Diamond D B
Am J Psychother. 1985 Jan;39(1):114-25. doi: 10.1176/appi.psychotherapy.1985.39.1.114.
The clinical and theoretical material presented points to the value of looking at the syndrome of panic attacks, hypochondriasis, and agoraphobia from a self-psychology perspective. From this vantage, the nature of the constellation of symptoms and its relationship to premorbid personality characteristics can be understood and a coherent view of the syndrome can be constructed. Phenomenologically and pathogenetically, panic attacks, hypochondriasis, and agoraphobia are related to states of self-fragmentation. Despite longstanding faulty anxiety-regulatory mechanisms, from which arises the vulnerability to self-fragmentation, a cohesive self may be formed in childhood through compensatory and defensive structures. If these structures are undermined, cohesion is lost and as the self experiences fragmentation, panic ensues. The panic state has far-reaching consequences by setting in motion a regression to a precohesive state and evoking powerful feelings as well as the need for selfobjects appropriate to that early troubled developmental period. Hypochondriasis and agoraphobia arise out of this regressed matrix: hypochondriasis as a somatic representation and elaboration on the state of self-fragmentation, and agoraphobia as a defense against and an attempt to repair self-fragmentation. Transference phenomena during the treatment of patients with the syndrome can best be understood in the light of this formulation.
所呈现的临床和理论资料表明，从自体心理学的角度审视惊恐发作、疑病症和广场恐惧症综合征具有重要价值。从这个有利视角出发，能够理解症状群的本质及其与病前人格特征的关系，并构建出该综合征的连贯观点。从现象学和发病机制来看，惊恐发作、疑病症和广场恐惧症都与自体分裂状态相关。尽管存在长期的焦虑调节机制缺陷，由此导致了对自体分裂的易感性，但在童年期，通过补偿性和防御性结构可能会形成一个凝聚的自体。如果这些结构受到破坏，凝聚力就会丧失，随着自体经历分裂，惊恐随之而来。惊恐状态会引发向未凝聚状态的退行，唤起强烈的情感以及对适合那个早期困扰发展阶段的自体客体的需求，从而产生深远的影响。疑病症和广场恐惧症就源于这种退行基质：疑病症是自体分裂状态的躯体表现和细化，而广场恐惧症则是对自体分裂的防御和修复尝试。根据这一表述，能够最好地理解该综合征患者治疗过程中的移情现象。
