Neurosis

A neurosis or neurotic disorder is a collective term for many different mental and emotional disorders. Usually there are no physical causes. Various anxiety disorders often accompany the neurosis. A neurosis must be separated from its counterpart, the psychosis. The most common neurotic disorders are anxiety disorder, obsessive-compulsive disorder and hypochondria.

Neurosis

What is a neurosis?

The term neurosis is no longer used in the diagnostic manuals used today: The WHO ICD-10 categorizes various mental illnesses without a physical cause under neurotic disorders. Phobic disorders, anxiety and obsessive-compulsive disorders, stress and adjustment disorders, dissociative disorders, multiple personality disorders, somatoform and “other neurotic disorders” are summarized here in Chapter F 4.┬áSee nonprofitdictionary for Cardiac Arrest (abbreviated as CA).

Historically, William Cullen defined neurosis in 1776 as a functional neurological disease that has no underlying organic cause. In the tradition of psychoanalysis, Sigmund Freud developed the concept of a mild mental disorder that arose from a mental conflict. Freud related this conflict to suppressed fears or sexual problems.

Causes

Behavior therapy sees the cause of a neurosis in a conditioned (learned) maladjustment. The triggers here are so-called stressors, which have a traumatizing effect on the organism. Today, a neurosis is usually understood to mean a pathological disorder in the processing of experiences: the lack of processing of a conflict or the dysfunctional perception of a triggering situation leads to mental, psychosocial or physical symptoms.

An organic involvement in the development of a neurosis can no longer be ruled out: Genetic dispositions are described in “Vulnerability Stress Hypotheses” as contributing to the cause. An increased willingness to fear or an exaggerated fear reaction to neutral stimuli is seen as a connecting element of the individual disorders despite their different symptoms.

Statistically, neurotic disorders account for a large proportion of mental illnesses. In the somatoform disorders in particular, females from the middle to upper social class are overrepresented, although this accumulation could also be due to the fact that women visit a doctor more often and are easier to record statistically.

Symptoms, Ailments & Signs

Depending on the type and severity, a neurosis can produce various symptoms. In the case of a panic disorder, panic attacks occur suddenly, which are expressed by severe heart palpitations, shortness of breath, dizziness, chest pains, tremors, sweating, dry mouth and fear of death. The seizures appear to have no direct trigger and usually only last a few minutes.

If only physical symptoms that affect the heart (increased heart rate, chest pain, shortness of breath) are perceived as increased, doctors speak of cardiac neurosis. A phobia is characterized by an unfounded fear of certain situations, objects or animals, while generalized anxiety disorder is characterized by a diffuse feeling of fear that lasts for a long time without a specific trigger. Symptoms of this can be constant internal tension accompanied by tremors and restlessness, feelings of anxiety, dry mouth, dizziness and sleep disturbances.

Signs of OCD can include an uncontrollable urge to do an activity, such as washing your hands, repeatedly and for no apparent reason. Obsessive-compulsive thoughts or the compulsive impulse to hurt oneself or others also make one think of an obsessive-compulsive disorder.

Hypochondria manifests itself through an increased perception of one’s own body, even harmless deviations from the norm are perceived as serious disorders. Bodily functions are constantly checked, even an inconspicuous test result does not dissuade the hypochondriac from being seriously ill.

course of the disease

As with many mental disorders, the one-third rule applies to the course of a neurosis: one-third of those affected are able to lead a normal life largely unaffected by the neurotic abnormalities, one-third experiences continuous phases with severe symptoms that require treatment, one-third is so affected by the disease that only a social niche existence is possible. This latter third is resistant to treatment.

Neuroses manifest themselves mainly between the ages of 20 and 50 with a peak in the third decade of life. Neurotic depression, now known as dysthymia, appears to be the most common neurosis at around 5%. Neuroses can also appear as early or bridging symptoms in childhood and adolescence, some of which can persist into adulthood: wetting, defecation, eating disorders, mental heart and breathing problems, anxiety, social insecurity, disturbed attachment behavior, compulsions, phobias, stuttering, nail biting, aggressiveness, truancy, etc.

Complications

The complications associated with neurosis depend on the type of neurosis. Neuroses that also intervene in the environment of third parties (order mania, sociophobic disorders, paranoid disorders, hysteria) can lead to social isolation and a negative self-image in those affected. Because they are consistently aware of their neurosis, limitations and isolation can amplify negative feelings.

Neuroses that are only aimed at the person concerned (compulsive washing, compulsive tidiness with one’s own objects) at best waste time, but can also lead to skin irritations, physical overload and the like.

Neuroses have a great potential to permanently burden the affected person. The ongoing psychological stress leads to the same effects as permanent stress. Depressive tendencies, heart problems, low self-esteem, and other symptoms follow and may require treatment.

A special case are the neuroses, which only manifest themselves physically. Cardiac neuroses, intestinal neuroses or stomach neuroses can represent a permanent burden for the body and, in the worst case, lead to pain or persistent functional disorders of the affected organs.

