Neurosis: Causes, Symptoms & Treatment

A neurosis or neurotic disorder is a collective name for many different psychological and mental disorders. In most cases, no physical causes arise in this case. Often, various anxiety disorders accompany the neurosis. Neurosis must be separated from its counterpart, psychosis. Most common neurotic disorders are anxiety disorder, obsessive-compulsive disorder and hypochondria.

What is neurosis?

The term neurosis is no longer used in diagnostic manuals in use today: WHO’s ICD-10 categorizes under Neurotic Disorders of various mental illnesses without physical cause. Phobic disorders, anxiety and obsessive-compulsive disorders, stress and adjustment disorders, dissociative disorders, multiple personality disorder, somatoform and “other neurotic disorders” are grouped here under chapter F 4. Historically, William Cullen defined neurosis in 1776 as a nervous functional disorder with no underlying organic cause. In the tradition of psychoanalysis, Sigmund Freud developed the concept of a mild mental disorder that arose from mental conflict. Freud related this conflict to repressed fears or sexual problematics.

Causes

Behavior therapy sees the cause of a neurosis in a conditioned (learned) maladjustment. Triggers here are so-called stressors that have a traumatizing influence on the organism. Today, neurosis is usually understood as a pathological disturbance 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 is no longer excluded: Thus, genetic dispositions are described in “vulnerability-stress hypotheses” as co-causing. An increased readiness to fear or an exaggerated fear reaction to neutral stimuli is shown to be a unifying element of the individual disorders despite their different symptomatology. Statistically, neurotic disorders account for a large proportion of mental disorders. In particular, the female gender of the middle to upper social class is overrepresented in somatoform disorders, although this clustering may also be due to the fact that women consult a physician more frequently and are statistically easier to record.

Symptoms, complaints, and signs

Depending on its type and severity, neurosis can cause a variety of symptoms. In panic disorder, panic attacks occur abruptly and are characterized by severe palpitations, shortness of breath, dizziness, chest pain, tremors, sweating, dry mouth, and fear of death. The seizures appear to have no direct trigger and usually last only a few minutes. If only physical symptoms that affect the heart (increased pulse, chest pain, shortness of breath) are increasingly perceived, the physician speaks of a 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 anxiety that lasts for a long time without a specific trigger. Symptoms may include constant inner tension accompanied by trembling and restlessness, feelings of anxiety, dry mouth, dizziness, and sleep disturbances. Signs of obsessive-compulsive disorder may include an uncontrollable urge to perform an activity, such as washing one’s hands, repeatedly and for no apparent reason. Obsessive-compulsive thoughts that constantly intrude or the compulsive impulse to hurt oneself or others are also suggestive of obsessive-compulsive disorder. Hypochondria is expressed by an intensified perception of one’s own body; even harmless deviations from the norm are perceived as serious disorders. Body functions are permanently checked, even an inconspicuous examination result does not dissuade the hypochondriac from the conviction of being seriously ill.

Course of disease

With regard to the course of neurosis, as with many mental disorders, the rule of one-third applies: one-third of those affected are able to lead a normal life largely undisturbed by the neurotic abnormality, one-third experience continuous phases of severe symptomatology requiring treatment, and one-third are so impaired by the disease that only a social niche existence is possible.This last third is resistant to treatment. Neuroses manifest mainly between the 20th and 50th year of life with a peak in the 3rd decade of life. Neurotic depression, today called dysthymia, seems to constitute the most frequent neurosis with about 5%. Neuroses may also present in childhood and adolescence as early or bridging symptoms, some of which may persist into adulthood: Wetting, defecation, eating disorders, emotional heart and respiratory 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. For example, neuroses that also interfere with the environment of others (delusions of order, sociophobic disorders, paranoid disorders, hysterias) can lead to social isolation and a negative self-image in those affected. Because they are consistently aware of their neurosis, restrictions and isolation can reinforce negative feelings. Neuroses that only target the affected person (compulsive washing, compulsive tidying of one’s own objects) have at best a time-wasting effect, but can also lead to skin irritations, a physical overload and the like. Neuroses have a great potential to put a permanent strain on the person affected. The ongoing psychological strain leads to the same effects as permanent stress. Depressive tendencies, heart problems, lowered self-esteem and other symptoms follow and may require treatment. Neuroses that manifest themselves exclusively physically are a special case. For example, cardiac neuroses, intestinal neuroses, or gastric neuroses can be a constant burden on the body and, in the worst cases, lead to pain or persistent dysfunction of the affected organs.

