ANXIETY DISORDERS

Composite Diagnostic Evaluation

Thomas A. Ban, M.D.

 

Spatiality

            The fourth organizing principle of psychiatric nosology, spatiality, or representation of psychopathology in space, is based on Wernicke’s (1899) conceptualization of psychic reflex and his descriptions of different psychopathologic symptoms display in terms of the different affected components of this reflex, i.e., afferent-perceptual, central affective and/or efferent psychomotor. It was on the basis of the fourth organizing principle that Leonhard (1957) separated the bipolar cycloid psychoses from unipolar manic depressive illness. It was also on the basis of the fourth organizing principle that phobic disorders, i.e., disorders in which fear (anxiety) is triggered by specific perceptual experience, was separated from obsessive-compulsive disorders, i.e., disorders in which fear (anxiety is triggered by images, thoughts and impulses which against one’s will, protrude into and persist in consciousness.