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유범희,이인수,Yu Bum-Hee,Lee In-Soo 대한불안의학회 2005 대한불안의학회지 Vol.1 No.1
The Diagnostic and Statistical Manual 4th edition (DSM-IV) has been widely accepted and used for international classification of mental disorder. The DSM has been changed to improve diagnostic reliability and validity through descriptive and categorical approaches which was undertaken atheoretically. The authors reviewed current studies about the DSM-IV classification system and the diagnostic issues of representative categories of anxiety disorder. The authors concluded that the anxiety disorder classification system in DSM-IV has limitations such as a lack of empirical consideration for overlapping features of anxiety disorders and a lack of discriminant validity. To improve diagnostic validity and revise the current DSM-IV classification system, the authors suggested 1) more longitudinal studies for collecting empirical evidence, 2) decreasing the dependence upon operational criteria, 3) deceasing diagnostic boundary blurring, 4) developing disease specific biological diagnostic techniques and 5) continued collaboration between the DSM and International Classification of Diseases (ICD) systems.
유범희 韓國精神病理-診斷分類學會 2001 精神病理學 Vol.10 No.1
The psychoanalytic concept of anxiety has been changed continuously since 1895 when Freud suggested that anxiety should be a transformation of libido. He thought this transformation resulted from excessive repression of sexual drives. In 1926, Freud suggested a new theory of anxiety based on his understanding of interagency conflict in the structural model. According to his new theory, anxiety is a signal of danger when an individual perceives a danger from the internal and external realities. The new theory on anxiety involves traumatic and danger situations. The prototype of the traumatic situation is the experience of birth, while the danger situation can be perceived when people anticipate a traumatic situation under different conditions before it really happens. The signal anxiety in response to the anticipation of danger can be viewed as relatively less unpleasurable than the anxiety that would develop if there were no signal and the traumatic situation of abandonment fully developed. Thus, signal anxiety is a way of attenuating a more profound and terrifying anxiety. From the perspective of a developmental hierarchy, Freud also viewed anxiety as follows ; fear of losing object, fear of losing love, castration fear, and fear of conscience. The concepts on persecutory and disintegration anxiety were later added to this perspective by Klein and Kohut. According to the modern psychoanalytic concepts on anxiety, it is practically classified for clinicians such as id anxiety, separation anxiety, castration anxiety, and superego anxiety. I present brief clinical vignettes to illustrate the 4 different kinds of anxiety better.