Origins, Categories, Causes, Diagnosis, Treatment
A term generally used to describe a nonpsychotic mental illness that triggers feelings of distress and anxiety and impairs functioning.
The word neurosis means "nerve disorder," and was first coined in the late eighteenth century by William Cullen, a Scottish physician. Cullen's concept of neurosis encompassed those nervous disorders and symptoms that do not have a clear organic cause. Sigmund Freud later used the term anxiety neurosis to describe mental illness or distress with extreme anxiety as a defining feature.
There is a difference of opinion over the clinical use of the term neurosis today. It is not generally used as a diagnostic category by American psychologists and psychiatrists any longer, and was removed from the American
Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders in 1980 with the publication of the third edition (it last appeared as a diagnostic category in DSM-II). Some professionals use the term to describe anxious symptoms and associated behavior, or to describe the range of mental illnesses outside of the psychotic disorders (e.g., schizophrenia, delusional disorder). Others, particularly psychoanalysts (psychiatrists who follow a psychoanalytical model of treatment, as popularized by Freud and Carl Jung), use the term to describe the internal process itself (called an unconscious conflict) that triggers the anxiety characteristic of the neurosis.
The neurotic disorders are distinct from psychotic disorders in that the individual with neurotic symptoms has a firm grip on reality, and the psychotic patient does not. There are several major traditional categories of psychological neuroses. These include:
- Anxiety neurosis. Mental illness defined by excessive anxiety and worry, sometimes involving panic attacks and manifesting itself in physical symptoms such as tremor, chest pain, sweating, and nausea.
- Depressive neurosis. A mental illness characterized by a profound feeling of sadness or despair and a lack of interest in things that were once pleasurable.
- Obsessive-compulsive neurosis. The persistent and distressing recurrence of intrusive thoughts or images (obsessions) and repetitive behaviors or mental acts (compulsions).
- Somatization (formerly called hysterical neurosis). The presence of real and significant physical symptoms that cannot be explained by a medical condition, but are instead a manifestation of anxiety or other mental distress.
- Post-traumatic stress disorder (also called war or combat neurosis). Severe stress and functional disability caused by witnessing a traumatic event such as war combat or any other event that involved death or serious injury.
- Compensation neurosis. Not a true neurosis, but a form of malingering, or feigning psychological symptoms for monetary or other personal gain.
In 1996, a specific human gene and its corresponding alleles (two components of a gene which are responsible for encoding the gene) were linked to neuroticism. The identified gene and its allele pair help to control the amount of serotonin (a central nervous system neuro-transmitter) released into the body through the production of a protein known as a transporter. This transporter protein, which helps to carry the serotonin across the synaptic space (the gap between nerve cells) to stimulate nerve cells, also assists the cell in reabsorbing the serotonin (a process known as "reuptake").
In the case of the "neurosis gene," one possible version of its corresponding alleles (called s for their short length) was found to produce an insufficient amount of this transporter protein, and the other (named l for long), a significantly large amount. If the amount of transporter protein produced is inadequate, an excessive amount of serotonin must remain in the synaptic gap while the protein "catches up" with reuptake, and the serotonin will continue to stimulate surrounding nerve cells, resulting in neurosis or neurotic symptoms. A corresponding study of 500 patients showed that patients who were assessed as having neurotic personality traits usually possessed the shorter allele pair (or a combination of one short and one long) that produced insufficient transporter protein.
This finding is consistent with a study published the same year that found that women in 37 different countries scored consistently higher on measurements of neuroticism than men. The fact that such high scores were found across a variety of socioeconomic classes and cultures but specific to one gender seems to support a genetic basis for the disorder. However, a 1998 study of over 9,500 United Kingdom residents found that those with a lower standard of living had a higher prevalence of neurotic disorders. It is possible that genetic factors predispose an individual to anxiety and neurosis, and outside factors such as socioeconomic status trigger the symptoms.
Patients with symptoms of mental illness should undergo a thorough physical examination and detailed patient history to rule out organic causes (such as brain tumor or head injury). If a neurotic disorder is suspected, a psychologist or psychiatrist will usually conduct an interview with the patient and administer clinical assessments (also called scales, inventories, or tests), to evaluate mental status. Tests which may be administered for the diagnosis and assessment of neurosis include the Neuroticism Extraversion and Openness (NEO-R) scale, the Sixteen Personality Factor Questionnaire (16PF), and the Social Maladjustment Schedule.
Neurosis should be treated by a counselor, therapist, psychologist, psychiatrist, or other mental healthcare professional. Treatment for a neurotic disorder depends on the presenting symptoms and the level of discomfort they are causing the patient. Modes of treatment are similar to that of other mental disorders, and can include psychotherapy, cognitive-behavioral therapy, creative therapies (e.g., art or music therapy), psychoactive drugs, and relaxation exercises.
Fenichel, Otto M. The Psychoanalytic Theory of Neurosis: 50th Anniversary Edition. New York: W.W. Norton & Son. 1995.
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders 4th ed. Washington, DC: American Psychiatric Press, Inc., 1994.
Anxiety Disorders Association of America (ADAA). 11900 Parklawn Drive, Suite 100, Rockville, MD, USA. 20852, fax: 301-231-7392, 301-231-9350. Email: AnxDis@adaa.org. http://www.adaa.org.