What does Generalized Anxiety Disorder mean for psychoanalysts? An empirical qualitative approach about its conceptualization in the psychoanalytic framework

Gómez Penedo, J.M., Etchebarne, I., Juan, S., & Roussos, A. (2013). Um olhar ao transtorno de ansiedade generalizada desde a psicanalise: uma aproximação empírica sobre sua conceptualização [A View of Generalized Anxiety Disorder from the Psychoanalytic Perspective: an Empirical Approach about its Conceptualization]. Psicanálise Revista da  Sociedade Psicanalítica de Porto Alegre, 15 (2), 331-356.
Juan, S., Etchebarne, I., Gómez Penedo, J.M., & Roussos, A. (2010). Una perspectiva psicoanalítica sobre el Trastorno de Ansiedad Generalizada: Raíces históricas y tendencias actuales [A Psychoanalytic Perspective on Generalized Anxiety Disorder: Historical Roots and Current Trends]. Revista de la Sociedad Argentina de Psicoanálisis, 14, 197-219
Juan, S., Gómez Penedo, J.M., Etchebarne, I., & Roussos, A. J. (2012). El método de investigación cualitativa consensual (Consensual Qualitative Research, CQR): Una herramienta para la investigación cualitativa en psicología clínica [Consensual Qualitative Research (CQR) Method: a Tool for Qualitative Research in Clinical Psychology]. Anuario de investigaciones de la Facultad de Psicología de la Universidad de Buenos Aires, 18 (1), 47-56.

Aims and rationale of the study

This study analyzed how expert psychoanalysts conceptualized Generalized Anxiety Disorder (GAD), as it is described in DSM-IV-TR (2001). Potential GAD´s defense mechanisms, predominant anxieties, and etiological factors were explored; as well as psychoanalysts’ conceptualization on GAD´s diagnostic validity and possible underlying structure.

There are current debates regarding GAD´s psychopathological understanding and diagnostic validity that represent a challenge when identifying how different theoretical frameworks, such as psychoanalysis, conceptualize generalized anxiety phenomenon (Juan, Etchebarne, Gómez Penedo, & Roussos, 2010). This study focuses on analyzing the way in which the psychoanalytic tradition, that historically reject descriptive diagnostic manuals such as DSM, approach this condition, given that many patients in psychoanalytic treatments could be potentially diagnosable as a GAD case. Thus, studying the psychoanalytic conceptualization of GAD could help to address the gap between psychiatry and psychoanalysis in the conceptualization and treatment of these patients, as well as enrich the knowledge regarding GAD and anxiety in general terms. Further details about this study are presented in: Gómez Penedo, Etchebarne, Juan, & Roussos, A. (2013).

Methods

10 Individual semi-structured interviews were conducted with certified expert psychoanalytic psychotherapists from Buenos Aires exploring their conceptualizations about GAD. A Spanish guide (Juan, Gómez Penedo, Etchebarne, & Roussos, 2012) for conducting Consensual Qualitative Research (CQR) (Hill, Thompson y Nutt-Williams, 1997) was used for the data analysis.

Results and discussion

GAD was generally related to Freudian classical notions of anxiety neurosis (Freud, 1895/2001) and anxiety hysteria (Freud, 1909/2001). Also there was a generally trend to relate GAD with insecure attachment and primitive anxieties. Although participants typically considered that GAD did not present main defense mechanism as other pathologies, they related it to primitive defense mechanisms and even considered that worry, GAD´s main feature, could be conceptualized as a non-effective defense mechanism to avoid traumatic representations. Regarding the underlying structure, most of the psychoanalysts conceptualized generalized anxiety as a trans-structural phenomenon that could be present in both neurotic and borderline structures.

The study performed has triggered some questions and hypotheses about the nature of GAD from a psychoanalytic perspective. Future studies are needed to increase knowledge of the relationships (and potential mutual enrichment) between GAD and fundamental concepts of the psychoanalytic framework for clinical practice and psychotherapy research.

Limitations of the study and future directions

The qualitative and exploratory nature of this research was not orientated to test hypotheses but to generate them. Because of the non-probabilistic sampling, and the fact that we only studied expert psychoanalysts, generalization of these results to the population of psychoanalysts is unknown. Further research may analyze GAD conceptualization from the psychoanalytic perspective in a bigger sample and also study the links between these conceptualizations and the way in which psychoanalysts treat patients with GAD.

Contact

Juan Martín Gómez Penedo1, 2, 3, Ignacio Etchebarne2, Santiago Juan1, & Andrés J. Roussos1,2,3

1Universidad de Buenos Aires, 2Universidad de Belgrano, 3CONICET.

E-mail : juanmartin.gomez@comunidad.ub.edu.ar