Meeting of the New York Psychoanalytic Society

May 16, 1978. EXAMINATION ANXIETY IN WOMEN. Eleanor Galenson, M.D.

Dr. Galenson noted that many of her women patients exhibited a unique clinical syndrome when faced with graduate school examinations. Their symptoms were related to fear of competing with men and seemed to include important aspects of the more general problem of female self-esteem. While quite different in character structure and psychopathology, these patients all manifested similar examination anxiety which was derivative of three major preoedipal factors: fear of object loss, fear of loss of body integrity, and fear of genital imperfection. For example, eating binges, intense feelings of emotional isolation, and retreats into sleep all reflected oral phase anxieties and fear of separation from the mother. Exaggerated concerns over body imperfections often accompanied strong feelings of intellectual inadequacy and were associated with earlier fears of shame and humiliation, linked to sadomasochistic fantasies involving excretory functions and toilet training. Fear of genital imperfection expressed in the analyses led to early childhood memories of exploratory games and deep fears of being revealed as missing something—a defect which these patients felt was the basis of their "stupidity" and intellectual "phoniness."

Acknowledging that penis envy was intimately involved in this syndrome, Dr. Galenson emphasized the striking correspondence between these reactions and the preoedipal castration reactions seen in direct observation of girls between the ages of eighteen and twenty-four months. During these months a phase of early genital masturbation was noted which was always followed by a marked reaction to the genital differences between the sexes. These reactions varied from mild anxiety, with subdued affects and an obvious sense of loss, to intense, behaviorally disruptive castration anxiety. The milder reaction occurred in children whose earlier relationship with the mother was strong, and