What is a neurosis?
The term neurosis is no longer used in the diagnostic manuals used today: the ICD-10 of the WHO categorized under Neurotic disorders of various mental illnesses without physical cause. Phobic disorders, anxiety and obsessive-compulsive disorders, stress and adaptation disorders, dissociative disorders, multiple personality disorder, somatoform and "other neurotic disorders" are summarized here in chapter F 4.
Historically, William Cullen defined neurosis as a nervous conditional functional disease in 1776 that is not based on any organic cause. In the tradition of psychoanalysis, Sigmund Freud developed the concept of a mild mental disorder that arose through a mental conflict. Freud referred this conflict to suppressed fears or sexual problems.
Behavior therapy sees the cause of a neurosis in a conditioned (learned) mismatch. The trigger here are so-called stressors, which have a traumatizing effect on the organism. Today, a neurosis is usually understood as a pathological disorder of the processing of experience: the lack of processing of a conflict or the dysfunctional perception of a triggering situation subsequently leads to emotional, psychosocial or physical symptoms.
An organic involvement in the development of a neurosis is no longer excluded: For example, genetic dispositions in "vulnerability stress hypotheses" are described as contributing. An increased anxiety readiness or exaggerated anxiety reaction to neutral stimuli shows up as a connecting element of the individual disorders despite their different symptoms.
Statistically, neurotic disorders account for a majority of mental illnesses. Especially in somatoform disorders, the female gender of the middle to upper social class is over-represented, and this accumulation may also be due to the fact that women are more likely to see a doctor and are more easily detected statistically.
Symptoms, complaints & signs
Depending on the type and severity, a neurosis can cause various symptoms. When panic disorder occurs suddenly panic attacks, which are manifested by severe palpitation, shortness of breath, dizziness, chest pain, trembling, sweating, dry mouth and dread. The seizures do not seem to have a direct trigger and usually last only a few minutes.
If only physical symptoms are perceived that affect the heart (increased heart rate, chest pain, respiratory distress), the physician speaks of a cardiac neurosis. A phobia is manifested by unfounded fear of certain situations, objects or animals, while the generalized anxiety disorder is characterized by a long-lasting diffuse anxiety without a specific trigger. Symptoms may include a constant internal tension, anxiety, dry mouth, dizziness, and sleep disturbances associated with tremors and restlessness.
Indications of obsessive-compulsive disorder may be the uncontrollable urge to perform an activity such as hand washing repeatedly and for no apparent reason. Also permanently compulsive obsessive thoughts or the compulsive impulse to hurt oneself or others, let think of an obsessive-compulsive disorder.
Hypochondria expresses itself through an increased perception of the own body, also harmless deviations from the norm are perceived as serious disturbances. Body functions are constantly checked, even an inconspicuous examination results the hypochondriac not from the conviction of being seriously ill.
With regard to the course of a neurosis, as with many mental disorders, the one-third rule is that one third of those affected are able to lead a normal life without being disturbed by the neurotic abnormality. One-third continuously experiences phases with severe symptomatic symptoms, one-third is so affected by the disease that only a social niche existence is possible. This latter third is treatment-resistant.
Neuroses mainly manifest between the age of 20 and 50 with a peak in the third decade of life. Neurotic depression, known today as dysthymia, appears to be the most common neurosis, accounting for about 5%. Even in childhood and adolescence, neurosis can be seen as early or bridge symptoms, some of which can persist into adulthood: wetting, Einkoten, eating disorders, mental heart and breathing problems, anxiety, social insecurity, disturbed attachment behavior, obsessions, phobias, stuttering, Nail biting, aggressiveness, truancy, etc.
The complications associated with neurosis depend on the type of neurosis. For example, neuroses that also intervene in the environment of third parties (delusional disorder, sociophobic disorders, paranoid disorders, hysteria) can lead to social isolation and a negative self-image in those affected. Because they are fully aware of their neurosis, limitations and isolation can increase negative sensations.
Neuroses, which have only the victim's own goal (washing compulsion, compulsive order in one's own objects), are at best time-consuming, but can also lead to skin irritations, physical overload and the like.
Neuroses have great potential to permanently burden those affected. The ongoing mental stress leads to the same effects as permanent stress. Depressive tendencies, heart problems, decreased self-esteem and other symptoms follow and may require treatment.
A special case is the neurosis, which only makes itself physically noticeable. Thus, cardiac neuroses, intestinal neuroses or stomach neuroses can be a permanent burden on the body and in the worst case lead to pain or prolonged dysfunction of the affected organs.
When should you go to the doctor?
