“Neurosis” is now a term that encompasses an extremely wide range of symptoms, both mental and somatic. In most cases, it is difficult to define the strict boundaries between neurosis as a disease entity and neurotic ailments accompanying almost every human being, of varying severity. Learn the types, symptoms, causes and methods of treating neurosis.

Most people also recognize their own behaviors, fears and habits in the symptoms of neurosis. This does not mean, however, that we all suffer from neurosis. Due to this commonness of symptoms, it is extremely important to distinguish between neurosis and neurotic ailments. Fear, one of the main symptoms of neurosis, and at the same time its source to a large extent, accompanies all people.

As with many other disorders, neurosis interferes with functioning in everyday life. Symptoms – fears, phobias, intrusive thoughts or activities – take up most of the day and make it difficult to maintain social contacts and, for example, to function properly at work.

What is neurosis?

The term neurosis was first used by the physician W. Cullen in the second half of the 18th century. Initially, neurosis was associated primarily with organ neurosis, so it was considered in psychosomatic categories. The discoveries of Freud were undoubtedly a revolution in the understanding of neurosis. The psychoanalytic understanding of this disease is still the basic understanding among psychiatrists and psychologists.

Freud, the creator of the pansexual theory of human personality, focused primarily on the conflict in the sexual sphere and called theneurosesbased on this conflict current neuroses. He understood psychoneurosis as all ailments that are rooted in conflict, but not necessarily in the sexual sphere.

Currently, in the terminology of the psychodynamic approach derived from psychoanalysis, the notions of current neurosis and psychoneurosis do not exist. The change in terminology results from the belief thatconflictis the source of every neurosis, and that is the most important thing. The statement of this fact is preceded by the determination of the psychological area in which the conflict is located.

Neurosis and psychosis

Freud and his successors distinguished two levels of disorders –neurosisandpsychosis.

• In neuroses, the contact of the individual with reality was confirmed, as well as too strong defense mechanisms.
• Psychoses, on the other hand, would define people who have lost contact with reality, which is not a constant point of reference for them.

The division of neuroses into symptomatic neuroses and neuroses of character turned out to be an important distinction. Nowadays, psychotherapists usually equate character neurosis with personality disorders, which you can also read about on our website.

The causes of neurosis

When explaining the etiology ofsymptomatic neuroses, reference was made to somestressor of everyday life,which activated a childhood conflict, previously placed in the unconscious, and now returning in the form of anxiety and symptoms. Conflict is back, and so are the coping mechanisms used in childhood and now inadequate. In symptomatic neurosis, feelings related to the conscious conflict are processed and the patient tries to implement more effective coping mechanisms. In personality disorders, these mechanisms tend to be more diffuse

e,traumais repeated in many areas of personality functioning.

In psychiatry, the axis of pathology is still accepted, ranging from:

• the healthy end
• neuroses (symptomatic),
• Personality disorder,
• borderline disorder,
• until the end marked by the most serious pathology – ie psychosis.

However, this axis should be treated conventionally, because, firstly, the boundaries between neuroses and personality disorders are sometimes difficult to define, and secondly, it is difficult to rigidly determine which of these types of disorder is the deepest.

Neurosis – anxiety

Both conflict and neurosis are closely related to the concept of fear. A person suffering from neurosis always experiencessevere anxiety, which can come in various forms. Again, it is worth bearing in mind that there is probably no man who has never experienced fear. In neurosis, however, the dimension of fear is inadequate, irrational and disproportionate to the object –exaggerated.

The anxiety experienced in variousmental illnesses, from depression to schizophrenia, and through neurosis, is notadaptive. Fear in such cases does not warn us of an objective danger. A person with strong neurotic anxiety often, at least initially, is unaware of theirrationality of his fearand experiences it as a fear of a real threat. Usually, at some point, fear is recognized as inadequate, but this knowledge does not free the neurotic from experiencing fear over and over again. The fear that is felt so intensely hinders human functioning in the broad sense.

Sometimes leaving home is associated with such great fear that we stop all going out. Sometimes, however, fear does not manifest itself so tangibly, but more indirectly. A personcannot focus, has serious problems with concentration, memory, and finally feels irritable and very tense. According to psychoanalytical theories, anxiety is an announcement, or a reaction, to the transfer of conflict from the unconscious to the consciousness. Man defends himself against unwanted content and at the same time tries to overcome the fear that appears in response to this content.

Neurotic anxiety can take several forms:

• constant anxiety,
• paroxysmal,
• localized.

