Actual Neurosis as the Underlying Psychic Structure of Panic Disorder, Somatization, and Somatoform Disorder: an Integration of Freudian and Attachment Perspectives

Abstract

Starting from a contemporary critique of the DSM-IV, this paper argues that the diagnostic categories of panic disorder, somatization, and undifferentiated somatoform disorders can be understood as belonging to a common type of psychopathology—i.e., the Freudian actual neuroses. In addition to their strong clinical similarity, these disorders share an etiological similarity; and the authors propose a combination of Freud’s focus on this type of patient’s inability to represent an endogenous drive arousal with the post-Freudian focus on separation anxiety. An etiological hypothesis is put forward based on contemporary psychoanalytic attachment theory, highlighting mentalization. Concrete implications for a psychoanalytically based treatment are proposed.