Precipitation anxiety

Therapy with autistic and psychotic children led the author to introduce the concept of precipitation anxiety. Freud's first theory of the instincts was expressed in the dynamics of conflict, but his subsequent development of life and death instincts is better understood in terms of a gradient of energy between two extremities of the same axis. Object relations result from a caesura (Bion) which creates a gradient of psychic energy experienced initially as a precipice which, if left unregulated, generates intolerable anxiety. Satisfactory emotional encounters with the mind of the object bring about the necessary adjustments to the slope of the gradient. Autistic mechanisms may block off precipitation anxiety, but they also prevent mental growth. Both the dynamics of conflict and the dynamics of the gradient are vital for psychic development, but the very existence of the former is contingent on successful negotiation of the energy gradient (working through). After illustrating his thesis with clinical material drawn from a group therapeutic setting, the author discusses points of convergence and divergence with two other fundamental notions: the aesthetic conflict (Meltzer) and premature psychic birth (Tustin). The proposed model furthers our understanding of the therapeutic process and stresses the importance of the containing object in the transference situation.     

Health anxiety, hypochondriasis, and the anxiety disorders

Although clinical observations suggest that health-related anxiety is present, to some extent, in a number of anxiety disorders, this relationship has not been examined empirically. The present study therefore utilized the Short Health Anxiety Inventory (SHAI) to elucidate the structure of such symptoms among patients with anxiety disorders and to empirically investigate the presence of health anxiety in various anxiety disorders. Confirmatory factor analysis yielded equivalent support for either a 2-factor or 3-factor model of the SHAI's latent structure. The measure demonstrated good reliability, convergent validity, and discriminant validity. Comparison of SHAI scores across groups of patients with various anxiety disorders revealed elevated levels of health anxiety among patients with hypochondriasis and panic disorder relative to those with other anxiety disorders. Receiver operating characteristic analyses supported the utility of the SHAI as a diagnostic tool for screening patients with hypochondriasis utilizing empirically derived cut scores. Findings are discussed in terms of cognitive-behavioral models of anxiety disorders.     

Comorbidity of test anxiety and other anxiety disorders in children

Elementary school children with clinically significant test anxiety, as determined by self-report and a clinical interview, were assessed for the incidence of other fears and anxiety. The results indicated that test-anxious children reported more fears and general worries than their non-test-anxious peers. As expected, the test-anxious children experienced more negative cognitions and subjective distress when taking a test. Furthermore, the fear of negative evaluation was not limited to an actual test, since these children also reported identical symptoms when engaged in a second social-evaluative task. Finally, 60% of the testanxious sample met DSM-III criteria for an anxiety disorder. The results are discussed in terms of the relationship of text anxiety to more complex social-evaluative dysfunctions, more pervasive anxiety conditions, DSM-III anxiety disorders, and the utility of test anxiety as an indicator of the presence of these more pervasive anxiety states.This research is based on a dissertation conducted by the first author under the direction of the second author. Thanks are expressed to Stephen B. Manuck, Scott M. Monroe, Sharon Nelson-LeGall, and Saul Shiffman, who served as committee members. This study was supported in part by National Institute of Mental Health Grants No. 30915 and No. 16804, and a grant to the first author from the Sigma Xi Foundation.     

Religion and anxiety

This is the second half of Dr. May's article, “Toward the Understanding of Anxiety,” the first portion of which appeared in the March issue.