When should you see a doctor?

Neuroses are serious mental illnesses that can cause sufferers to put themselves and others in danger. For the layperson, neuroses are difficult to recognize as such; however, any outsider can tell by an affected person’s behavior that he or she may not be doing well psychologically. Neuroses can be temporary or permanent conditions – regardless of the form they take, they require psychological help as soon as possible in any case. Often, neurosis sufferers will not turn to a doctor themselves, so relatives are called upon. If there is reason to believe that a neurotic patient could harm or endanger himself or others, or even plans to commit suicide, there is the possibility of having him forcibly committed to a psychiatric facility. This is for his own protection and he will not be released until he is no longer a danger. Affected persons who have previously refused any help can often only be helped in this way and remain in treatment after such a drastic experience. Temporary neurosis, such as in the case of postpartum disorder, is now so well known that potentially vulnerable patients can be educated about this possibility beforehand.

Treatment and therapy

Depending on the specific clinical picture of a neurosis and the theoretical orientation, different therapeutic procedures have become established: While psychoanalysis tries to fathom early childhood conflicts, modern behavioral therapy focuses on learning coping strategies that allow adapted behavior (and thus sensation) in acute conflict situations. In most cases, especially in obsessive-compulsive and anxiety disorders, a combination of psychopharmacological and behavioral therapy is used. Phobias respond very well to so-called exposure methods of behavioral therapy, whereby the affected person is exposed to the confrontation with the phobic stimulus, which can take place in real (in vivo) or in imagination (in sensu). Obsessive-compulsive disorder is shown to be very difficult to treat despite supportive medication.

Outlook and prognosis

The prognosis in neurosis depends on the type and severity of the disorder. If the neurosis is organic, i.e., functional without an identifiable trigger or cause, simple interventions can sometimes correct the problem. Afterwards, at best, no more complaints occur, or the complaints are noticeably reduced and the quality of life of the affected person can be improved.Psychic neuroses usually fall into the category of personality disorders or learned maladjustment and can be treated by appropriate psychotherapy and, if necessary, by taking medication. If the neurotic disorder is a maladaptive disorder, it can be assumed that the affected person once adapted better to certain situations or at least has this normal reaction in him. Psychotherapy can help to steer the learned maladaptive behavior back into healthy and socially desirable channels. After treatment, those affected at best no longer notice anything of the neurosis that once existed. Personality disorders, on the other hand, often persist even with treatment, but those affected can learn a healthier way of dealing with them through various therapeutic approaches. Medication can also help to cope better with the consequences of such a disorder and reduce the suffering of those affected in the long term. However, the voluntary cooperation of the affected person in the therapy is important for a good prognosis.

Aftercare

In neurosis, consistent aftercare is often quite crucial, especially in the phase following the completion of therapy, when it comes to stabilizing the success of treatment in the long term. Aftercare is usually coordinated with the treating psychologist or psychotherapist. If questions or problems arise, the patient can also clarify these in a new session during aftercare. Follow-up care is ideally tailored to the exact form of neurosis the patient has and the extent to which it has manifested itself. For example, if the neurosis is an anxiety neurosis that was treated in the course of behavioral therapy, it is usually important that the patient continues to practice the newly learned behavioral patterns on his or her own and consistently integrates them into everyday life. 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 thus an important component 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 applied independently at home. Attending yoga classes also helps with relaxation.

What you can do yourself

Since the term “neurosis” can be interpreted in different ways, the possibilities for self-help are also wide-ranging. For many neurotic disorders, relaxation techniques and mindfulness show a positive effect, including anxiety disorders, obsessive-compulsive disorders, various personality disorders, and somatoform disorders. Scientifically proven deep relaxation offers, for example, autogenic training or progressive muscle relaxation. Both methods can help to reduce symptoms in the long term. There are various ways to learn a relaxation method. If sufferers want to teach themselves deep relaxation, they can turn to books or well-founded instructions from the Internet. Audio recordings with instructions can also help. Another option is to take part in a relaxation course taught by a qualified instructor. In Germany, statutory health insurance funds promote relaxation as primary prevention. The costs of a relaxation course can therefore be reimbursed by the health insurer. The prerequisite is that the course instructor must be licensed by the health insurer. A diagnosis is not required. The relaxation should also be applied regularly after the end of the course in order for it to be effective. People with personality disorders can benefit from good self-reflection in everyday life. In doing so, they apply what they have learned in therapy. Exchanging ideas with other people affected can be helpful; however, care should be taken not to create competition in the self-help group.