the neurosis of fear, as noted by V.V. Kovalev, turns into a hypochondriacal neurosis. At the same time, the paroxysmal characteristic of the neurosis of fear gradually smoothes out and disappears, and the fears take on a more permanent, although not so acute, character.

There are diseases with a picture of anxiety neurosis, in the etiology of which it is not possible to identify either somatogenic or psychogenic factors, including abnormalities in sexual activity. The possibility is not excluded that in these cases we are dealing with manifestations of a special endogenous disease, not related to either manic-depressive psychosis or schizophrenia.

States of fear can occur in a wide variety of diseases. Feeling fear is a normal psychological reaction in a life-threatening situation. They talk about pathology when this feeling arises without an adequate external reason, or when its strength and duration do not correspond to the situation. Attacks of fear are often intertwined with the picture of a diencephalic autonomic crisis. They are observed only at a certain phase of this crisis, and patients do not fight them.

Anxiety neurosis should be differentiated from phobias in obsessive-compulsive disorder and psychasthenia. With phobias, the feeling of fear arises only in a certain situation or when evoking certain ideas and is absent outside of them. So, for example, a patient with a phobia of chicken feathers experiences fear at the sight of them, but is completely calm when she does not see feathers or does not think about them. In contrast, fear in anxiety neurosis is substandard and persists almost constantly, fluctuating only in its intensity. It is either empty or accompanied by unstable anxiety

fears, secondarily caused by a feeling of fear and psychologically understandably connected with it. The intensity of these fears depends on the intensity of the fear. Phobias can be mono- or polythematic, but their content is more or less constant. It usually does not happen that a patient with a phobia is afraid of wide streets today, tomorrow he stops being afraid of them and begins to feel fear of sharp objects, and the day after tomorrow, instead of that, a fear of infection appears. In contrast, fear neurosis is variable in fear neurosis. Appearing at the height of the affect of fear, they are close in content to those fears that are inherent in a healthy person (has something happened to the child if he is not around; when an unpleasant sensation appears in the heart, fear of the corresponding content). The fear of something that in real life usually does not cause fear (unlike phobias) is not observed. Therefore, they do not occur with anxiety neurosis, for example, the fear of brown spots or chicken feathers, the fear of contamination (touching) or the fear of being with unbuttoned trousers, or harm to the daughter's health, if the number 7 encountered in the book is not immediately circled.

Persistent carcinophobia, heart phobia, not having the character of fear at the height of the primary affect of fear, usually refer to neurosis not fear, but obsessive states. It must be said that sometimes there are patients with psychasthenia, in whom, in addition to phobias, the phenomena of anxiety neurosis can also be found. As follows from the data of P.V. Bunzen, in diseases that we would attribute to anxiety neurosis, there is a sharp increase in the level of excitability of adrenergic structures - sharper than in phobias, while in the latter, a decrease in reactivity is more pronounced cholinergic structures.

Pictures similar to anxiety neurosis can be observed in neurosis-like conditions caused by somatic reasons - hypertension and hypotonic disease, cerebral atherosclerosis, heart disease, infections (especially rheumatic ones), intoxication.

Fear, as indicated, can arise in a psychogenic way, that is, under the influence of signals about a threat to a person's life or well-being, and physiogenically. Acute hypoxemia caused by cardiovascular disorders or reflex influences, for example, from the heart, can

cause a feeling of fear in a physiogenic way. Physiogenically conditioned feelings of fear can give rise to a condition similar to those observed in anxiety neurosis. At the same time, the fear that arises can be less often athematic, meaningless, more often it revives the representations associated with it, causing alarming fears.

So, in one of our patients with hypotension, there was a feeling of anxiety when blood pressure decreased and unpleasant sensations appeared in the region of the heart. Then she began to worry about either supposedly possible work or family troubles, or the health of the child or the delay of her husband at work, or because of her health (isn't it cancer?). Often the anxiety was meaningless.