The presence of these fears may be overlapping, that is, the presenceof anxiety attacksis not the same as the absence of persistent anxiety. The latter, also known as free-flowing or undefined anxiety, is manifested by a feeling of constant tension. Man is internally tense, sometimes irritated.

Fear is externalized and placed in single problems that are trivial from the observer’s point of view.

With anxiety,irritationusually comes along , which in turn breaks out into aggression, whether direct or indirect. Internal “swelling” grows to such an extent that a person reacts either with fear and withdrawal, or with fear and aggression. In his environment, the neurotic begins to function as a constantlynervous and stiffened person.For such an individual, however, stiffness is first and foremost a defense against pressing, repressed content that tries to penetrate into consciousness.

Both free-flowing anxiety and panic disorder have consequences for the functioningof the vegetativeandendocrine systems.

Occur:

• stomach discomfort,
• increased heart rate
• sweating,

that is, many of the symptoms also occur in stressful situations, i.e. in an emergency. The main difference between persistent anxiety and its paroxysmal form isduration.

Free- flowing anxietymaintains a constant, high level of tension, whilepanic disorderis associated with certain discharges. A person experiences a sudden, strong feeling of fear accompanied by numerous somatic ailments. This state of affairs may last from a few minutes to several hours, and then the severity of the experience diminishes. The intensity of such an attack is well illustrated by the experiential individual’s belief that “I will not endure soon, I will die, I will go mad.”

Localized anxiety isrelated to the displacement of this feeling into the situation, one’s own body or activities. In the first case, we are dealing with phobias, in the second, usually with hypochondria, and in the third, with intrusive thoughts and compulsive actions.

Neurosis – phobias

Phobias are a socially known and recognizable phenomenon. Almost all of us have encountered an irrational fear of various kinds of situations or animals, if not in our own experience, then in the experience of a loved one.

Phobiasare characterized by avery strong anxiety, the intensity of which, and sometimes the object, exceeds rational limits. Fear of death is natural, but in the case of phobias, it prevents proper functioning. In a phobia, there aresomatic complaintsand, above all, a strong avoidance reaction. The most common and perhaps the widest group of phobic objects areagoraphobes, i.e. phobias related in some way tospace.

It can be fear of crowds, open spaces. In a way, the opposite seems to be claustrophobia, i.e. the fear of being closed. Another large group are animal phobias, e.g .:

• arachnophobia (spiders),
• cynophobia (dogs),
• ofidiophobia (snakes),
• avizophobia (birds).

However, there are a number of phobias that affect unclassified objects. Sometimes the phobia is focused only on the details, e.g. a person is only afraid of bees and not all insects. How does such a strong feeling of fear arise? The two dominant understandings of phobias are centered around the cognitive-behavioral and psychodynamic approaches.

Behavioral approaches talk about learning an anxious attitude throughthe class conditioning processthatusually occurred in childhood. Therefore, scaring children with a dog may result in a phobia in the later period. The fear and the dog were combined into one behavioral construct.

The cognitive-behavioral approach to such an understanding of etiology adds to the creation of generalized beliefs about the object of the phobia. The child generalizes (and makes other mistakes in thinking) the terrible dog to all dogs, and thus the false beliefs are perpetuated.

Treatment of phobias

Phobias are treated bybehavioriststhrough a number of techniques suchas systematic desensitization.It consists in gradually bringing people closer to the phobic object, until they come into direct contact with, for example, a spider. The whole process takes place simultaneously with the use of relaxation techniques. Of course, it is not a matter of one session, but of many, as the patient tames the fear step by step.

A deeper understanding of phobias, not only on the behavioral level, but also on the emotional level, is proposed by psychodynamic psychologists. Phobia is understood here as symbolization and the transfer of certain deeper fears to a specific, external object. Usually, these fears are fears for our ownunacceptable impulses, such as aggressive or sexual impulses. Strong displacement of such impulses can, in turn, lead to tension, which is placed in a given object or situation. It is then that the projection process takes place, because this situation, the animal, the insect gain completely new aggressive and threatening abilities that are ascribed to them, and which are often our own. Speaking of self-aggression, I do not mean the incredibly high level of aggression that lies dormant in a person. Rather, they are phobiastransferring the fearof one’s own impulses, which a person is afraid of himself.

