Hầu hết các bệnh nhân chú ý đặc biệt hướng tới phát triển cơ thể cảm giác của họ, với sự nhạy cảm quá mức cho năm vị thành niên và trao đổi bình thường. Các bệnh nhân tại cộng đầu tiên một số triệu chứng soma với kinh nghiệm chủ quan của một cuộc tấn công hoảng sợ, làm luận án Malthus triệu chứng kích thích có điều kiện | 60 C. FARAVELLI AND A. PAIONNI phobic disorders thus accepting the position that the phobic attitude is the core aspect of this disorder. Hypochondriasis Most of the patients develop a particular attention towards their bodily sensations with an exaggerated sensitivity for minor and normal changes. The patient at first associates a number of somatic symptoms with the subjective experience of a panic attack these symptoms thus acting as conditional stimuli. Later on the occurrence of these symptoms whatever their origin then bring on by conditioning the subjective anxiety symptoms of the attack. This mechanism termed interoceptive conditioning makes some subjects avoid activities that provoke physical sensations which can be interpreted as anxiety-like . physical efforts drinking coffee etc. . A similar phenomenon could also explain these patients intolerance to the side-effects of antidepressants the frequent worsening of their anxiety symptoms during somatic affections. Many patients around 20 develop a true hypochondriac elaboration during which they are seriously afraid of being ill or even persuaded they are ill. The hypochondriac worries mainly concern the fear of cardiac illness or of the cerebral ictus. Interoceptive conditioning could account for the anxiety crescendo which is often described by these patients during the premonitory phase of certain attacks Boulenger and Uhde 1987 . In fact the sudden brutal and unpredictable nature of the first panic attacks often disappears after a time progression of the disease with subsequent attacks occurring when the patient is confronted with phobogenic situations or at the apex of a period of rapidly growing apprehension. These provoked patients often describe a vicious circle their apprehension brings on somatic symptoms which in turn increase their anxiety which gradually grows in intensity until the panic attack is triggered off in all its severity. Often patients are perfectly aware of this mechanism and .
