Anxiety played an important role in the development of psychoanalysis and psychiatry psychodynamics. Freud invented “anxious neurosis” concept, and also he identified 2 types of anxiety; one with a vague feeling of fear or threatening, caused by repressed thoughts or wishes, and the second one was represented by panic, followed by somatic conduct such as:

• Profuse perspirations
• Respiratory and cardiac rhythm increasement
• Diarrhea
• Feeling of terror

          Anxiety is the representation of an unconscious danger signal, and as a result, a person’s self triggers defensive mechanisms to prevent thoughts and unacceptable feelings from entering the conscious area. It is an adjusting signal meant to drive away the conflict from the conscious zone. When these adjusting mechanisms become inefficient, or surpassed, the symptoms become more intense, they generate somatic effects and therefore the panic attack takes place.

          Anxiety can mask a deeper and less acceptable preoccupation and this is the reason why some people have no idea why they are anxious.

          Anxiety or the perception of fear as physical pain, the fear of loosing someone close’s love or approval is in fact the fear of separation. Other anxiety themes are persecution fear driven by external factors and self disintegration fear.

          As a worry signal for something that might happen in the future, anxiety can lead to a strong creative thinking, providing fast and efficient solutions. Therefore, anxiety as a signal can be a good or bad adjusting mechanism, however it transforms into a panic attack when it becomes disorganizing for the individual.

          Panic attacks last only a few minutes, but they produce intense suffering to the individual, by living some alarming physiological symptoms such as: chocking sensation, dizziness, perspirations, trembling and tachycardia. Most people also experience agoraphobia (fear to be in a place or situation difficult to get out off). Because panic attacks are recurrent, patients also develop an anticipation anxiety, secondary, by permanent worrying regarding the date and place of the next panic attack. Panic disorder and agoraphobia patients travel less, in order to control the situations they are afraid of, in the eventuality of an attack occurring while they are in a place they could get out of with difficulty.

          From a psychological point of view, these attacks can start out of nowhere and can seem without foundation. Scientists proved that there is an anxiety pattern related to social behavior during childhood, to unsupportive parental relationships and the feeling of being trapped.

          Most patients present a difficulty in facing fury and aggressivity. They also experience more stressful events and loss of close people, more than regular persons. Anxiety is therefore strongly associated with the parents’ separation and death.

          A very important element is early motherly separation and also interpersonal loss that creates a physical prejudice and predisposing neurophysiologic vulnerability. In 1988, Kagan identified in children an inborn temperamental characteristic that he named “behavior inhibition to the unfamiliar”. These children get frightened easily, which is unusual in the surrounding environment. In order to cope with the fear, children rely on their parents to protect them. However, as they grow and mature, they learn that their parents cannot always be by their side to protect and comfort them, and that is the reason why they project their own deficits on their parents. Later in life, they will see their parents as unpredictable and unserious. These children will be enraged by the adults’ unavailability, and the fury will cause them trouble as they will fear their aggressive and destructive delusive pictures. In this manner, they chase away their parents, the only ones that can protect them. (Busch 1991; Milrod 1997). The result is a vicious circle, where the children’s fury threatens the bond with the parent and therefore the fearing and hostile attitude of the child increases.

          As the childhood traumas interfere in child-parent attachment, physical or sexual abuse can be made responsible for a series of difficulties encountered by patients regarding the safety and meaning of the persons in their life. In 1996, Ledoux stated that the unconscious fear memory, located in the tonsil, seems to leave inerasable brain marks.  This is the first cerebral area to be activated by fear signal, fear that can be entirely unconscious. This area determines a fight like reaction or the run, before the thalamus has the necessary time to send the information to the prefrontal cortex, in order to involve the rational thinking and to elaborate an adequate response to the situation.

          DeMasi showed that the panic attack’s overwhelming anxiety is located in the tonsil circuit/ limbic system and it cannot be adequately processed by cortex areas. This is the point of origin for the imaginary processes that are usually based on previous traumas, and that cannot be set apart from the real threats.

          The patient’s defensive actions against “the catastrophe” are the somatisation, when attention is focused on physiological phenomenon, and the externalization when the problems are projected on someone else, who is seen as ill-willed.

          Patients with these disorders are hard to treat because of decreased compliance, therapy abandonment, therapist mistrust, and therefore they need a complete and individualized approach.

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