Symptoms of phobias – problems with sleep

Apart from anxiety, the main symptoms of neurosis are somatic disorders and the vicious circle characteristic of neurotics. Sleep encompasses a bit more than the concept of somatic ailments. Problems with falling asleep and maintaining sleep are verycharacteristic in neurosis. Most often, people cannot fall asleep, because anxiety effectively hinders silence and relaxation, which are the basis for falling asleep.

Completely sleepless nights are rare, usually night is the timeof brief intermittent sleep periods.However, after a few problematic nights, the fear of another night increases the overall tension, making it even more difficult to fall asleep. Takinghypnotic drugsis common, the more that they not only induce sleep, but also have a calming effect, which brings relief. However, it should be remembered that the agents most often used in anxiety disorders are also agents that areeasy to get addicted to,therefore dosages and self-medication responses should be monitored. In many cases, the patient is asleep, but this sleep does not bring rest. It can be suspected that daytime fears remain in a person, do not disappear when you close your eyes. Therefore, in the morning a person gets up tired and resigned at the very beginning of the day.

Symptoms of phobias – problems with appetite

Another vegetative symptom is achange in appetite. In some, anxiety willincrease the appetite, in others it will causereluctance to eat. The psychoanalytic approach has always associated the attitude to food with the oral phase according to Freud’s psychosexual theory. Today, alsoanorexia,or aversion to food, is understood as the desire for symbiosis with the mother and, at the same time, separation from her. In anorexia, however, there is a strong decision not to eat, which patients sometimes equate with a lack of appetite.

In the case of individuals who are not affected by anorexia, the lack of appetite is not the result of a resolution, but rather an actual reluctance to eat. An anorexic wants to lose weight, the neurotic is unlikely to think about it. He makes a distinction here betweenneuroticsand anorexics, but I would like to emphasize that neurotic mechanisms are very strong in anorexia and many other mental disorders.

Such a separation is of a more theoretical nature, as in practice neurotic conflicts are common. However, when I write about neurotics, I do mean cases in which conflicts dominate the patient’s daily functioning. However, not everyone, as I have already noticed, does not have a feeling of anxiety reflected in a loss of appetite. Some seek outlets for tension incompulsive eatingand gain weight. Compulsions that bring apparent and temporary relief may concern many areas of life (e.g. shopping), not only food, which I will write about later in this article.

Symptoms of phobias – sexual dysfunction

Of course, lack of sleep, food, anxiety, fatigue and tension do not contribute to a satisfying sex life. Sexual dysfunction can include many problems, such as reluctance to have sex or painful intercourse. There is also a question to what extent sexual disorders are a consequence of other symptoms (such as fatigue), and to what extent are a symptom in itself, which symbolizes a certain difficulty, or rather a deeper conflict.

Other symptoms

Sleep disorders, eating disorders, and sexual dysfunction are large groups of somatic symptoms, but apart from them, there are also a number of ailments that the individual experiences on a daily basis.

• Persistent headaches,
• migraines
• stomach pain,
• stomach problems,
• choking
• palpitations
• limb cramps

– all of this may be the result of neurosis.However, a given examination (eg EEG) should always be performed to exclude the pathological etiology of pain. Only after confirming the correct results, one can talk about the psychological genesis of malaise. Psychiatry talks about the hyperactivity and particular sensitivity of the human nervous system, which cause an intense reaction to external stimuli (sensory, emotional, cognitive, etc.). Thus, the sensitivity of the nervous system exceeds the ability to cope with the pressing stimuli.

Neurotic vicious circle

On the example of sleep, you can easily observe the so-calledneurotic vicious circle.Anxiety causes problems with sleep, while a sleepless night, in turn, increases irritability, but also fatigue and anxiety, which again disturbs sleep even more.

The neurotic vicious cycle is a mechanism that will effectivelyprevent you from breaking out of fear. Usually, anxiety is closely related to aggressive, repressed impulses. The more a person defends himself against these impulses, the more he will feel fear of revealing them. The tension resulting from internal conflicts is of course felt by the patient himself, but usually he also projects them on the people around him, which makes him see them more aggressive than they actually appear. The alleged aggression of others increases anxiety and a vicious circle continues.

When describing their situation, neurotic patients usually talk about helplessness, emotional exhaustion and the inability to break free from the feeling of tension. They feel trapped, aggrieved, deprived of the ability to decide about their own lives. A clearly marked higher level of egocentrism is noticeable in neurotics. Their internal tension, swelling is so great that they are unable to go beyond themselves and their problems, which, according to the vicious circle principle, makes it difficult for them to resolve conflicts.

