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Freud described a clinical entity, anxiety neurosis, which he distinguished from hysteria and psychoneurosis. Dos Santos reviews at length the history of the concept and Freud's elaboration of it. The main themes of Freud's descriptions involved general excitability, floating anxiety, and anxiety attacks with somatic manifestations
which may be cardiac, respiratory, vasomotor, etc. Dos Santos is impressed with the accuracy of Freud's early clinical descriptions, and argues for the continued applicability of the phenomenological descriptions of the clinical entity. In Freud's view this was an actual neurosis that disturbs the libidinal economy only. Dos Santos does not agree with this purely economic explanation that led Freud to stress the role of contemporary sexual dissatisfaction and the accumulation of toxins. For Dos Santos, structural and genetic aspects are also inseparably involved.
There is a characteristic ego structure in patients with anxiety neurosis. Dos Santos stresses the experience of fragmentation or dissolution of the ego at the times of "crises of anxiety" as described by Freud. The anxiety has an organizing character similar to that of phobia or hypochondria. Rather than neurotic manifestations, however, there is a "brutal regression" of the ego, establishing an anxiety neurosis with a predominantly pregenital makeup. The ego is unable to contain the amount of excitation which invades the psychic apparatus at the time of crisis, and the anxiety comes to have a catastrophic character, in which it is as if all the mechanisms of defense suddenly disappeared. Dos Santos believes that this inability to contain excitation can be linked with the early difficulties such patients have in organizing their anxiety dreams as infants, dreams that in normal development become organizers of aggression and symbolizations of the primal scene, preparing the entry into latency. The apparent cause of the anxiety attacks often seems to be some event, su