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neurosis, in psychiatry, a broad category of psychological disturbance, encompassing various mild forms of mental disorder. Until fairly recently, the term neurosis was broadly employed in contrast with psychosis, which denoted much more severe, debilitating mental disturbances. The two terms were used regularly until 1980, when the American Psychiatric Association released a precise listing of known mental disorders excluding the two broad categories of “mild” and “serious” mental disorders.
Neurosis, according to Sigmund Freud, arose from inner conflicts and could lead to anxiety. In his formulation, the causal factors could be found roughly in the first six years of life, when the personality, or ego, is weak and afraid of censure. He attributed neurosis to the frustration of infantile sexual drives, as when severe eating and toilet habits and other restrictions are parentally imposed (see Oedipus complex), which appear in adulthood as neurotic symptoms (see psychoanalysis). Other authorities have emphasized constitutional and organic factors. Among the psychoanalysts, Alfred Adler and H. S. Sullivan stressed social determinants of personal adjustment, and Karen Horney emphasized insecurity in childhood as causes of neurosis.
Until 1980, neuroses included anxiety disorders as well as a number of other mild mental illnesses, such as hysteria and hypochondria. Anxiety disorders are fairly common, and generally involve a feeling of apprehension with no obvious, immediate cause. Such intense fears of various situations may be severe enough to prevent individuals from conducting routine activities. Phobias, the most common type of anxiety disorder, involve specific situations which cause irrational anxiety attacks. For instance, an individual with agoraphobia (fear of open spaces) may be too anxious to leave their house. Obsessive-compulsive disorder occurs when an individual relentlessly pursues a thought or action in order to relieve anxiety. Panic disorder is characterized by anxiety in the form of panic attacks, while generalized anxiety disorder occurs when an individual experiences chronic anxiety with no apparent explanations for the anxiety. Post-traumatic stress disorder, occurring in the wake of a particularly traumatic event, can lead to severe flashbacks and a lack of responsiveness to stimuli. Anxiety disorders are usually accompanied by a variety of defense mechanisms, which are employed in an attempt to overcome anxiety. Hypochondriasis and hysteria (now generally known as conversion disorder) are classified today as somatoform disorders, and involve physical symptoms of psychological distress. The hypochondriac fears that minor bodily disturbances indicate serious, often terminal, disease, while the individual suffering from conversion disorder experiences a bodily disturbance—such as paralysis of a limb, blindness, or deafness—with no clear biological origin. Treatment of neurosis may include behavior therapy to condition an individual to change neurotic habits, psychotherapy, and group psychotherapy. Various drugs may also be employed to alleviate symptoms.
See M. Trimble, Post-Traumatic Neurosis (1981); S. Henderson et al., Neurosis and the Social Environment (1982); J. Lopez Pinero, The Historical Origins of the Concept of Neurosis (tr. 1983); G. Russell, ed. The Neuroses and Personality Disorders (1984).
An intense irrational fear that often leads to avoidance of an object or situation. Phobias (or phobic disorders) are common (for example, fear of spiders, or arachnophobia; fear of heights, or acrophobia) and usually begin in childhood or adolescence. Psychiatric nomenclature refers to phobias of specific places, objects, or situations as specific phobias. Fear of public speaking, in very severe cases, is considered a form of social phobia. Social phobias also include other kinds of performance fears (such as playing a musical instrument in front of others; signing a check while observed) and social interactional fears (for example, talking to people in authority; asking someone out for a date; returning items to a store). Individuals who suffer from social phobia often fear a number of social situations. Although loosely regarded as a fear of open spaces, agoraphobia is actually a phobia that results when people experience panic attacks (unexpected, paroxysmal episodes of anxiety and accompanying physical sensations such as racing heart, shortness of breath).
The origin of phobias is varied and incompletely understood. Most individuals with specific phobias have never had anything bad happen to them in the past in relation to the phobia. In a minority of cases, however, some traumatic event occurred that likely led to the phobia. It is probable that some common phobias, such as a fear of snakes or a fear of heights, may actually be instinctual, or inborn. Both social phobia and agoraphobia run in families, suggesting that heredity plays a role. However, it is also possible that some phobias are passed on through learning and modeling.
Phobias occur in over 10% of the general population. Social phobia may be the most common kind, affecting approximately 7% of individuals. When persons encounter the phobic situation or phobic object, they typically experience a phobic reaction consisting of extreme fearfulness, physical symptoms (such as racing heart, shaking, hot or cold flashes, or nausea), and cognitive symptoms (particularly thoughts such as “I'm going to die” or “I'm going to make a fool of myself”). These usually subside quickly when the individual is removed from the situation. The tremendous relief that escape from the phobic situation provides is believed to reinforce the phobia and to fortify the individual's tendency to avoid the situation in the future.
Many phobias can be treated by exposure therapy: the individual is gradually encouraged to approach the feared object and to successively spend longer periods of time in proximity to it. Cognitive therapy is also used (often in conjunction with exposure therapy) to treat phobias. It involves helping individuals to recognize that their beliefs and thoughts can have a profound effect on their anxiety, that the outcome they fear will not necessarily occur, and that they have more control over the situation than they realize.
Medications are sometimes used to augment cognitive and exposure therapies. For example, beta-adrenergic blocking agents, such as propranolol, lower heart rate and reduce tremulousness, and lead to reduced anxiety. Certain kinds of antidepressants and anxiolytic medications are often helpful. It is not entirely clear how these medications exert their antiphobic effects, although it is believed that they affect levels of neurotransmitters in regions of the brain that are thought to be important in mediating emotions such as fear.