Sometimes, in connection with hypertensive or hypotonic crises, or with disturbances in the activity of the heart, attacks of fear of death or attacks of fear for the fate of loved ones may occur. With a very strong attack of fear, anxious fear can turn into an overvalued idea or can lead to the development of acute paranoid. The following observation is characteristic.

Patient M., 62 years old, a cashier of a store, suffered from hypertension for a number of years. In recent years, BP was 240 / 133-266 / 160 hPa.

In the morning, crossing the street at the store in which the work, slipped and fell. I didn't hurt my head. I got up on my own, came to the store, sat down at the cash register and started working. I experienced a sensation of noise in the head, compression in the region of the heart, a feeling of anxiety. After working for several minutes, I suddenly felt a strong, unmotivated fear. I tried to overcome it and continue working, but suddenly the thought arose that her daughter was now taken to a surgical clinic with an attack of appendicitis, she was being operated on, she was dying. She left the cashier, ran to the director's office and told him about it with an expression of horror on her face. The store manager immediately phoned the emergency room of the hospital and established that M.'s daughter had not been admitted there.

The patient sobbed, tossed about in a state of fear and despair, mourned her daughter. She was taken home, where she found her daughter safe and sound. She grabbed her hand, repeating with an expression of horror on her face: "My poor girl, you are being operated on, you were taken to the hospital!" She did not succumb to persuasion and reassurance, she assured that her daughter was dying. Was hardly put to bed. HELL was

313/173 hPa. Introduced papaverine, delivered leeches, given barbamil. Gradually, the patient began to calm down, although she continued to assure that her daughter was dying. I spent about 2 hours in a state of half-drowsiness. By 5 pm I calmed down. The blood pressure dropped to 266/160 hPa. I began to doubt that my daughter had been operated on. By the evening, there was a complete criticality to the transferred disease.

In this case, the hypertensive crisis caused, in all likelihood, brain hypoxemia, which in turn gave rise to a physiogenically conditioned feeling of fear. Due to the bilateral conduction of the conditioned connection, the process of unconditional reflex excitation spread along this connection in the opposite direction - from a feeling of fear to thoughts about an operation for appendicitis.

The fact that the process of excitation proceeded precisely along this, and not along any other connection, was explained, obviously, by its strength and durability. At the same time, it is interesting to note that the patient had a connection between the feeling of fear and her son's admission to the hospital. During her illness, she had thoughts that the operation was not on her son, but on her daughter. Obviously, the idea that now they can operate on their son, in connection with his death, turned out to be sharply inhibited; the process of arousal spread along close associative paths, reviving the idea that the daughter was being operated on.

In contrast to the neurosis of fear, states of fear of cardiovascular genesis are characterized by the presence of signs of the underlying disease, for example: an increase or decrease in blood pressure and an increase in anxiety during the period of deterioration of a somatic illness, the onset of an attack of fear in connection with a vascular crisis (often in the morning), headaches , dizziness, tinnitus, increased fatigue, etc. In case of fear associated with a malfunction of the heart - the emergence or sharp increase in fear due to the appearance of pain in the heart (before pain, then fear), electrocardiographic and other objective data , indicating a violation of the function of the heart; in infectious diseases - signs of a previous infection, severe asthenia and autonomic lability, etc.

Acute attacks of angina pectoris and myocardial infarction are often accompanied by a sharp attack of fear. At the same time, pain in the region of the heart, hypotonic and hypertensive crises increase the fear associated with naturally occurring

health concerns. The severity of it will depend on the personality traits of the patient. Physiogenic and psychogenic causes of fear can be closely intertwined.

Sometimes anxiety neurosis is difficult to differentiate from the states of fear that occur with certain cyclothymic depressions. They are characterized, in addition to feelings of anxiety or fear, low mood background and signs of mild psychomotor retardation (feeling of heaviness, "laziness", sometimes emptiness in the head), sometimes constipation and amenorrhea, daily mood swings. With depression, there is often a deterioration in well-being in the morning and an increase in fear in the evening. Finally, cyclothymia is characterized by a phase course of the disease (such phases with anxiety and fear often last 2-4 months and are replaced by light intervals, less often by hypomanic phases). Anxiety concerns are most often hypochondriacal.