When should you go to the doctor?

Neuroses are serious mental illnesses that can lead to those affected putting themselves and other people in danger. For the layman, neuroses are difficult to recognize as such; however, every outsider notices from the behavior of an affected person that they cannot be doing well psychologically. Neuroses can be temporary or permanent conditions – regardless of the form in which they occur, they require psychological help as quickly as possible. Often those affected by neurosis will not turn to a doctor themselves, so that the relatives are called upon.

If there is reason to believe that a neurotic patient could harm or endanger themselves or others, or even intends to commit suicide, there is the possibility of forcible admission to a psychiatric facility. This is for his own protection and he will only be released when he is no longer a threat. Affected people who previously refused any help can often only get help in this way and remain in treatment after such a drastic experience. Temporary neuroses, such as in the case of a postpartum disorder, are now so well known that patients who are potentially at risk can be informed about this possibility beforehand.

Treatment & Therapy

Depending on the specific clinical picture of a neurosis and the theoretical orientation, different therapeutic methods have been established: while psychoanalysis tries to fathom early childhood conflicts, modern behavioral therapy concentrates on learning coping strategies that allow adapted behavior (and thus feelings) in acute conflict situations.

In most cases, especially in the case of obsessive-compulsive and anxiety disorders, a combination of psychopharmacological and behavioral therapy is used. Phobias respond very well to so-called exposure methods of behavior therapy, whereby the sufferer is exposed to the confrontation with the phobic stimulus, which can take place in real (in vivo) or imagined (in sensu). Despite supportive medication, obsessive-compulsive disorders are very difficult to treat.

Outlook & Forecast

The prognosis for a neurosis depends on the type and severity of the disease. In the case of organic neuroses, i.e. functional diseases without a recognizable trigger or reason, the problem can sometimes be solved with simple interventions. After that, at best, there are no more symptoms at all, or the symptoms are noticeably reduced and the quality of life of the person affected can be improved.

Mental neuroses mostly fall into the category of personality disorder or learned maladjustment and can be treated with appropriate psychotherapy and, if necessary, by taking medication. If the neurotic disorder is a maladjustment, it can be assumed that the person affected used to adapt better to certain situations or at least has this normal reaction in him. Psychotherapy can help to steer the learned misconduct back into healthy and socially desirable paths.

At best, after the treatment, those affected no longer notice anything about the neurosis that once existed. Personality disorders, on the other hand, often persist even with treatment, although those affected can learn to deal with them in a healthier way through various therapeutic approaches. Medications can also help to cope better with the consequences of such a disorder and to reduce the suffering of those affected in the long term. However, it is important for a good prognosis that the person affected voluntarily cooperates in the therapy.

Aftercare

In the case of a neurosis, consistent follow-up care, especially in the phase after the end of therapy, is often crucial when it comes to stabilizing the success of the treatment in the long term. Aftercare is usually coordinated with the treating psychologist or psychotherapist. If there are any questions or problems, the patient can also clarify them in a new session as part of the aftercare.

The follow-up care is optimally tailored to the type of neurosis the patient has and the extent to which it has manifested itself. If, for example, it is an anxiety neurosis that was treated as part of behavioral therapy, it is usually important during follow-up care that the patient repeatedly practices the newly learned behavioral patterns on their own and consistently integrates them into their everyday lives.

A self-help group is often the ideal companion in this context. Discussing problems with like-minded people is often particularly helpful and the exchange of experiences can help overcome crises and offer valuable tips. Relaxation is also important for neurosis patients and therefore an important building block in the aftercare of this disease.

Relaxation methods such as progressive muscle relaxation and autogenic training are ideally learned under supervision in a course and then used independently at home. Going to yoga classes is also great for relaxation.

You can do that yourself

Since the term “neurosis” can be interpreted in different ways, there are also a wide range of possibilities for self-help. Relaxation techniques and mindfulness have a positive effect on many neurotic disorders, including anxiety disorders, obsessive-compulsive disorders, various personality disorders and somatoform disorders. Scientifically verified deep relaxation is offered, for example, by autogenic training or progressive muscle relaxation. Both procedures can help reduce symptoms in the long term.

There are a number of ways to learn a relaxation technique. If those affected want to teach themselves deep relaxation, they can use books or well-founded instructions from the Internet. Audio recordings with instructions can also help.

Another option is to take a relaxation class conducted by a qualified instructor. In Germany, the statutory health insurance funds promote relaxation as primary prevention. The costs of a relaxation course can therefore be reimbursed by health insurance. The prerequisite is that the course instructor has a corresponding health insurance license. A diagnosis does not have to be present. The relaxation should also be used regularly after the end of the course so that it can be effective.

People with personality disorders can benefit from good self-reflection in everyday life. They apply what they have learned in therapy. The exchange with other affected people can be helpful; however, care must be taken to ensure that there is no competition within the self-help group.