Neuroses are serious mental illnesses that can cause people to endanger themselves and other people. For the layman, neuroses are difficult to recognize as such; However, every outsider notices the behavior of an affected person that he is mentally ill. Neuroses can be temporary or permanent conditions - regardless of the form in which they occur, they always require the fastest possible psychological help. Frequently, neurosis sufferers themselves will not turn to a doctor, so the relatives are required.
If there is reason to believe that a neurotic patient might injure or endanger himself or others, or if he intends to commit suicide, he or she may be forcibly admitted to a psychiatric facility. This is for his own protection and he will not be released until he is no longer a threat. Those who have previously refused any help can often be helped in this way and remain in treatment after such a dramatic experience. Temporary neuroses, such as in the case of a postpartum disorder, are now so well-known that potentially at-risk patients can be informed in advance about this possibility.
Treatment & Therapy
Depending on the specific clinical picture of a neurosis and theoretical orientation, different therapeutic methods have been established: While psychoanalysis tries to fathom early childhood conflicts, modern behavioral therapy focuses on learning coping strategies that allow for adapted behavior (and thus perception) in acute conflict situations.
Mostly, especially in cases of obsessive-compulsive disorder and anxiety disorders, a combination of psychopharmacological and behavioral therapy is used. Phobias respond well to so-called exposure methods of behavioral therapy, exposing the person to the confrontation with the phobic stimulus that can take place in real (in vivo) or in imagination (in sensu). Obsessive-compulsive disorder is very difficult to treat despite supportive medication.
Outlook & Forecast
The prognosis of a neurosis depends on the type and severity of the disease. In the case of organic neuroses, that is, functional diseases without a recognizable cause or cause, sometimes simple interventions can correct the problem. After that, at best no more discomfort occurs, or the symptoms are noticeably reduced and the quality of life of the person affected can be improved.
Mental disorders usually fall into the area of personality disorder or learned mismanagement and can be treated by appropriate psychotherapy and, if necessary, by the intake of medication. If the neurotic disorder is a mismatch, it can be assumed that the affected person has once better adapted to certain situations or at least has this normal reaction. Psychotherapy can help to redirect learned misconduct into healthy and socially desirable pathways.
At best, those affected no longer notice anything of the once-existing neurosis after treatment. Personality disorders, on the other hand, often persist with treatment, but sufferers can learn to use it more healthily through various therapeutic approaches. Even medications can help to cope better with the consequences of such a disorder and reduce the suffering of those affected long-term. Important for a good prognosis, however, is the voluntary participation of the person concerned in the therapy.
In a neurosis consistent follow-up, especially in the post-therapy phase, is often crucial when it comes to stabilizing treatment success in the long term. The aftercare is usually matched with the attending psychologist or psychotherapist. If questions or problems arise, the patient can also clarify these in a follow-up session as part of the aftercare.
The aftercare is optimally matched exactly to what form of neurosis the patient has and in what form this has been shown. For example, if it is an anxiety neurosis that has been treated in the context of behavioral therapy, it is generally important in the aftercare that the patient practices the newly learned patterns of behavior over and over again and consistently integrates them into his everyday life.
Often a self-help group is the ideal companion in this context. Discussing problems with like-minded people is often helpful, and exchanging experiences can help overcome crises and provide valuable tips. Relaxation is also important for neurosis patients and thus an important component in the follow-up of this disease.
Relaxation methods such as progressive muscle relaxation and autogenic training are ideally learned under instruction in a course and then independently applied at home. Also, the visit of yoga classes is for relaxation.
You can do that yourself
Since the term "neurosis" can be interpreted differently, the possibilities for self-help are also widely diversified. In many neurotic disorders, relaxation procedures and mindfulness have a positive effect, including anxiety disorders, obsessive-compulsive disorder, 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 the symptoms in the long term.
To learn a relaxation process, there are several possibilities. If those concerned want to teach the deep relaxation themselves, they can fall back on books or in-depth instructions from the Internet. Also audio recordings with instructions can help.
Another option is to take a relaxation course, which is conducted by a qualified instructor. In Germany, the statutory health insurance funds promote relaxation as primary prevention. The cost of a relaxation course can therefore be reimbursed by the health insurance. The prerequisite is that the instructor has a corresponding cash receipt. A diagnosis does not have to be present. Relaxation should also be used regularly after the end of the course to be effective.
People with personality disorders can benefit from a good self-reflection in everyday life. In doing so, they apply what they have learned in therapy. Sharing with other stakeholders can be helpful; However, it must be ensured that there is no competition in the self-help group.