The presence of ideas of guilt or self-deprecation ("I am bad, lazy, a burden to the family ...") is characteristic not of anxiety neurosis, but of depression and always puts on the agenda the question of the possibility of suicidal thoughts and the need for timely hospitalization.

Ex juvantibus the therapeutic effect of amitriptyline (prescribed for anxiety in combination with an evening intake of tranquilizers), in our opinion, speaks in favor of cyclothymia.

A special variant of anxiety neurosis is the so-called affective shock neurosis, or fright neurosis.

Superstrong stimuli that cause neurosis are usually signals of a serious threat to the life or well-being of the patient, for example, signals received during an earthquake, in a combat situation, as well as at the sight of the unexpected death of a loved one. The extreme strength of mental trauma depends mainly not on the physical power of the stimulus (sound strength, brightness of a flash of light, body swing amplitude), but on the information value, on the extent to which it causes a "mismatch between the actual situation and the predicted one."

For stimuli that cause affective-shock neuroses, extraordinary strength, suddenness, short duration and single action are characteristic.

These neuroses most often occur in persons with a weak type of nervous system, as well as with insufficient mobility of nervous processes.

Based on our observations (1948, 1952), based on the experience of wartime, the following five forms of affective-shock neuroses and psychosis were identified: simple, agitated, stuporous, twilight, fugue-form.

Simple form. The simple form is characterized by a slowdown in the course of mental processes and a number of somatovegetative disorders characteristic of the fear affect.

In all cases, the disease occurred acutely after the action of shock mental trauma - an irritant that signaled a great danger to life. The greatest severity of the phenomena occurred immediately or several hours after the action of the pathogenic stimulus. Somatovegetative disorders, characteristic of the fear affect, developed, but more sharply and for a long time than usually in the latter. There were pallor of the face, tachycardia, fluctuations in blood pressure, increased or shallow breathing, increased urge and the acts of defecation and urination, hypersalivation, loss of appetite, weight loss, trembling of hands, knees, feeling of weakness in the legs.

On the part of the mental sphere, a slight slowness of verbal-speech reactions and thought processes was noted. The answers to the questions (regardless of their content) were given with some delay. The list of subordinate concepts was carried out slowly, the latent period of speech reactions was lengthened (on average, 1-2 s instead of 0.1-0.2 s in the norm).

When asked to enumerate the properties or give a definition of the concept, the answers were also slowed down, and not the entire volume of the understood fully emerged in the patient's mind. Verbal and speech reactions were poorer and more monotonous than those of the same individuals in a healthy state. Among the answers, there were often familiar speech patterns, adjectives describing the properties of an object (for example, "snow-white"), sometimes in some patients individual responses were noted according to the echolalic type (repetition of the stimulus word). The process of judgment and inference was slowed down, and significant stress was required on the part of the patient to

its implementation. Indicative responses were reduced. Arbitrary and automated movements are slightly slowed down. The patients were somewhat apathetic and inert. On their own initiative, they did not ask questions, did not show interest in their surroundings. Difficulty with active tension of attention, insufficiently rapid emergence of the necessary words, difficulty in establishing relationships between phenomena, at times, a feeling of compression in the region of the heart, a painful sensation in the chest were noted. Sleep disturbance was expressed either in the form of difficulty falling asleep, or in increased sleepiness, frequent awakening during sleep, sometimes motor-speech restlessness during sleep and frightening dreams.

Gradually, the patients became more active, the course of verbal and speech reactions and thought processes in them accelerated, autonomic disorders decreased, the painful sensation in the chest disappeared. Sleep disturbances in the form of nightmares and motor-speech disturbances during sleep persisted for the longest time.

