A Case of Anxiety Neurosis with Obsessions1

The application of the psychoanalytic method in the successful treatment of a case of anxiety neurosis which failed to respond to the usual methods is well demonstrated in the following:

The patient in question was a young lady whom I was called in to see several years ago. She was in bed and appeared to be greatly alarmed and worried concerning her heart. She stated she was subject to attacks of palpitation and dizziness with a peculiar “sinking feeling as if about to die.” These attacks were always associated with great fear which at intervals kept her from work for periods of weeks.

She was twenty-two years old, single, American, had had a high-school education, and in intelligence was above the average. She had been employed as a stenographer by one firm for four years. The physical findings were almost nil, with the exception of the somewhat increased reflexes, hippus of the pupils, and some vasomotor disturbances. Her heart, upon examination, was found normal. I was told that she had been treated at intervals by various physicians for some time with no benefit. Recently she had taken up Christian Science as a last resort. I therefore spent considerable time questioning her in order to find an explanation for her attacks and for her marked state of apprehension.

The information she gave me was that she first became nervous three years previous, due to her mother's illness. She feared at that time that her mother was going to die from “inward goitre” and “choke to death.” Her mother, I ascertained, was quite ill with hyperthyroidism. After her mother's recovery she remained more or less nervous. She then became dissatisfied with her work at the office, which was monotonous to her. She, however, was unwilling to give up the position, as the hours and pay were liberal. She frequently was in conflict with the head girl, whom she disliked. Just before her last attack she became frightened by a man in the office