Drawing on psychoanalytic concepts of anxiety, the author formulates the question, “Is there an anxiety specific to psychosis?” Using examples from her clinical practice, she demonstrates psychotherapeutic work with “psychotic anxiety,” which occurs not only in individuals experiencing psychosis but also in other patients with early traumatic experiences. Various authors have defined this anxiety, which originates in very early childhood and recurs throughout life, as: “psychotic anxiety,” “nameless terror,” “unthinkable anxiety,” “fear of breakdown,” “annihilation anxiety,” and “disintegrative anxiety.” She presents a theory of psychosis in which the experience of “fear of breakdown” may play a key role. In this theory, psychotic symptoms are understood as a defense against chaos and emptiness. She considers anxiety associated with delusions, anxiety associated with traumatic relational experiences during psychosis (e.g., hospitalization), and anxiety associated with information about the illness to be specifically related to the experience of psychosis. Comparing the theories of Klein, Bion and Winnicott, she explores how to recognize and work with a patient who shows symptoms of psychotic/annihilationist anxiety.