Meetings of the New York Psychoanalytic Society

October 16, 1951. PAVOR NOCTURNUS. Max M. Stern, M.D.

'The problem of neurosis is the problem of anxiety', and pavor nocturnus is one of the most striking manifestations of anxiety. In childhood, pavor nocturnus represents mainly the Oedipal trauma which also encompasses infantile masturbation and the experience of the primal scene. Awakening in fright without memory of a dream is sometimes called pavor nocturnus, but Stern believes that in every instance there has been a preceding dream. The common denominator of nightmares is an increasing paralysis in the face of an increasing threat. Stern defines pavor nocturnus as an anxiety state during sleep, with real or hallucinated sensations of progressive inhibition affecting CNS functions as well as the vital functions of respiration and circulation. All these are superseded after awakening, by objective (cold sweat, palpitation), and subjective (fear of death) symptoms. There is a sense of utter helplessness. The condition is compared to neurogenic shock of central origin.

Any stress produces physiological shock, and homeostatic response or shock defense. The state of shock is the consequence of failure of the homeostatic response. Any traumatic event, including the experience of anxiety is a danger situation which produces a disturbance of the homeostatic process, and induces the shock complex (shock and shock defense). Observations of children reveal that physiological shock reactions are common responses to postnatal stresses. Depending on the degree of frustration in the postnatal period, there are varying degrees of stress reaction up to the full shock reaction in which paralysis of vital functions may lead to death. In adult anxiety reactions one finds comparable phases of shock reactions. Of special interest is that reaction which Stern labels inhibitory or catatonoid, apparently representing a biological regression to a vegetative existence. 'Its defensive function is a consequence of the anoxic