Page:Freud - Selected papers on hysteria and other psychoneuroses.djvu/166

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A few observations still remain to be mentioned on the relations of the anxiety neurosis to the other neuroses in reference to occurrence and inner relationship.

The purest cases of anxiety neurosis are also usually the most pronounced. They are found in potent young individuals with a uniform etiology, and where the disease is not of long standing.

To be sure, the symptoms of anxiety are found more frequently as a simultaneous and common occurrence with those of neurasthenia, hysteria, compulsive ideas, and melancholia. If on account of such clinical mixtures one hesitates in recognizing anxiety neurosis as an independent unity, he will also have to abandon the laboriously acquired separation of hysteria and neurasthenia.

For the analysis of the "mixed neuroses "I can advocate the following proposition : Where a mixed neurosis exists, an involvement of many specific etiologies can be demonstrated.

Such a multiplicity of etiological moments determining a mixed neurosis can only come about accidentally, if the activities of a newly formed injury are added to those already existing. Thus, for example, a woman who was at all times a hysteric begins to practice coitus reservatus at a certain period of her married life, and adds an anxiety neurosis to her hysteria; a man who had masturbated and become neurasthenic, becomes engaged and excites himself with his fiancee so that a fresh anxiety neurosis allies itself to his neurasthenia.

The multiplicity of etiological moments in other cases is not accidental, one of them has brought the other into activity. Thus, a woman, with whom her husband practices coitus reservatus without regard to her gratification, finds herself forced to finish the tormenting excitement following such an act with masturbation, as a result of which she shows an anxiety neurosis with symptoms of neurasthenia. Under the same noxiousness another woman has to contend with lewd pictures against which she wishes to defend herself, and in this way the coitus interruptus will cause her to acquire obsessions along with the anxiety neurosis. Finally a third woman, as a result of coitus interruptus loses her affection for her husband and forms another which she