The repetition of a part of the situation that caused the disease (the action of conditioned reflex stimuli, although close or similar to those that caused the disease, but less intense), in some patients caused the appearance of a painful feeling in the region of the heart, a slight start, or a relapse of the emotion of fear.

Of the 13 patients we observed, the course of the disease was favorable in 11 and unfavorable in 2. The duration of the disease with a favorable course is 1-5 days. Only a sleep disorder and the appearance of an unpleasant sensation under the action of stimuli that resembled the stimulus that caused the disease persisted in some patients for a longer period (several weeks or months). With an unfavorable course, the phenomena of hysteria developed.

Agitated form. It is characterized by the development of anxiety and motor restlessness, a slowdown in verbal and speech reactions and thought processes and autonomic disorders inherent in a simple form.

Fright neurosis in children is especially easy [G. E. Sukhareva, 1969; Zhukovskaya N. S, 1972; Kovalev V.V., 1979]. It most often occurs in young children or infantile children with mental retardation. The disease can be caused by new, unusual type of irritants that do not have a pathogenic effect on adults,

for example, a person in an inverted fur coat or mask, a sharp sound, light or other stimulus (the whistle of a locomotive, an unexpected imbalance of the body, etc.). In older children, fear is often caused by a scene of a fight, the sight of a drunk person, or the threat of being beaten by hooligans.

At the moment of fright, short-term stuporous states with mutism ("numbness") or states of sharp psychomotor agitation with tremors are often noted. Further, there is a fear of the frightened stimulus or what is associated with it. Young children may experience a loss of previously acquired skills and abilities, for example, loss of speech function, neatness skills, and the ability to walk. Sometimes children begin to bite their nails, masturbate.

The course of the disease in most cases is favorable, the impaired functions are restored. In children over 5 - 7 years old, the experience of fear can lead to the formation of phobias, that is, obsessive-compulsive disorder.

Anxiety neurosis, as a form of neurosis, was first described by 3. Freud in 1892, manifested by a feeling of anxiety or fear of the most varied content. However, up to the present time in child and general psychiatry there are conflicting points of view on the advisability of isolating this type of general neurosis. Most domestic and foreign psychiatrists distinguish fear neurosis as an independent form of mental illness (G.E.Sukhareva, 1959; A.M. Svyadosch, 1971, 1982; V.V. Kovalev, 1974, 1979; K. Jasper, 1946; L. Kanner, 19bb). At the same time, S.N.

This question is rather complicated, not only in terms of nosological independence, but also in contrast to fear in general from illness. It is known that every person throughout life, including in childhood, experiences fear, like a feeling of illness, fear of various objects, phenomena and actions that can harm health. This is actually a reaction of the body's defense against danger, which requires an urgent concrete decision. Usually, with the disappearance of the cause of the danger, the feeling of fear soon disappears. With regard to the neurosis of fear, the latter is considered as a pointless (causeless) negatively colored emotion, accompanied by tension, a sense of immediate danger to life and various vegetative disorders.

In children, especially young and preschool children, fear is often associated with fear. In this regard, within the framework of the neurosis of fear, G. Ye. Sukhareva (1959) singled out, as a variety, “ fright neurosis».

It has been established that the clinical manifestations of anxiety neurosis have some age-related characteristics. According to A.M. Svyadosch, in adults, the neurosis of fear is substandard in nature, i.e. it does not depend on any situation or perceptions in the past (including the reason that caused the fear, if it is established), is unmotivated, meaningless. He seems to be "floating freely". For clarity, A.M. Svyadoshch gave a description of fears from the stories of the patients he observed. “The state of fear does not leave me all the time. All day I experience a feeling of vague anxiety, then fear. At the same time, what I am afraid of, what I am waiting for - I myself do not know. " It can be a sense of undefined danger, misfortune that should or may happen. Sometimes a feeling of fear encompasses all the actions of the patient. For example, he is afraid to pick up a knife so as not to hit someone else, is afraid to go out onto the balcony, and suddenly throw himself out of it, afraid to turn on the gas stove, and suddenly forgets to light it or turn it off, etc.

