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Una perspectiva psicoanalítica sobre el trastorno de ansiedad generalizada. Raíces históricas y tendencias actuales

Revista de la Sociedad Argentina de Psicoanálisis 01/2010; 14:197-219.

ABSTRACT This paper intends to revalue the psychoanalytic contribution to the current concept of Generalized Anxiety Disorder (GAD). Considering Freud’s (1895 / 2001) notion of Actual Neurosis as one of the fundamental historical roots, this paper describes and analyses how the notion of generalized anxiety relates to this concept and is complemented with subsequent developments, both psychoanalytic and from other theoretical frameworks. The terminological problem linked to the term «angst» used by Freud is mentioned, and a brief overview of classical Freudian ideas about anxiety is presented, identifying their possible changes and permanences in today’s psychoanalytic field. Psychoanalytic clinical and research developments are presented as a possible articulation among GAD’s diagnostic standardized criteria, and the psychoanalytic theoretic-clinical approach to this disorder. Likewise, the authors highlight the influence of psychoanalysis in classification systems such as DSM-IV-TR (American Psychiatric Association, 2001). Within this context, the most important contributions of psychodynamic diagnostic manual are considered for the conceptualization of GAD, such as the PDM (PDM Task Force, 2006) and the OPD-2 (OPD Task Force, 2006 / 2008). Finally, contributions from psychoanalytic empirical research for the understanding and treatment of GAD are reviewed.

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    ABSTRACT: Generalized Anxiety Disorder (GAD) is the anxiety disorder that has undergone greater amount of modifications from its first publication in the DSM-III to the drafts of the DSM-5, and its nature is still in discussion within different theoretical frameworks. The goal of the present study was to compare current research debates about GAD with its clinical conceptualization by Cognitive Therapists (CTs) and Psychoanalysts (Ps). Individual interviews of two samples of psychotherapists from Buenos Aires were conducted: A first group of 20 psychotherapists (10 CTs and 10 Ps) with varying degrees of experience, were asked to listen to the audio of a fictional patient meeting DSM-IV-TR criteria for GAD, and to present their case conceptualization (patient´s main problem and preliminary diagnosis). A second group of 10 expert Ps and 5 expert CTs were asked explicitly about their theoretical-clinical conceptualization of what DSM-IV-TR typifies as GAD. Consensual Qualitative Research (CQR) methodology developed by Hill, Thompson & Nutt-Williams (1997) was used to analyze the data. Domains and categories related to GAD´s diagnostic validity; GAD´s psychopathological conceptualization; and the function of worry and anxiety in GAD were developed; generating hypotheses about future research and implications for clinical practice.
    Memorias del III Congreso Internacional de Investigación y Práctica Profesional en Psicología, XVIII Jornadas de Investigación y Séptimo Encuentro de Investigadores en Psicología del MERCOSUR. 11/2011;
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    ABSTRACT: The present study classified a GAD´s case conceptualization made by psychoanalytic therapists using Operationalized Psychodynamic Diagnostic 2 (OPD-2) criteria. Information from the first author´s ongoing dissertation research was re-analyzed. In that study, 30 psychotherapists (15 psychoanalytic and 15 cognitive) proposed prognostic inferences and a case conceptualization for a GAD patient. The aim of the present study was to use OPD-2´s criteria for a secondary analysis of the 15 interviews already conducted with the psychoanalytic participants. The present study`s rationale, procedures and central research questions are described. OPD-2 is presented as a data analysis` instrument. According to preliminary results, OPD-2´s axis III and IV were predominant in the patient´s main problem identification; axis IV and V were used to describe patient´s preliminary diagnosis, and axis II was observed in the patient´s inferred treatment expectations. Implications for psychoanalytic clinical practice are discussed. Key Words: Case Conceptualization – GAD – Psychoanalysis – OPD-2
    Anuario de Investigaciones de la Facultad de Psicología UBA. 09/2013; 20(1):65-74.
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    ABSTRACT: The aim of the present paper is to investigate how experienced psychoanalysts define generalized anxiety disorder (GAD), as outlined in the DSM-IV-TR (American Psychiatric Association, 2001). Semistructured interviews were performed with psychoanalysts who met expertise criteria (Eells et al., 2011) in order to assess their ideas about the possible etiologic factors, defense mechanisms, prevailing anxieties related to this disorder, signs and symptoms associated with it, the underlying structure ascribed to GAD, as well as their opinions about its validity or duration. The Consensual Qualitative Research (CQR), developed by Hill, Thompson and Nutt-Williams (1997), was used for qualitative data analysis. The analysis indicated associations between GAD and freudian notions about anxiety neurosis (Freud, 1895) and anxiety hysteria (Freud, 1909), primitive anxieties and defense mechanisms, and insecure attachment. Also, there was a tendency to regard GAD as a phenomenon with several psychic structures, observed both in neurotic anxiety and in borderline disorders. This paper raised some questions and allowed making several assumptions about the nature of GAD from a psychoanalytic standpoint, indicating the need of empirical research studies in the future to shed further light upon the association between this disorder and the key concepts of the psychoanalytic theoretical framework. Keywords: Anxiety Neurosis. Consensual Qualitative Research (CQR). Generalized Anxiety Disorder.
    Psicanálise Revista da Sociedade Psicanalítica de Porto Alegre. 01/2013; 15(2):331-356.

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