Types of neurosis

Kępiński’s classification of neuroses includes five types:

• neurasthenic neurosis,
• hysterical,
• hypochondriac,
• obsessions,
• depressive.

It is a classification based primarily on the quality of symptoms and is now treated more flexibly than before. The patient’s symptoms may fit the descriptions below, but in addition to them, there are personality traits of the disrupted personality that permeate the symptoms.

Neurasthenic neurosis

Fatigueis the key concept in neurosis . Neurasthenic patients suffer from a constant feeling of fatigue. This fatigue and the irritation associated with it can take two forms of neurosis –hyposthenic and hypersthenic. In hyposthenia, weakness dominates. Sleep does not bring rest, and in the morning people feel weak instead of energy. As the day goes on it becomes more active, but the night, usually full of nightmares, brings a difficult morning again.

Discouragement and boredom are common symptoms here. In contact, such a person seems incapable and reluctant to live, focused primarily on his own inabilities. The hypersthenic type, on the other hand, is irritable and nervous, unlike the weary hyposthenic. He finds the vast majority of stimuli irritating, and he often shows it.

Brawling, complaining and the malice of hyperstenikas often lead to increased tension in the group – whatever it is, whether family or professional. The nervousness of the group does not soothe the hypersthenic again, and such a vicious cycle continues, reassuring the individual that the world and life are irritating. If the hyposthenic is bored, the hypersthenic is in a hurry, but in effect both of them, as rightly pointed out by prof. Kępiński,they avoid living in the present time. In neurasthenic neurosis there are problems with concentration and selection of stimuli. Man accepts all stimuli and either feels weakened by them, or he cannot stand the tension and explodes into irritation. There are also tension headaches and neckaches.

Depressive neurosis

Depressive neurosis sometimes causes diagnostic problems. The boundaries between low mood, as a symptom accompanying neurosis, and endogenous depression and depressive personality are sometimes very poorly defined. One solution is contact with a sick person. The relationship with the patient is marked by what he brings to contact.

In the case of a depressed person, we will experience, above all, sadness, emptiness, a sense of the meaninglessness of life– everything that the patient himself feels. Compassion prevails in the relationship with a depressive patient, while in the case of depressive neurosis, our feelings will be different.

As I have already written, the neurosis is dominated by conflict and this conflict will be perceptible. It is more difficult to empathize with a neurotic in a depressed mood, because he feels asense of harm and repressed aggression. When depressive symptoms are over, the well-being of a person suffering only from depressed mood improves significantly. On the other hand, when the depressive symptoms disappear in the neurotic, his well-being will not improve significantly, as the conflict will remain unresolved.

Hypochondriac nerve

In hypochondriacal neurosis, the problem is aroundpain. People complain of pains, ailments, are convinced of their illness. However, after a series of tests, it turns out that the disease does not exist and the doctor is powerless to locate the problem. The important thing about hypochondriacs is that theydo not simulate or pretend to be pain. Their suffering is real – they do feel pain. For a physician, e.g. an internist who visits such a person, the treatment seems not so much difficult as impossible. Usually, a person convinced of his illness will not stop at one visit, but will keep coming back, tormented by pain and fear for his own health.

The doctors’ patience ends at some point and a visit to apsychiatrist is suggested.Hypochondriac symptoms, like any other, are a cry for help. The hypochondriac seeks strictly medical help, but pain sensation usually has other functions as well. Pain distracts you from your desires, drives, unwanted feelings, and confrontations with life. Being immersed in the disease causes a person to move away from life at the same time. The question to be asked is from what and why does the patient run away with the disease?

Obsessive-compulsive disorder

The obsessive compulsive disorder is also calledanankastic neurosisfrom the Greek word ananke, meaning necessity. A sick person feels compelled to perform a given activity, to think about a specific topic or in a specific form. Three symptoms of obsessive compulsive disorder have been classically adopted, i.e .:

• the occurrence of intrusive thoughts (obsessions)
• compulsive actions (compulsions)
• intrusive fears (phobias).

The latter are recognizable not only in obsessive-compulsive disorder, but also in other mental disorders.

Obsessions, or compulsive thoughts, can be either emotional or more neutral.

The second type of thought from the above mentioned is relatively rare and refers to theunrestrained desire to repeatwords, numbers and even sentences in one’s mind, which are a compulsory object somewhat by chance. Emotionally important thoughts to us are more frequent. The polarity of these thoughts in relation to the conscious experience is characteristic, e.g. suddenly a girl very much in love with her boyfriend cannot free herself from thoughts about his death or even murdering him, and obsessive erotic thoughts suddenly begin to harass the priest, etc.