The reason fear neurosis in childhood can be shock and subacute psychotrauma causing fear; emotional deprivation factors(especially long separation from parents), serious illnesses of loved ones, wrong upbringing type of overprotection.

The content of fears, their external manifestations in children of different age groups, as V.V.Kovalev writes (1979), are usually associated with the nature of the traumatic situation. So, in the first 6 years of life, fears of animals, characters from TV shows, movies, from "scary" fairy tales or intimidation of a child with events prevail in order to induce obedience. Children are often frightened by a doctor who will give an injection, a baba-yaga, a policeman or a "harmful guy" who will take a naughty child. And if you then have to see a doctor, you may be hysterical. In preschool and primary school age, there is often a fear of the dark, separation from loved ones, loneliness. Often one has to see how a child of early and preschool age does not let go of his mother, holding his hands to the hem of her skirt, and follows her everywhere. And how often do mothers hear from children of this age, especially from girls, "Mom, you won't die?" The reason for this may be the state of the mother, when she felt bad either from neurosis, or from an organic disease, and she was taking medications.

During puberty, the content of anxiety neuroses often concerns the concept of illness and death.

Flow fear neurosis can be like short-term- several weeks - 2-3 months, and protracted- some years. In the case of a protracted course, periodically occurring exacerbations are possible. The long course of anxiety neurosis is often due to the peculiarities of the premorbid development of the personality in the form of anxiety, suspiciousness, hypochondriasis and various types of asthenization.

In adolescence, the connection between the neurosis of fear and the theme of the traumatic situation is gradually lost, i.e. its manifestations approach those observed in adults.

The anxiety neurosis that has arisen in childhood can last for many years and turn into neurotic personality development. It was also noted that the neurosis of fear in children and adolescents, in contrast to obsessive fears, is not accompanied by the recognition of their unusualness and strangeness, there is also no desire to overcome them.

In foreign (Western) literature, within the framework of the neurosis of fear, a special form is distinguished - “ school neurosis". Its essence lies in the fact that children, especially primary grades, are afraid to attend school because of their fear of it: strictness, discipline, exactingness of teachers. In this regard, the child is looking for an excuse not to go to school, citing illness or other reasons. It can be a categorical refusal of the child, neurotic vomiting, it is possible to leave school and even from home, the emergence of systemic neuroses, such as urinary and fecal incontinence.

Refusal to attend school may be due not only to the unusual requirements for a child who was brought up according to the principle of permissiveness, but also due to the fear of separation from the mother.

In the Russian-language literature of past years, and even today, school neurosis is not distinguished as a kind of fear neurosis. He is not mentioned either in the BME or in the Encyclopedic Dictionary of Medical Terms. V.V. Kovalev (1979) wrote “about the relative rarity of school fears among children in our country, which is obviously associated, firstly, with other, more favorable social conditions, and secondly, with the widespread public preschool education of children, which helps to overcome selfish attitudes and fear of separation from parents. "

Of course, this form or variety of anxiety neurosis may or may not be isolated. The point is different. Do similar conditions occur in our reality? They are encountered, but quite rarely, including by the type of interpersonal conflicts. After all, teachers, like students, are susceptible to various diseases, including neuroses. And if the teacher has a neurosis, and 30-40 people entered the first grade, of whom 4-5 have increased neuroticism, i.e. formed a tendency towards neurosis, then everything can be expected from the meeting of a neurotic with a neurotic. One will induce the other. I have seen such children, including recently there was one typical case.

A 9-year-old girl categorically refused to go to school due to the fact that the teacher (of retirement age) stubbornly refuses to call the child either by name or surname, but simply "heifer". I watched this girl. She's not so complete for such a nickname, although "not quite thin". It is strange that the child's parents could not find justice for this teacher. The girl was transferred to another school, and everything fell into place.