Descriptive Psychopathology: The Signs and Symptoms of ...

220 Section 3: Examination domainsThese conditions are variations of the same syndrome, and overlap with neurasthenia.Persons with these conditions may also experience specific, multiple phobias.Persons with social phobia are fearful of public speaking, talking on the telephone,and any novelty, including meeting new people. The notion that they arefearful of being scrutinized or judged is unproved. Persons with agoraphobiaare fearful of being away from home, particularly in unfamiliar places, and ofhaving a panic attack. Persons with GAD have continuous unspecified anxiety.Phobic-anxiety-depersonalization syndrome (PAD)Martin Roth first described a variation of GAD that is characterized by initialepisodes of depersonalization, usually following acute stress. As the episodesof depersonalization became less frequent, anxiety becomes more prominent.Dizziness and syncope are often experienced. Episodes of panic also occur. Themore severe and frequent the symptoms, the more likely agoraphobia willemerge. 88 PAD is a variant of GAD.ConclusionHuman emotional expression and its subjective experience represent an evolutionarychange from the fight/flight protective function common to manyspecies. The psychopathology of emotional expression and experience reflectsdeficits in stimulus perception and the generation of emotion and its subjectiveand observable expression. The distinction between emotional expressions thatrepresent normal adaptive processes from those that are pathological is theclinical challenge.Prolonged and intense states of emotion are associated with disruption ofadrenocortical–hypothalamic pituitary functions and related neurochemical cascadesthat alter brain structure and function. Persons with melancholia, mania andanxiety disorder have features of an abnormal response to stress. The abnormalemotional states are themselves stress-inducing and elicit further stress-relatedbrain changes. Several general medical and neurologic disorders produce neurochemicalchanges or involve neuroanatomic lesions in the circuitries subservingemotional experience, also causing abnormal behavior and emotional expression.NOTES1 Robert Gooch, lecturer on midwifery and physician to London’s Lying-in Hospitals, citedby Hunter and Macalpine (1963), p. 798.2 Damasio (1999).