Generality
Neurosis is a set of disorders caused by psychic conflicts, which cause a serious state of anxiety .
At the base of neuroses, there are variable and multiple reasons, all attributable to the existence of intrapsychic conflicts between desires and impulses (mostly unconscious) existing in the person or present between him and his environment. At a time when these unacceptable and repressed thoughts threaten to enter consciousness, the human mind defends itself by generating anxiety, through the use of processes such as repression, denial or reactive training. Often, symptoms occur when a previously used defense mechanism stops being effective for various reasons. In any case, neurosis does not depend on organic causes and the subject's judgment of reality and personality organization remain intact.
Usually, the disorder manifests itself with a sense of inadequacy, excessive concern, dissatisfaction and behavioral disorders. During an episode of neurosis, the patient is no longer able to control his own feelings, but is dominated by them. This causes significant suffering and a strong discomfort in the subject.
The diagnosis is based on the anamnesis, the physical examination and the interview with the patient, to evaluate the clinical conditions and the mental state. Treatment generally includes psychotherapy, drug therapy or both.
Causes
Neurosis is a condition of suffering and altered psychic functioning, inherent in numerous activities or events, which has no organic substrate.
This problem recognizes a psychological origin and, according to classical psychoanalytic theory, it would express a conflict that derives from existential events, from traumatic experiences and from the difficulty of adaptation (in relation to the inner models of behavior and the discomforts in the relationship with the environment), which, however, continue to act at the subconscious level.
In this sense, neurosis constitutes a compromise between an unconscious desire and the need to implement defense mechanisms against these same instinctive tendencies (drives) considered unacceptable and "dangerous". In the neurotic subject, the "overload" of these defensive processes directed inside the mind can cause a psychological difficulty, associated with a very intense and sometimes even chronic anxiety .
The use of mechanisms, such as removal or rationalization, to try to keep the problem under control and to resolve conflict situations, are, in fact, solutions that turn into neurotic symptoms, that is expressions that replace an impulse that threatens to become conscious.
Through these manifestations the neurotic subject would find a partial and indirect satisfaction of his desires. When anxiety is poured, however, a phobia can develop on a specific object or situation.
Possible triggers
The causes of neuroses are complex and multifactorial, and not always ascertainable in every single case. Many times, the neurotic conflict is related to a chain of unconscious psychological events that originate in the more or less remote past (eg, sexual stimuli, aggressions and painful memories of a loss or an unfulfilled desire dating back to childhood). The appearance of neurosis can be determined or triggered by exposure to situations perceived as seriously threatening .
The neurotic disorder can find its roots in childhood and, precisely, in the incomplete resolution of the Oedipus complex in the early stages of development, which hinders the individual's full psychological maturation. In other cases, it is possible to go back to a more complex situation that contrasts emotional needs and repressed mental and ethical-disciplinary contents that the subject makes his own.
Classification
The concept of "neurosis" has undergone a revision process (still in progress): nowadays, the term is no longer generally used by psychologists and psychiatrists to indicate a diagnostic category, and is not part of the classification systems of psychiatric illnesses (furthermore, it has been removed from the Diagnostic and Statistical Manual of Mental Disorders). In its place, the expression of "disorder" (eg anxiety disorder, dissociative disorder, etc.) was preferred, addressing the prevailing symptoms expressed in the neurotic subject.
Thus, the morbid pictures that were included in the "neurosis" category were thus divided into:
- Anxiety disorders;
- Somatoform disorders;
- Dissociative disorders;
- Phobic disorders;
- Obsessive-compulsive disorder;
- Dysthymic disorders.
The term "neurosis" therefore includes a large group of psychological disorders; the common psychopathological nucleus is constituted by anxiety, but there is no single equivalent on the clinical level: the meaning and the area of delimitation of the problem have therefore lost any specificity. The conditions previously considered as "neurotic" are today defined as "acute stress reaction" and "adaptation disorder" and have been replaced by a series of other clinical pictures.
However, a neurosis may be sufficient to alter a person's functioning in numerous areas and the term could still be used to describe the centrality of the conflict dynamics that activate anxiety symptoms and associated behaviors. For this reason, some professionals believe that this concept is still useful in contemporary psychiatry and should be maintained to describe the range of mental illnesses outside of psychotic disorders (such as schizophrenia or delusional disorder).
Difference between psychosis and neurosis
- Psychosis implies a profound alteration of the personality and, in some way, the patient's relationship with the surrounding reality is always compromised; more frequent psychotic symptoms are delusions, hallucinations, confusion, severe mood swings and behavioral alteration.
- On the psychological level, neurosis is characterized, instead, by anxiety and the existence of unconscious or partially conscious conflicts. The neurotic personality is only partially altered by the morbid picture: next to the psychic functions disturbed by anxiety symptoms, there are others that remain intact. In general, the neurosis is, therefore, less severe than the psychotic disorder.
Symptoms
The symptoms of neurosis are the symbolic expression of conflicts and represent a compromise between desires and defense mechanisms .
The most frequent manifestation is anxiety, but commonly there are also feelings of inadequacy, behavioral disorders and reactive depression (ie in response to an event deemed offensive).
Emotional imbalance can lead to a state of continuous apprehension, so those affected are tense, irritable, tend to suffer from insomnia and react excessively to conflicting situations. Other manifestations that are always present are hyperemotivity, the constant feeling of dissatisfaction and discouragement, experienced as inevitable.
In the neurotic patient, phobias (excessive fear of speaking in public, of open spaces, of insects, etc.) or obsessive-compulsive behaviors (eg continuing to wash your hands) can also be observed.
Neurovegetative functions are also deeply involved; this can lead to sleep, appetite and visceral function disorders . In some cases, neuroses induce various psychosomatic manifestations, including asthenia, acceleration of the pulse, heart palpitations, excessive sweating, trembling, vertigo, migraine, sometimes even with nausea, vomiting or diarrhea.
Unlike psychoses, neuroses usually do not compromise social adaptation (the behavior may be altered, but usually remains within acceptable limits) and the person does not lose contact with reality (generally, one does not create a confusion between one's own experiences and subjective fantasies with respect to external stimuli).
Furthermore, in neurosis, cognitive functions are mostly preserved and the subject maintains the capacity for introspection, therefore he has an awareness of his own suffering, limitations and symptoms and - even if he is unable to face and overcome anxiety - criticism as a morbid manifestation.
Course
The manifestations generally have an episodic course. Exacerbations are frequent especially on the occasion of particular ages or stages of existence (such as marriage, motherhood, menopause, etc.) or in situations of strong emotional resonance (accidents, failures, etc.). Depressive episodes can occur in the course of neurosis.
Diagnosis
The diagnosis of neurosis is placed by a psychiatrist on the basis of the interview with the patient and, possibly, of the answers to specific standardized questionnaires to evaluate the clinical conditions and the mental state.
The subject with neurotic symptoms should also undergo a complete physical examination and a detailed medical history, to exclude any underlying diseases (for example: tumors or brain injuries).
Treatment
The neurosis must be treated with the help of a psychotherapist, psychologist and / or psychiatrist. The choice of possible interventions depends on the symptoms the patient presents and the level of discomfort they are causing.
The main treatment of neuroses consists in psychotherapy, which helps the patient to modify, at least partially, his reaction modalities. Medicines are often associated with this approach to reduce the most disabling symptoms, including anxiolytics (eg benzodiazepines), antidepressants and hypnotics for insomnia.
Other intervention modalities that can be useful to reduce the subjective discomfort and behavioral alterations of the neurosis can include cognitive-behavioral therapy, relaxation techniques, biofeedback and creative intervention methodology (for example: art or music therapy).