Another type of anankastic thought is related toself-control, the desire to do everything perfectly, exactly and right. Such an attitude leads to repeating doubts in my mind – did I turn the gas off or did I close the door? There are also thoughts on topics that a person usually does not devote time to, such as existential issues, questions about the origin and importance of man in the universe, etc.

Obsessions are about thoughts, andcompulsions about activities. We are still wondering if we turned off the iron, but we can also go home three times and check if it is actually turned off. Activities become certainritualsto protect against evil. Magical thinking often accompanies activities. Stirring the teaspoon three times one way and three times the other way makes the tea just as it should be.

Compulsive activities are often associated withhygiene– washing hands, taking a shower several times a day, avoiding certain tiles on the street because they are dirty. In the psychoanalytic tradition, purity compulsions can be interpreted in terms of denial of sexual impulses. In anankastic neurosis, unconscious impulses and conflicts are placed in symptoms – thoughts and actions – which, when displaced, enter consciousness in the form of symptoms. In compulsion and perseveration, i.e. repetition, it is also clearly visible how important a role anxiety plays in neurotic disorders. Carefully repeated treatments are tosoothe and calm down anxiety.However, compulsions provide peace for a short time only, they do not overwhelm anxiety.

Hysterical neurosis

The basic symptom of hysterical neurosis isconversion,i.e. the projection of emotions on the body. The projected emotions are very strong and, above all, repressed. In hysteria, an important process is the process of splitting off unwanted emotions and projecting them onto the body. This split is not as deep as in schizophrenia, where it involves the disintegration of the entire personality, along with cognitive functions. Hysterical neurosis, on the other hand, the patient dissociates only an unresolved conflict, which is less extensive than in the case of psychosis.

Conversionsconcern three areas:movement, feeling andpsyche.

• The first group includes both excessive movements (so-called hyperkinesia, e.g. convulsions) and paralysis (e.g. limbs).
• In the second group, there is either excessive sensation (high sensitivity to stimuli, pain) or loss of sensation (in the limbs, as well as loss of smell, taste, less blindness).

Mental conversionsinclude :

• hysterical attacks,
• stupor (hysterical dementia).

A hysterical attack lasts up to several minutes, is marked by an outbreak of strong emotions combined with motor hyperactivity. Usually, the sick persondoes not remember the attack. Hysteria reveals fugues, i.e. the desire to escape, which, if it is successful, is again covered with oblivion. There have also been changes in identity, including experiencing oneself as an animal. Usually, however, the symptoms are simpler – pain, hypersensitivity, hysterical attacks are the most common.

Treatment of neurosis

Currently, the most common methodof treating neurosesispsychotherapy,especiallypsychodynamic psychotherapy,both individual and group. Hospitalization andoutpatient treatmentare possible . The psychodynamic approach is based on clarifying conflicts, as well as interpreting, confronting and interpreting the patient’s behavior.

The therapist bases on the analysis of the therapeutic relationship and the material contributed by the patient. Psychodynamic therapy is usually long-term therapy, although short-term therapy in this trend is also becoming more and more popular. When a strict change of behavior is necessary – e.g. in phobias – cognitive-behavioral therapies are used more often, aimed at unlearning pathological avoidance habits.

Sometimespharmacotherapy(antidepressants and anxiolytics) is used, but it is treated as a supportive action, not a basic therapeutic process.

Neurosis – test

Check how much you remembered from our article!
Do you think the following sentences are true? Tick ​​P (true) or F (false).

Anxiety is the primary symptom of neurosis. P F
Symptomatic neuroses are the same as personality disorders. P F
Hypochondriacs pretend to be pain. P F
Fugue is an unbridled urge to run away. P F
Fugues occur mainly in hypochondriacic neurosis. P F
In hysterical neurosis, an important process is the splitting off of certain emotions. P F
Compulsive activities and thoughts eliminate anxiety effectively. P F
Depression and depressive neurosis are two names for the same disorder. P F
The hyposthenic form of neurasthenia is dominated by weakness and fatigue. P F
Agoraphobias are phobias related to space. P F
The main method of treating neuroses is pharmacotherapy. P F
In psychodynamic therapy of neuroses, it is important to bring out the unconscious conflict. P F

Answers:
1-P, 2-F, 3-F, 4-P, 5-F, 6-P, 7-F, 8-F, 9-P, 10-P, 11-F, 12-P

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