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Paroxysmal tachycardia is characterized by attacks of rapid heartbeat. Unlike other more usual forms of tachycardia, where onset and termination are gradual, in this case the accelerated beat begins and ends suddenly. Best and Taylor (1) describe paroxysmal tachycardia as a condition in which the rate of the heart is greatly accelerated for a longer or shorter period, without obvious cause. However, the causal connection between emotional stress and paroxysmal tachycardia has long been known. At the beginning of this century, Hoffmann (2) published a number of cases of paroxysmal tachycardia wherein the onset of the illness was attributed to emotional stress. Later, Wyss (3) concluded that the attacks doubtless are precipitated by emotional factors. He cited a case of a young suitor whose marital plans were blocked by the girl's father. After the first argument with the girl's father, the young man suffered his first attack of rapid heartbeat. Wyss believed that repeated attacks result in a hypersensitivity so that often only a slight noise or a draft may be sufficient to provoke an attack. Moreover, if the patient is not aware of the often innocent nature of his affliction, each new attack may produce a serious psychic shock.
In the case described here, the patient was a 38-year-old white single woman and a member of the armed services. The onset of her attacks of paroxysmal tachycardia was related to a constellation of emotional circumstances. The army doctor grudgingly referred the patient for psychotherapy to the Veterans Out-Patient Clinic. He told her that the treatment would be experimental and that she had nothing to lose. The patient balked, comparing the clinic to a kennel, and demanded that she be sent to a woman therapist for private treatment. The fact that the Veterans Administration yielded to her demand convinced the patient that she was badly in need of psychotherapy.
In the first session, the patient appeared in casual civilian clothes, which she pre